geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-4-2025-546-556geriatr-590Research ArticleОБЗОРЫREVIEWSАтеросклеротические сердечно-сосудистые заболевания и сахарный диабет 2 типа у пожилых пациентов: управление рисками (обзор)Atherosclerotic cardiovascular disease and type 2 diabetes mellitus in elderly patients: risk management (review)https://orcid.org/0000-0003-0019-0820БогомоловА. Н.BogomolovA. N.

Санкт-Петербург

Saint Petersburg

https://orcid.org/0000-0003-1595-7692КурочкинаО. Н.KurochkinaO. N.

Курочкина Ольга Николаевна

Сыктывкар

 

Kurochkina Olga Nikolaevna

Syktyvkar

olga_kgma@mail.ruhttps://orcid.org/0000-0001-7257-5768КозловК. Л.KozlovK. L.

Санкт-Петербург

Saint Petersburg

ГоликоваЕ. Н.GolikovaE. N.

Сыктывкар

Syktyvkar

СПб ГБУЗ «Городская Александровская больница»РоссияAleksandrovskaya HospitalRussian FederationФГБОУ ВО «СГУ им. Питирима Сорокина»РоссияSyktSURussian FederationАНО НИЦ «Санкт-Петербургский институт биорегуляции и геронтологии»РоссияSaint Petersburg Institute of Bioregulation and Gerontology Research CenterRussian FederationГБУЗ РК «Коми республиканская клиническая больница»РоссияKomi Republican Clinical HospitalRussian Federation20251412202504546556Copyright © Богомолов А.Н., Курочкина О.Н., Козлов К.Л., Голикова Е.Н., 20252025Богомолов А.Н., Курочкина О.Н., Козлов К.Л., Голикова Е.Н.Bogomolov A.N., Kurochkina O.N., Kozlov K.L., Golikova E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/590

Атеросклеротические сердечно-сосудистые заболевания (АССЗ) являются причиной почти половины случаев смерти в Российской Федерации. Во многих случаях у пожилых пациентов АССЗ сочетаются с сахарным диабетом 2 типа (СД2), причем основными причинами смерти у больных СД2 являются именно АССЗ. Эти заболевания объединены общими факторами риска (ФР) и тесными патофизиологическими связями, что предполагает возможность лечебного воздействия одновременно на СД2 и АССЗ. Терапия СД2 у пожилых больных с АССЗ является сложной задачей из-за изменения функционального и психосоциального статуса пациентов, сопутствующих заболеваний и полипрагмазии, вследствие чего ее подбор требует индивидуального подхода. В настоящее время выбор гипогликемических препаратов определяется с учетом их влияния на сердечно-сосудистые исходы и безопасность в отношении гипогликемии, что особенно актуально для пациентов пожилого и старческого возраста. В обзоре проанализированы современные литературные данные о лекарственных препаратах для лечения пожилых больных с АССЗ и СД2, кратко представлены механизмы действия и доказательная база их эффективности и безопасности. Данная информация призвана помочь практикующим врачам в принятии решений о назначении лечения пациентам с СД2 и АССЗ, в том числе лицам пожилого и старческого возраста, в обычной клинической практике.

Atherosclerotic cardiovascular diseases (ASCVD) account for nearly half of all deaths in the Russian Federation. In a considerable number of cases, elderly patients have concomitant ASCVD and type 2 diabetes mellitus (T2DM), with ASCVD being the primary cause of death in patients with T2DM. The presence of shared risk factors and the presence of close pathophysiological relationships among these diseases suggests the potential for therapeutic action on both T2DM and ASCVD simultaneously. The therapeutic approach for type 2 diabetes mellitus (T2DM) in elderly patients with atherosclerotic cardiovascular disease (ASCVD) is a complex task due to changes in the functional and psychosocial status of patients, comorbidities, and polypharmacy. Therefore, the selection of therapeutic interventions for these patients requires an individualized approach. Presently, the selection of hypoglycemic medications is informed by their impact on cardiovascular outcomes and the safety profile with respect to hypoglycemia, a consideration of particular significance for elderly and senile patients. The review methodically analyzes current literature data on drugs for the treatment of elderly patients with ASCVD and T2DM, providing a concise overview of the mechanisms of action and the evidence base for their efficacy and safety. The objective of this information is to facilitate treatment decisions for patients with T2DM and ASCVD, including elderly and geriatric patients, within the context of routine clinical practice.

