老年2型糖尿病缓解的研究进展

doi:10.3969/j.issn.1003-9198.2026.09.015

Abstract

Abstract: Traditionally, it is believed that type 2 diabetes mellitus (T2DM) in elderly is an irreversible disease requiring lifelong pharmacotherapy. Nevertheless, with the introduction of the concept of diabetes remission and the steady accumulation of relevant clinical evidence, this conventional perspective is undergoing gradual redefinition. Elderly T2DM refers to diabetes affecting patients aged 65 years and older. For this population, achieving diabetes remission presents greater challenges, which can be attributed to longer disease duration, more pronounced deterioration of islet β-cell function, and the frequent coexistence of multiple complications and comorbidities. This paper systematically reviews the proposal and evolution of its concept, pathophysiological mechanisms, applicable populations and intervention goals. It further summarizes the latest research advances in current clinical intervention strategies and their effects on long-term prognosis, aiming to provide evidence for the clinical management of T2DM in older adults.

Key words: type 2 diabetes mellitus in elderly, diabetes remission, life style intervention, drug treatment, metabolic surgery

CLC Number:

R 587.1

ZHOU Keyi, ZHU Huan, CHE Chenghang, WANG Shuang, SUN Qianqian. Research progress in remission of type 2 diabetes in elderly adults[J]. Practical Geriatrics, 2026, 40(9): 941-946.

