从基层全科医生视角解读《中国老年糖尿病诊疗指南(2021年版)》

Interpretation of "Guidelines for Diagnosis and Treatment of Elderly Diabetes in China(2021 Edition)" from the perspective of grassroots general practitioners

国际糖尿病联盟2019年糖尿病调查数据显示,我国≥65岁老年糖尿病患者约3550万人,居世界首位,占全球老年糖尿病患者人数的1/4。而且随人口老龄化越来越严重,老年糖尿病的发病率呈现逐年上升的趋势。然而,在基层医疗机构,糖尿病早期诊断率低,早期规范降糖治疗率低,影响我国基层糖尿病管控工作。本研究从老年糖尿病一级病因预防、二级早诊断和早治疗、三级临床规范化治疗3个方面对《中国老年糖尿病诊疗指南(2021年版)》进行解读,旨在帮助全科医生掌握指南并在临床实践中恰当应用。一级病因预防:基层医生应做好健康教育、提高社区人群糖尿病防治意识;通过基层健康体检工作,尽早发现糖尿病前期患者,行健康管理工作,指导生活方式干预,必要时进行药物干预。二级早诊断、早治疗:做好高危人群糖尿病筛查工作;对于初诊断糖尿病老年患者做好健康评估,及时发现糖尿病并发症和伴发病,依此制定个体化治疗方案;对于随诊患者应每次进行病情评估,使血糖保持在稳定范围,监测是否出现并发症,以便调整降糖方案;三级临床规范化治疗:根据患者个体健康状态,制定个体化的治疗、护理及康复策略;糖尿病并发症的处理;基层医院如何做好老年糖尿病患者随访工作。提示,老年糖尿病指南将对基层全科医生在老年糖尿病的防治方面起到指导或推动作用。

According to the 2019 diabetes survey by the international diabetes federation(IDF),there were about 35.5 million elderly diabetics aged 65 and above in China,ranking first and accounting for 1/4 of the number of elderly diabetics in the world.With the aging of the population becoming worse,the incidence of diabetes in old people elderly was increased year by year.However,in grassroots medical institutions,the rate of early diagnosis of diabetes was low,and the rate of early standardized treatment for glucose decrease was low,which affected the control of diabetes at the primary level in China.This study was to interpret the"Guidelines for Diagnosis and Treatment of Elderly Diabetes in China(2021 Edition)"from 3 aspects:prevention of first stage diabetes,diagnosis and treatment of two stages,and three level clinical standardized treatment.The aim was to help general practitioners master the guidelines and apply them in clinical practice.Primary cause prevention:Grass-roots doctors should do a good job in health education to improve the awareness of diabetes prevention and treatment among community people.Through primary health examination,pre-diabetic patients should be found as soon as possible,health management should be carried out,lifestyle intervention should be guided,and drug intervention should be carried out when necessary.Secondary early diagnosis and treatment:Do a good job in diabetes screening for high-risk groups.Health assessment should be done for elderly patients with newly diagnosed diabetes,complications and concomitant diseases of diabetes should be found in time,and individualized treatment plans should be formulated accordingly.For follow-up patients,the condition should be evaluated every time to keep blood sugar in a stable range and monitor whether complications occur so as to adjust the hypoglycemic plan.Three-level clinical standardized treatment:According to the individual health status of patients,formulate individualized treatment,nursing and rehabilitation strategies.Treatment of complications of diabetes mellitus.As well as how to do a good job in the follow-up of elderly diabetic patients in grass-roots hospitals.The guidelines for elderly diabetes will play aguiding role in the prevention and treatment of geriatric diabetes in general practitioners.