пожилой и старческий возрастсахарный диабетингибиторы натрий-глюкозного котранспортера 2-го типасердечно-сосудистые заболеванияагонисты рецепторов глюкагоноподобного пептида-1ишемическая болезнь сердцахроническая болезнь почекоценка сердечно-сосудистого рискаdiabetes mellitussodium-glucose cotransporter type 2 inhibitorscardiovascular diseasesglucagonlike peptide-1 receptor agonistscoronary heart diseasechronic kidney diseasecardiovascular risk assessmentReferencesБарбараш О. Л., Карпов Ю. А., Панов А. В. и др. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2024 // Российский кардиологический журнал. — 2024. — Т. 29, № 9. — С. 166–229.Barbarash O. L., Karpov Yu. A., Panov A. V., et al. 2024 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024 ; 29 (9) : 166–229. (In Russ.). doi: 10.15829/1560-4071-2024-6110.Дедов И. И., Шестакова М. В., Викулова О. К. и др. Сахарный диабет в Российской Федерации: динамика эпидемиологических показателей по данным Федерального регистра сахарного диабета за период 2010–2022 гг. // Сахарный диабет. — 2023. — Т. 26, № 2. — С. 104–123.Dedov I. I., Shestakova M. V., Vikulova O. K., et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes (4) : Mellitus for the period 2010–2022. Diabetes mellitus. 2023 ; 26 (2) : 104–123. (In Russ.). doi: 10.14341/DM13035.Курочкина О. Н., Керимова С. Н., Исмаилов З. Б., Ягупова Т. А. Оценка динамики скорости клубочковой фильтрации у пациентов с хронической болезнью почек по данным регионального регистра // Клиническая нефрология. — 2022. — № 2. С. 9–18.Kurochkina O. N., Kerimova S. N., Ismailov Z. B., Yagupova T. A. Evaluation of the dynamics of glomerular filtration rate in patients with chronic kidney disease according to the regional registry. Clinical Nephrology. 2022 ; 2 : 9–18 (In Russ.). doi: 10.18565/nephrology.2022.2.9-18.Курочкина О. Н. Региональные особенности хронической болезни почек в Республике Коми по данным регистра республиканской больницы // Нефрология и диализ. — 2020. — Т. 22, № 2. С. 210–220.Kurochkina О. N. Regional features of chronic kidney disease in the Komi Republic according to the register of the republican hospital. Nephrologу and Dialуsis. 2020 ; 22 (2) : 210–220. (In Russ.)]. doi: 10.28996/2618-9801-2020-2-210-220.Курочкина О. Н. Особенности хронической болезни почек у пожилых пациентов. // Успехи геронтол. — 2020. — Т. 33. № 6. С. 113–120.Kurochkina O. N. Features of chronic kidney disease in elderly patients. Adv. geront. 2020 ; 33 (6) : 113–120. (In Russ.). doi: 10.34922/AE.2020.33.1.015.Курочкина О. Н., Коротков Д. А., Богомолов А. Н. и др. Отдаленный прогноз неблагоприятных сердечно-сосудистых событий у пациентов с острым коронарным синдромом после чрескожных коронарных вмешательств. // Кардиология: новости, мнения, обучение. — 2023. Т. 11, № 4. С. 8–13.Kurochkina O. N., Korotkov D. A., Bogomolov A. N., et al. Long-term prognosis of adverse cardiovascular events in patients with acute coronary syndrome after percutaneous coronary interventions. Kardiologiya: novosti, mneniya, obuchenie. 2023 ; 11 (4) : 8–13. (In Russ.)]. doi: 10.33029/2309-1908-2023-11-3-7-12.Ткачева О. Н., Котовская Ю. В., Рунихина Н. К. и др. Комплексная гериатрическая оценка у пациентов пожилого и старческого возраста с сердечно-сосудистыми заболеваниями. Экспертное мнение Рос. ассоц. геронтологов и гериатров // Кардиология. — 2021. — Т. 61, № 5. С. 71–78.Tkacheva O. N., Kotovskaya Yu. V., Runihina N. K., et al. Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians. Kardiologiia. 2021 ; 61 (5) : 71–78. (In Russ.). doi: 10.18087/cardio.2021.5.n1349.