Heart failure (HF) and type 2 diabetes mellitus (T2DM) represent two important public health problems, and despite improvements in the management of both diseases, they are responsible for high rates of hospitalizations and mortality. T2DM accelerates physiological cardiac aging through hyperglycemia and hyperinsulinemia. Thus, HF and T2DM are chronic diseases widely represented in elderly people who often are affected by numerous comorbidities with important functional limitations making it difficult to apply the current guidelines. Several antidiabetic drugs should be used with caution in elderly individuals with T2DM. For instance, sulfonylureas should be avoided due to the risk of hypoglycemia associated with its use. Insulin should be used with caution because it is associated with higher risk of hypoglycemia, and may determine fluid retention which can lead to worsening of HF. Thiazolindinediones should be avoided due to the increased risk of fluid retention and HF. Biguanides may lead to a slightly increased risk of lactic acidosis in particular in elderly individuals with impaired renal function. Dipeptidyl peptidase 4 (DPP-4) inhibitors are safe having few side effects, minimal risk of hypoglycemia, and a neutral effect on cardiovascular (CV) outcome, even if it has been reported that saxagliptin treatment is associated with increased risk of hospitalizations for HF (hHF). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a CV protection without a significant reduction in hHF. On the other hand, sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown a significant improvement in CV outcome, with a strong reduction of hHF and a positive impact on renal damage progression. However, it is necessary to consider the possible some side effects related to their use in elderly individuals including hypotension, bone fractures, and ketoacidosis.

It is important to remark that elderly patients, in particular the very elderly, are not sufficiently represented in the trials; thus, the management and treatment of elderly diabetic patients with HF should be mainly based on the integration of scientific evidence with clinical judgment and patients’ condition, with respect to the dignity and quality of life.

心力衰竭 (HF) 和 2 型糖尿病 (T2DM) 是两个重要的公共卫生问题，尽管这两种疾病的管理有所改善，但它们仍是导致高住院率和死亡率的原因。T2DM 通过高血糖和高胰岛素血症加速生理性心脏老化。因此，HF 和 T2DM 是老年人中广泛存在的慢性疾病，他们经常受到许多具有重要功能限制的合并症的影响，因此很难应用当前的指南。老年 T2DM 患者应谨慎使用几种抗糖尿病药物。例如，应避免使用磺脲类药物，因为使用磺脲类药物有发生低血糖的风险。应谨慎使用胰岛素，因为它与较高的低血糖风险有关，并且可以确定可导致心力衰竭恶化的体液潴留。由于体液潴留和 HF 的风险增加，应避免使用噻唑啉二酮。双胍类药物可能导致乳酸性酸中毒的风险略有增加，尤其是在肾功能受损的老年人中。二肽基肽酶 4 (DPP-4) 抑制剂是安全的，副作用少，低血糖风险最小，对心血管 (CV) 结果的影响中性，即使据报道沙格列汀治疗与 HF 住院风险增加有关（高频）。胰高血糖素样肽-1 受体激动剂 (GLP-1 RAs) 已显示出 CV 保护作用，而不会显着降低 hHF。另一方面，钠-葡萄糖协同转运蛋白 2 (SGLT2) 抑制剂已显示出显着改善 CV 结果，hHF 的强烈减少和对肾损伤进展的积极影响。然而，有必要考虑与老年人使用它们相关的一些可能的副作用，包括低血压、骨折和酮症酸中毒。

重要的是要注意老年患者，尤其是高龄患者，在试验中的代表性不足；因此，老年糖尿病伴心衰患者的管理和治疗应主要基于科学证据与临床判断和患者病情相结合，尊重尊严和生活质量。