The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

在过去的 50 年里，随着 2 型糖尿病 (T2DM) 患病率的增加，老龄化人口不断增加；现在，近一半的糖尿病患者是老年人（≥65 岁）。患有 T2DM 的老年人提出了特别困难的挑战。例如，这些患者的高度异质性、多种合并症的潜在存在、对低血糖的易感性增加、对护理的依赖性增加以及虚弱的影响都增加了该年龄组糖尿病管理的复杂性。在这篇综述中，我们更新了与老年人 T2DM 相关的关键病理生理机制。然后，我们评估新的证据，特别是与虚弱和肌肉减少症的影响、与年龄相关的合并症的临床困难、以及对现有指南和治疗方案的影响。我们的结论将集中于 T2DM 对老龄化社会的影响。