Дудинская Е. Н., Ткачева О. Н. Сахарный диабет: управление рисками в пожилом и старческом возрасте // РМЖ. — 2017. — № 25. С. 1855–1859.Dudinskaya E. N., Tkacheva O. N. Diabetes mellitus: risk management in the elderly and senile age. RMJ. 2017 ; 25 : 1855–1859. (In Russ.).ACCORD Study Group; Buse J. B., Bigger J. T., et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol.2007 ; 99 (12A) : 21i–33i. doi: 10.1016/j.amjcard.2007.03.003.ACCORD Study Group; Buse J. B., Bigger J. T., et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol.2007 ; 99 (12A) : 21i–33i. doi: 10.1016/j.amjcard.2007.03.003.Marx N., Federici M., Schütt K., et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). European Heart Journal. 2023 ; 44 (39) : 4043–4140. doi: 10.1093/eurheartj/ehad192.Marx N., Federici M., Schütt K., et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Developed by the task force on the management of cardiovascular disease in patients with diabetes of the European Society of Cardiology (ESC). European Heart Journal. 2023 ; 44 (39) : 4043–4140. doi: 10.1093/eurheartj/ehad192.Стародубова А. В., Чазова И. Е., Тутельян В. А. и др. Евразийские клинические рекомендации по питанию при сердечно-сосудистых заболеваниях (2024) // Евразийский кардиологический журнал. — 2024. — № 4. — С. 6–67.Starodubova A. V., Chazova I. E., Tutelyan V. A., et al. Eurasian clinical practice guidelines for dietary management of cardiovascular diseases (2024). Eurasian heart journal. 2024 ; 6–67. (In Russ.). doi: 10.38109/2225-1685-2024-4-6-66.Дедов И. И., Шестакова М. В., Майоров А. Ю., и др. Клинические рекомендации. Сахарный диабет 2 типа у взрослых (2022г) // Сахарный диабет. — 2020. — Т. 23, № 2S. — С. 4–102.Dedov I. I., Shestakova M. V., Mayorov A. Y., et al. Diabetes mellitus type 2 in adults. Diabetes mellitus. 2020; 23(2S): 4-102. (In Russ.). doi: 10.14341/DM12507.Chen S., Tian P., Estau D., Li Z. Effects of β-blockers on all-cause mortality in patients with diabetes and coronary heart disease: A systematic review and meta-analysis. Front Cell Dev Biol. 2023 ; 11 : 1076107. doi: 10.3389/fcell.2023.1076107.Chen S., Tian P., Estau D., Li Z. Effects of β-blockers on all-cause mortality in patients with diabetes and coronary heart disease: A systematic review and meta-analysis. Front Cell Dev Biol. 2023 ; 11 : 1076107. doi: 10.3389/fcell.2023.1076107.Дедов И. И., Шестакова М. В., Майоров А. Ю. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под редакцией И. И. Дедова, М. В. Шестаковой, А. Ю. Майорова. 11-й выпуск // Сахарный диабет. – 2023. – Т. 26, № 2S. – С. 1–157.Dedov I., Shestakova M., Mayorov A., et al. Standards of Specialized Diabetes Care / Edited by Dedov I. I., Shestakova M. V., Mayorov A. Yu. 11th Edition. Diabetes mellitus. 2023 ; 26 (2S) : 1–157. (In Russ.). doi: 10.14341/DM13042.American Diabetes Association. Standards of Medical Care in Diabetes — 2022. Diabetes Care. 2022 ; 45 (Suppl. 1) : S1–S2. doi: 10.2337/dc22-Sint.American Diabetes Association. Standards of Medical Care in Diabetes — 2022. Diabetes Care. 2022 ; 45 (Suppl. 1) : S1–S2. doi: 10.2337/dc22-Sint.Buczyńska A., Sidorkiewicz I., Krętowski A. J., Adamska A. Examining the clinical relevance of metformin as an antioxidant intervention. Front. Pharmacol. 2024 ; 15 : 1330797. doi: 10.3389/fphar.2024.1330797.Buczyńska A., Sidorkiewicz I., Krętowski A. J., Adamska A. Examining the clinical relevance of metformin as an antioxidant intervention. Front. Pharmacol. 2024 ; 15 : 1330797. doi: 10.3389/fphar.2024.1330797.Леонова М. В. Ингибиторы натрий-глюкозного котранспортера 2: механизмы кардиоренальной защиты // Consilium Medicum. — 2024. — Т. 26, № 4. — С. 225–231.Leonova M. V. Sodium-glucose cotransporter 2 inhibitors: mechanisms of cardiorenal protection: A review. Consilium Medicum. 2024 ; 26 (4) : 225–231. (In Russ.). doi: 10.26442/20751753.2024.4.202763.Al Jobori H., Daniele G., Adams J., et al. Empagliflozin treatment is associated with improved β-cell function in type 2 diabetes mellitus. J Clin Endocrinol Metab. 2018 ; 103 (4) : 1402–1407. doi: 10.1210/jc.2017-01838.Al Jobori H., Daniele G., Adams J., et al. Empagliflozin treatment is associated with improved β-cell function in type 2 diabetes mellitus. J Clin Endocrinol Metab. 