Heart failure and type 2 diabetes often coexist in the older adults, with a bidirectional pathophysiological mechanism involving insulin resistance, chronic inflammation, neuroendocrine activation, and inter-organ communication, which is exacerbated by aging. This article provides an overview of the disease burden, pathophysiological mechanisms, clinical characteristics, treatment strategies, and future directions for heart failure and type 2 diabetes in the elderly.Their clinical manifestations are insidious and highly heterogeneous, and diagnosis requires precise assessment combining imaging and biomarkers. Treatment should follow the principle of "co-morbidity co-treatment", with sodium-dependent glucose transporters 2 inhibitors and angiotensin receptor-neprilysin inhibitor as the cornerstone of new heart failure drugs, and priority should be given to hypoglycemic drugs with both cardiovascular and renal benefits. Establishing a comprehensive management model with a multidisciplinary team is the key to improving prognosis. Future research should focus on conducting specialized studies on co-morbidities in the elderly and exploring new directions such as cell therapy, targeting aging, and digital health. This review focuses on the comorbidity of heart failure and type 2 diabetes in the elderly, systematically reviewing and summarizing the existing evidence to provide guidance for optimizing the clinical management of patients with this comorbidity.

心力衰竭与2型糖尿病在老年人群中常合并存在，两者存在双向恶性循环的病理生理机制，涉及胰岛素抵抗、慢性炎症、神经内分泌激活及器官间对话等，并因衰老而加剧。本文综述了老年心力衰竭合并2型糖尿病的疾病负担、病理机制、临床特点、治疗策略及未来方向。其中，老年心力衰竭合并2型糖尿病临床表现隐匿且异质性高，诊断需结合影像学与生物标志物进行精准评估。治疗上应遵循"共病共治"原则，将以钠-葡萄糖协同转运蛋白2抑制剂、血管紧张素受体脑啡肽酶抑制剂为代表的新型抗心力衰竭药物作为基石，并优先选择兼具心肾获益的降糖药物，建立多学科团队管理的综合模式是改善预后的关键。未来需开展针对老年共病的专项研究，并探索细胞治疗、靶向衰老及数字健康等新方向。本综述聚焦老年心力衰竭合并2型糖尿病共病，系统性梳理和总结现有证据，以期为优化共病患者的临床管理提供参考。