References

[1] SINCLAIR A, SAEEDI P, KAUNDAL A, et al. Diabetes and global ageing among 65-99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9th edition[J]. Diabetes Res Clin Pract, 2020, 162: 108078.
[2] PORIES W J, MACDONALD K G, MORGAN E J, et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up[J]. Am J Clin Nutr, 1992, 55(2 Suppl): 582S-585S.
[3] American Diabetes Association. Standards of medical care for patients with diabetes mellitus[J]. Diabetes Care, 2002, 25(1): 213-229.
[4] BUSE J B, CAPRIO S, CEFALU W T, et al. How do we define cure of diabetes[J]. Diabetes Care, 2009, 32(11): 2133-2135.
[5] NAGI D, HAMBLING C, TAYLOR R. Remission of type 2 diabetes: a position statement from the association of british clinical diabetologists (ABCD) and the primary care diabetes society (PCDS)[J]. Br J Diabetes Vasc Dis, 2019, 19(1): 73-76.
[6] RIDDLE M C, CEFALU W T, EVANS P H, et al. Consensus report: definition and interpretation of remission in type 2 diabetes[J]. Diabetes Care, 2021, 44(10): 2438-2444.
[7] 《缓解2型糖尿病中国专家共识》编写专家委员会. 缓解2型糖尿病中国专家共识[J]. 中国全科医学, 2021, 24(32): 4037-4048.
[8] 国家老年医学中心, 中华医学会老年医学分会, 中国老年保健协会糖尿病专业委员会. 中国老年糖尿病诊疗指南(2024版)[J]. 中华糖尿病杂志, 2024, 16(2): 147-189.
[9] KHUNTI K, PAPAMARGARITIS D, ARODA V R, et al. Re-evaluating the concept of remission in type 2 diabetes: a call for patient-centric approaches[J]. Lancet Diabetes Endocrinol, 2025, 13(7): 615-634.
[10] ROTHBERG A, LEAN M, LAFERRÈRE B. Remission of type 2 diabetes: always more questions, but enough answers for action[J]. Diabetologia, 2024, 67(4): 602-610.
[11] TAYLOR R. Pathogenesis of type 2 diabetes: tracing the reverse route from cure to cause[J]. Diabetologia, 2008, 51(10): 1781-1789.
[12] DI VINCENZO O, MINNETTI M, BAKER J L, et al. European association for the study of obesity position statement on the diagnosis and management of obesity in older adults[J]. Obes Facts, 2025: 1-16.
[13] LEAN M E, LESLIE W S, BARNES A C, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial[J]. Lancet, 2018, 391(10120): 541-551.
[14] HONG S H, CHOI K M. Sarcopenic obesity, insulin resistance, and their implications in cardiovascular and metabolic consequences[J]. Int J Mol Sci., 2020, 21(2): 494.
[15] ALEXANDER A M, FITZGIBBONS L M, KUNZ H E, et al. Intermuscular adipose tissue in healthy human aging-effects of exercise training and implications to metabolic health[J]. J Appl Physiol, 2025, 139(5): 1300-1308.
[16] FRANCESCHI C, GARAGNANI P, PARINI P, et al. Inflammaging: a new immune-metabolic viewpoint for age-related diseases[J]. Nat Rev Endocrinol, 2018, 14(10): 576-590.
[17] PALMER A K, SPINELLI R, PRATA L G L, et al. Senotherapeutics for metabolic disease and diabetic complications[J]. J Intern Med, 2026, 299(1): 2-19.
[18] TAYLOR R, AL-MRABEH A, ZHYZHNEUSKAYA S, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery[J]. Cell Metab, 2018, 28(4): 547-556. e3.
[19] TALCHAI C, XUAN S, LIN H V, et al. Pancreatic β cell dedifferentiation as a mechanism of diabetic β cell failure[J]. Cell, 2012, 150(6): 1223-1234.
[20] CINTI F, BOUCHI R, KIM-MULLER J Y, et al. Evidence of β-cell dedifferentiation in human type 2 diabetes[J]. J Clin Endocrinol Metab, 2016, 101(3): 1044-1054.
[21] WANG Z, YORK N W, NICHOLS C G, et al. Pancreatic β cell dedifferentiation in diabetes and redifferentiation following insulin therapy[J]. Cell Metab, 2014, 19(5): 872-882.
[22] WENG J, LI Y, XU W, et al. Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial[J]. Lancet, 2008, 371(9626): 1753-1760.
[23] SON J, DING H, FARB T B, et al. BACH2 inhibition reverses β cell failure in type 2 diabetes models[J]. J Clin Invest, 2021, 131(24): e153876.
[24] ROSENFELD R M, GREGA M L, KARLSEN M C, et al. Executive summary of lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: a clinical practice guideline from the american college of lifestyle medicine[J]. Am J Lifestyle Med, 2025, 19(2 Suppl): 132S-154S.
[25] GREGG E W, CHEN H, WAGENKNECHT L E, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes[J]. JAMA, 2012, 308(23): 2489-2496.
[26] GREGG E W, CHEN H, BANCKS M P, et al. Impact of remission from type 2 diabetes on long-term health outcomes: findings from the Look AHEAD study[J]. Diabetologia, 2024, 67(3): 459-469.
[27] TAHERI S, ZAGHLOUL H, CHAGOURY O, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2020, 8(6): 477-489.
[28] LIU Y, CHEN Y, MA J, et al. Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial[J]. BMJ, 2025, 388: e081820.
[29] CRABTREE T S J, ADAMSON K, BICKERTON A, et al. The impact of age on response to injectable semaglutide—insights from the Association of British Clinical Diabetologists’ audit Programme[J]. Diabetes, 2024, 73(Suppl 1): 791-P.
[30] WARREN M, CHAYKIN L, TRACHTENBARG D, et al. Semaglutide as a therapeutic option for elderly patients with type 2 diabetes: pooled analysis of the SUSTAIN 1-5 trials[J]. Diabetes Obes Metab, 2018, 20(9): 2291-2297.
[31] SCHAUER P R, BHATT D L, KIRWAN J P, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes[J]. N Engl J Med, 2017, 376(7): 641-651.
[32] COURCOULAS A P, PATTI M E, HU B, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes[J]. JAMA, 2024, 331(8): 654-664.
[33] MINGRONE G, PANUNZI S, DE GAETANO A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial[J]. Lancet, 2021, 397(10271): 293-304.
[34] MINGRONE G, PANUNZI S, DE GAETANO A, et al. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial[J]. Lancet, 2015, 386(9997): 964-973.
[35] American Diabetes Association Professional Practice Committee For Diabetes. 8. Obesity and weight management for the prevention and treatment of diabetes: standards of care in diabetes-2026[J]. Diabetes Care, 2026, 49(Supple 1): S166-S182.
[36] EISENBERG D, SHIKORA S A, AARTS E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery[J]. Surg Obes Relat Dis, 2022, 18(12): 1345-1356.
[37] BELLUZZI A, DE LUCA M, MONAMI M, et al. Primary metabolic and bariatric surgery in persons aged over 65 years. GRADE-based International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) position statement[J]. Obes Surg, 2025, 35(11): 4766-4796.
[38] VAZQUEZ ARREOLA E, GONG Q, HANSON R L, et al. Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study[J]. Lancet Diabetes Endocrinol, 2026, 14(2): 137-148.
[39] HOUNKPATIN H, STUART B, FARMER A, et al. Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups[J]. Endocrinol Diabetes Metab, 2021, 4(3): e00280.

Research progress in remission of type 2 diabetes in elderly adults

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