2018 ; 103 (4) : 1402–1407. doi: 10.1210/jc.2017-01838.Tanaka S., Sugiura Y., Saito H., et al. Sodium-glucose cotransporter 2 inhibition normalizes glucose metabolism and suppresses oxidative stress in the kidneys of diabetic mice. Kidney Int. 2018 ; 94 (5) : 912–925. doi: 10.1016/j.kint.2018.04.025.Tanaka S., Sugiura Y., Saito H., et al. Sodium-glucose cotransporter 2 inhibition normalizes glucose metabolism and suppresses oxidative stress in the kidneys of diabetic mice. Kidney Int. 2018 ; 94 (5) : 912–925. doi: 10.1016/j.kint.2018.04.025.Kogot-Levin A., Hinden L., Riahi Y., et al. Proximal tubule mTORC1 is a central player in the pathophysiology of diabetic nephropathy and its correction by SGLT 2 Inhibitors. Cell Rep. 2020 ; 32 (4) : 107954. doi: 10.1016/j.celrep.2020.107954.Kogot-Levin A., Hinden L., Riahi Y., et al. Proximal tubule mTORC1 is a central player in the pathophysiology of diabetic nephropathy and its correction by SGLT 2 Inhibitors. Cell Rep. 2020 ; 32 (4) : 107954. doi: 10.1016/j.celrep.2020.107954.Sun X., Han F., Lu Q., et al. Empagliflozin ameliorates obesity-related cardiac dysfunction by regulating sestrin2- mediated AMPK-mTOR Signaling and redox homeostasis in high-fat diet-induced obese mice. Diabetes. 2020 ; 69 (6) : 1292–1305. doi: 10.2337/db19-0991.Sun X., Han F., Lu Q., et al. Empagliflozin ameliorates obesity-related cardiac dysfunction by regulating sestrin2- mediated AMPK-mTOR Signaling and redox homeostasis in high-fat diet-induced obese mice. Diabetes. 2020 ; 69 (6) : 1292–1305. doi: 10.2337/db19-0991.Курочкина О. Н., Коротков Д. А., Сажина А. С., Богомолов А. Н. Метаболическое перепрограммирование как основа кардио- и нефропротективных эффектов ингибиторов натрий-глюкозного ко-транспортера 2 типа // Рациональная Фармакотерапия в Кардиологии. — 2024. — Т. 20, № 2. — C. 258–264.Kurochkina O. N., Korotkov D. A., Sazhina A. S., Bogomolov A. N. Metabolic reprogramming as the basis for sodium-glucose co-transporter type 2 inhibitors cardio- and nephroprotective effect. Rational Pharmacotherapy in Cardiology. 2024 ; 20 (2) : 258–264. (In Russ.). doi: 10.20996/1819-6446-2024-3014.Fitchett D., Zinman B., Wanner C., et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME trial. Eur Heart J. 2016 ; 37 (19) : 1526–1534. doi: 10.1093/eurheartj/ehv728.Fitchett D., Zinman B., Wanner C., et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME trial. Eur Heart J. 2016 ; 37 (19) : 1526–1534. doi: 10.1093/eurheartj/ehv728.Neal B., Perkovic V., Mahaffey K. W., et al. Optimizing the analysis strategy for the CANVAS Program: A prespecified plan for the integrated analyses of the CANVAS and CANVAS-R trials. Diabetes Obes Metab. 2017 ; 19 (7) : 926–935. doi: 10.1111/dom.12924.Neal B., Perkovic V., Mahaffey K. W., et al. Optimizing the analysis strategy for the CANVAS Program: A prespecified plan for the integrated analyses of the CANVAS and CANVAS-R trials. Diabetes Obes Metab. 2017 ; 19 (7) : 926–935. doi: 10.1111/dom.12924.Wiviott S. D., Raz I., Bonaca M. P., et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019 ; 380 (4) : 347–357. doi: 10.1056/NEJMoa1812389.Wiviott S. D., Raz I., Bonaca M. P., et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019 ; 380 (4) : 347–357. doi: 10.1056/NEJMoa1812389.Cosentino F., Cannon Ch., Cherney D. Z., et al. Efficacy of Ertugliflozin on Heart FailureRelated vents in Patients With Type 2 Diabetes Mellitus and Established Atherosclerotic Cardiovascular Disease: Results of the VERTIS CV Trial. Circulation. 2020 ; 142 (23) : 2205–2215. doi: 10.1161/CIRCULATIONAHA.120.050255.Cosentino F., Cannon Ch., Cherney D. Z., et al. Efficacy of Ertugliflozin on Heart FailureRelated vents in Patients With Type 2 Diabetes Mellitus and Established Atherosclerotic Cardiovascular Disease: Results of the VERTIS CV Trial. Circulation. 2020 ; 142 (23) : 2205–2215. doi: 10.1161/CIRCULATIONAHA.120.050255.Курочкина О. Н., Баранов А. В., Сажина А. С., Богомолов А. Н. Возможности организации оказания медицинской помощи пациентам с хронической сердечной недостаточностью в регионах России с низкой плотностью населения. // Профилактическая медицина. — 2023. — Т. 26, № 5. — С. 102–109.Kurochkina O. N., Baranov A. V., Sazhina A. S., Bogomolov A. N. Organizing medical care for patients with chronic heart failure in Russia regions with a low population density. The Russian Journal of Preventive Medicine. 2023 ; 26 (5) : 102–109. (In Russ.). doi: 10.17116/profmed202326051102.Курочкина О. Н., Баранов А. В., Сажина А. С., Богомолов А. Н. Современные методы лечения пожилых пациентов с хронической сердечной недостаточностью: обзор литературы. // Фарматека. — 2023. — Т. 30, № 1-2. — С. 94–99.Kurochkina O. N., Baranov A. V., Sazhina A. S., Bogomolov A. N. Modern methods of treatment of elderly patients with chronic heart failure: a literature review. Farmateka. 2023 ; 30 (1-2) : 94–99. (In Russ.). doi: 10.18565/pharmateca.2023.1-2.94-99.Szarek M., Bhatt D. L., Steg Ph. G., et al. Effect of Sotagliflozin on Total Hospitalizations in Patients With Type 2 Diabetes and Worsening Heart Failure: A Randomized Trial. Ann Intern Med. 2021 ; 174 (8) : 1065–1072. doi: 10.7326/ M21-0651.Szarek M., Bhatt D. L., Steg Ph. G., et al. Effect of Sotagliflozin on Total Hospitalizations in Patients With Type 2 Diabetes and Worsening Heart Failure: A Randomized Trial. Ann Intern Med. 2021 ; 174 (8) : 1065–1072. doi: 10.7326/M21-0651.Heerspink H. J. L., Stefánsson B. V., Correa-Rotter R., et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020 ; 383 : 1436–1446. doi: 10.1056/ NEJMoa2024816.Heerspink H. J. L., Stefánsson B. V., Correa-Rotter R., et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020 ; 383 : 1436–1446. doi: 10.1056/NEJMoa2024816.The EMPA-KIDNEY Collaborative Group. Empagliflozin in Patients with Chronic Kidney Disease. N. Engl. J. Med. 2022 ; 388 : 117–127. doi: 10.1056/NEJMoa2204233.The EMPA-KIDNEY Collaborative Group. Empagliflozin in Patients with Chronic Kidney Disease. N. Engl. J. Med. 2022 ; 388 : 117–127. doi: 10.1056/NEJMoa2204233.Baigent C., Emberson J., Haynes R., et al. Impact of Diabetes on the Effects of Sodium Glucose Co-Transporter-2 Inhibitors on Kidney Outcomes: Collaborative Meta-Analysis of Large Placebo-Controlled Trials. Lancet. 2022 ; 400 (10365) : 1788–1801. doi: 10.1016/S0140-6736(22)02074-8.Baigent C., Emberson J., Haynes R., et al. Impact of Diabetes on the Effects of Sodium Glucose Co-Transporter-2 Inhibitors on Kidney Outcomes: Collaborative Meta-Analysis of Large Placebo-Controlled Trials. Lancet. 2022 ; 400 (10365) : 1788–1801. doi: 10.1016/S0140-6736(22)02074-8.Mikhail N. Use of sodium-glucose cotransporter type 2 inhibitors in older adults with type 2 diabetes mellitus. South Med J. 2015 ; 108 (2) : 91–96. doi: 10.14423/ SMJ.0000000000000235.Mikhail N. Use of sodium-glucose cotransporter type 2 inhibitors in older adults with type 2 diabetes mellitus. South Med J. 2015 ; 108 (2) : 91–96. doi: 10.14423/SMJ.0000000000000235.Martin P., Tamblyn R., Benedetti A., et al. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE Randomized Clinical Trial. JAMA. 2018 ; 320 (18) : 1889–1898. doi: 10.1001/jama.2018.16131.Martin P., Tamblyn R., Benedetti A., et al. Effect of a pharmacistled educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE Randomized Clinical Trial. JAMA. 2018 ; 320 (18) : 1889–1898. doi: 10.1001/jama.2018.16131.Muskiet M. H., Tonneijck L., Huang Y., et al. Lixisenatide and renal outcomes in patients with type 2 diabetes and acute coronary syndrome: an exploratory analysis of the ELIXA randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2018 ; 6 (11) : 859–869. doi: 10.1016/S2213-8587(18)30268-7.Muskiet M. H., Tonneijck L., Huang Y., et al. Lixisenatide and renal outcomes in patients with type 2 diabetes and acute coronary syndrome: an exploratory analysis of the ELIXA randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2018 ; 6 (11) : 859–869. doi: 10.1016/S2213-8587(18)30268-7.Marso S. P., Poulter N. R., Nissen S. E., et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013 ; 166 (5) : 823–30.e5. doi: 10.1016/j.ahj.2013.07.012.Marso S. P., Poulter N. R., Nissen S. E., et al. Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. Am Heart J. 2013 ; 166 (5) : 823–30.e5. doi: 10.1016/j.ahj.2013.07.012.Leiter L. A., Bain S. C., Hramiak I., et al. Cardiovascular risk reduction with once-weekly semaglutide in subjects with type 2 diabetes: a post hoc analysis of gender, age, and baseline CV risk profile in the SUSTAIN 6 trial. Cardiovasc Diabetol. 2019 ; 18 (1) : 73. doi: 10.1186/s12933-019-0871-8.Leiter L. A., Bain S. C., Hramiak I., et al. Cardiovascular risk reduction with once-weekly semaglutide in subjects with type 2 diabetes: a post hoc analysis of gender, age, and baseline CV risk profile in the SUSTAIN 6 trial. Cardiovasc Diabetol. 2019 ; 18 (1) : 73. doi: 10.1186/s12933-019-0871-8.Gerstein H. C., Colhoun H. M., Dagenais G. R., et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019 ; 394 (10193) : 121–130. doi: 10.1016/S0140-6736(19)31149-3.Gerstein H. C., Colhoun H. M., Dagenais G. R., et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019 ; 394 (10193) : 121–130. doi: 10.1016/S0140-6736(19)31149-3.Green J. B., Hernandez A. F., D'Agostino R. B., et al. Harmony Outcomes: A randomized, double-blind, placebo-controlled trial of the effect of albiglutide on major cardiovascular events in patients with type 2 diabetes mellitusRationale, design, and baseline characteristics. Am Heart J. 2018 ; 203 : 30–38. doi: 10.1016/j.ahj.2018.03.030.Green J. B., Hernandez A. F., D'Agostino R. B., et al. Harmony Outcomes: A randomized, double-blind, placebo-controlled trial of the effect of albiglutide on major cardiovascular events in patients with type 2 diabetes mellitusRationale, design, and baseline characteristics. Am Heart J. 2018 ; 203 : 30–38. doi: 10.1016/j.ahj.2018.03.030.Sattar N., Lee M. M., Kristensen S. L., et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and metaanalysis of randomised trials. Lancet Diabetes Endocrinol. 2021 ; 9 (10) :653–662. doi: 10.1016/S2213-8587(21)00203-5.Sattar N., Lee M. M., Kristensen S. L., et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and metaanalysis of randomised trials. Lancet Diabetes Endocrinol. 2021 ; 9 (10) :653–662. doi: 10.1016/S2213-8587(21)00203-5.Verdecchia P., Murdolo G., Coiro S., et al. Therapy of Type 2 diabetes: more gliflozines and less metformin? Eur Heart J Suppl. 2023 ; 25 (Suppl B) : B171–B176. doi: 10.1093/ eurheartjsupp/suad098.Verdecchia P., Murdolo G., Coiro S., et al. Therapy of Type 2 diabetes: more gliflozines and less metformin? Eur Heart J Suppl. 2023 ; 25 (Suppl B) : B171–B176. doi: 10.1093/eurheartjsupp/suad098.Consoli A., Formoso G. Potential side effects to GLP1 agonists: understanding their safety and tolerability. Expert Opin Drug Saf. 2015 ; 14 (2) : 207–218. doi: 10.1517/14740338.2015.987122.Consoli A., Formoso G. Potential side effects to GLP1 agonists: understanding their safety and tolerability. Expert Opin Drug Saf. 2015 ; 14 (2) : 207–218. doi: 10.1517/14740338.2015.987122.Zoungas S., Chalmers J., Neal B., et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Eng J Med. 2014 ; 371 (15) : 1392–1406. doi: 10.1056/NEJMoa1407963.Zoungas S., Chalmers J., Neal B., et al. Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Eng J Med. 2014 ; 371 (15) : 1392–1406. doi: 10.1056/NEJMoa1407963.Rosenstock J., Kahn S. E., Johansen O. E., et al. Effect of linagliptin vs limepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial. JAMA. 2019 ; 322 (12) : 1155–1166. doi: 10.1001/jama.2019.13772.Rosenstock J., Kahn S. E., Johansen O. E., et al. Effect of linagliptin vs limepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial. JAMA. 2019 ; 322 (12) : 1155–1166. doi: 10.1001/jama.2019.13772.Glyburide, Gliclazide or Glimepiride for Elderly Patients with Type 2 Diabetes: A Review of the Clinical Effectiveness and Safety — An Update. Canadian Agency for Drugs and Technologies in Health. Ottawa. 2015. Available at: https://pubmed.ncbi.nlm.nih.gov/26355189/.Glyburide, Gliclazide or Glimepiride for Elderly Patients with Type 2 Diabetes: A Review of the Clinical Effectiveness and Safety — An Update. Canadian Agency for Drugs and Technologies in Health. Ottawa. 2015. Available at: https://pubmed.ncbi.nlm.nih.gov/26355189/.Mathur S., Zammitt N. N., Frier B. M. Optimal glycaemic control in elderly people with type 2 diabetes: what does the evidence say? Drug Saf. 2015 ; 38 (1) : 17–32. doi: 10.1007/s40264-014-0247-7.Mathur S., Zammitt N. N., Frier B. M. Optimal glycaemic control in elderly people with type 2 diabetes: what does the evidence say? Drug Saf. 2015 ; 38 (1) : 17–32. doi: 10.1007/s40264-014-0247-7.Holman R. R., Coleman R. L., Chan J. C. N., et al. Effects of acarbose on cardiovascular and diabetes out-comes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebocontrolled trial. Lancet Diabetes Endocrinol. 2017 ; 5 (11) : 877–886. doi: 10.1016/S2213-8587(17)30309-1.Holman R. R., Coleman R. L., Chan J. C. N., et al. Effects of acarbose on cardiovascular and diabetes out-comes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebocontrolled trial. Lancet Diabetes Endocrinol. 2017 ; 5 (11) : 877–886. doi: 10.1016/S2213-8587(17)30309-1.Салухов В. В., Ковалевская Е. А. Переосмысление роли пиоглитазона в современной диабетологии с позиции его кардиоренопротективных свойств. // Медицинский совет. — 2022. — Т. 16, № 10. — С. 10–21.Salukhov V. V., Kovalevskaya E. A. Rethinking the role of pioglitazone in modern diabetology from the perspective of its cardiorenoprotective properties. Medical advice. 2022 ; 16 (10) : 10–21 (In Russ.). doi: 10.21518/2079-701X-2022-16-10-10-21.Vaccaro O., Masulli M., Nicolucci A., et al. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial. Lancet Diabetes Endocrinol. 2017 ; 5 (11) : 887–897. doi: 10.1016/S2213-8587(17)30317-0.Vaccaro O., Masulli M., Nicolucci A., et al. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial. Lancet Diabetes Endocrinol. 2017 ; 5 (11) : 887–897. doi: 10.1016/S2213-8587(17)30317-0.Zhou Yu., Huang Ya., Ji Xi, et al. Pioglitazone for the primary and secondary prevention of cardiovascular and renal outcomes in patients with or at high risk of type 2 diabetes mellitus: a meta-analysis. J Clin Endocrinol Metab. 2020 ; 105 (5) : dgz252. doi: 10.1210/clinem/dgz252.Zhou Yu., Huang Ya., Ji Xi, et al. Pioglitazone for the primary and secondary prevention of cardiovascular and renal outcomes in patients with or at high risk of type 2 diabetes mellitus: a meta-analysis. J Clin Endocrinol Metab. 2020 ; 105 (5) : dgz252. doi: 10.1210/clinem/dgz252.White W. B., Bakris G. L., Bergenstal R. M. et al. Examination of cardiovascular outcomes with alogliptin versus standard of care in patients with type 2 diabetes mellitus and acute coronary syndrome (EXAMINE): a cardiovascular safety study of the dipeptidyl peptidase 4 inhibitor alogliptin in patients with type 2 diabetes with acute coronary syndrome. Am Heart J. 2011 ; 162 (4) : 620–626. e1. doi: 10.1016/j.ahj.2011.08.004.White W. B., Bakris G. L., Bergenstal R. M. et al. Examination of cardiovascular outcomes with alogliptin versus standard of care in patients with type 2 diabetes mellitus and acute coronary syndrome (EXAMINE): a cardiovascular safety study of the dipeptidyl peptidase 4 inhibitor alogliptin in patients with type 2 diabetes with acute coronary syndrome. Am Heart J. 2011 ; 162 (4) : 620–626. e1. doi: 10.1016/j.ahj.2011.08.004.Rosenstock J., Perkovic V., Alexander J. H., et al. Rationale, design, and baseline characteristics of the CArdiovascular safety and Renal Microvascular outcomE study with LINAgliptin (CARMELINA®): a randomized, double-blind, placebo-controlled clinical trial in patients with type 2 diabetes and high cardio-renal risk. Cardiovasc Diabetol. 2018 ; 17 (1) : 39. doi: 10.1186/s12933-018-0682-3.Rosenstock J., Perkovic V., Alexander J. H., et al. Rationale, design, and baseline characteristics of the CArdiovascular safety and Renal Microvascular outcomE study with LINAgliptin (CARMELINA®): a randomized, double-blind, placebo-controlled clinical trial in patients with type 2 diabetes and high cardio-renal risk. Cardiovasc Diabetol. 2018 ; 17 (1) : 39. doi: 10.1186/s12933-018-0682-3.Garber A. J., Clauson P., Pedersen C. B., Kolendorf K. Lower risk of hypoglycemia with insulin detemir than with neutral protamine hagedorn insulin in older persons with type 2 diabetes: a pooled analysis of phase III trials. J Am Geriatr Soc. 2007 ; 55 (11) : 1735–1740. doi: 10.1111/j.1532-5415.2007.01414.x.Garber A. J., Clauson P., Pedersen C. B., Kolendorf K. Lower risk of hypoglycemia with insulin detemir than with neutral protamine hagedorn insulin in older persons with type 2 diabetes: a pooled analysis of phase III trials. J Am Geriatr Soc. 2007 ; 55 (11) : 1735–1740. doi: 10.1111/j.1532-5415.2007.01414.x.ORIGIN Trial Investigators; Gerstein H. C., Bosch J. et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012 ; 367 (4) : 319–328. doi: 10.1056/NEJMoa1203858.ORIGIN Trial Investigators; Gerstein H. C., Bosch J. et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012 ; 367 (4) : 319–328. doi: 10.1056/NEJMoa1203858.Bourdel-Marchasson I., Magg S., Abdelhafiz A., et al. Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party For older people (EDWPOP) collaboration. Aging Clin Exp Res. 2023 ; 35 (11) : 2279–2291. doi: 10.1007/s40520-023-02519-3.Bourdel-Marchasson I., Magg S., Abdelhafiz A., et al. Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party For older people (EDWPOP) collaboration. Aging Clin Exp Res. 2023 ; 35 (11) : 2279–2291. doi: 10.1007/s40520-023-02519-3.Gough S. C., Bode B., Woo V., et al. Efficacy and safety of a fixed-ratio combination of insulin degludec and liraglutide (IDegLira) compared with its components given alone: results of a phase 3, open-label, randomised, 26-week, treat-to-target trial in insulin-naive patients with type 2 diabetes. Lancet Diabetes Endocrinol. 2014 ; 2 (11) : 885–893. doi: 10.2337/dc17-1114.Gough S. C., Bode B., Woo V., et al. Efficacy and safety of a fixed-ratio combination of insulin degludec and liraglutide (IDegLira) compared with its components given alone: results of a phase 3, open-label, randomised, 26-week, treat-to-target trial in insulin-naive patients with type 2 diabetes. Lancet Diabetes Endocrinol. 2014 ; 2 (11) : 885–893. doi: 10.2337/dc17-1114.Rosenstock J., Aronson R., Grunberger G., et al. Benefits of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus insulin glargine and lixisenatide monocomponents in type 2 diabetes inadequately controlled on oral agents: the LixiLan-O randomized trial. Diabetes Care. 2016 ; 39 (11) : 2026–2035. doi: 10.2337/dc16-0917.Rosenstock J., Aronson R., Grunberger G., et al. Benefits of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus insulin glargine and lixisenatide monocomponents in type 2 diabetes inadequately controlled on oral agents: the LixiLan-O randomized trial. Diabetes Care. 2016 ; 39 (11) : 2026–2035. doi: 10.2337/dc16-0917.Ткачева О. Н., Остроумова О. Д., Котовская Ю. В. и др. Депрескрайбинг сахароснижающих препаратов у пациентов пожилого и старческого возраста: современное состояние вопроса и обзор доказательной базы // Клиническая фармакология и терапия. — 2019. — Т. 28, № 33. — С. 62–67.Tkacheva O. N., Ostroumova O. D., Kotovskaya Yu. V., et al. Deprescribing of glucose-lowering medications in the elderly. Klinicheskaya farmakologiya i terapiya = Clin Pharmacol Ther. 2019 ; 28 (3) : 62–67. (In Russ.). doi: 10.32756/0869-5490-2019-3-62-67.

The authors declare that there are no conflicts of interest present.