从指南到实践——浅谈老年糖尿病的诊治策略

Strategy for diagnosis and treatment of diabetes in the elderly——from guideline to practice

老年人是糖尿病的高发人群,糖尿病人群中半数以上是老年人。这些人病情复杂,合并其他疾病多,受诸多因素影响,治疗水平差度大,故需要对老年糖尿病患者的多代谢调节能力、脏器功能、自我管理水平进行综合评估,选择个性化的治疗模式和控制目标。改变生活方式一直是多代谢异常的治疗基础,早检查、早诊断、早治疗对患者改善预后有决定性的意义。二甲双胍、糖苷酶抑制剂和二肽酶抑制剂是老年2型糖尿病的一线口服降糖药,适时启动胰岛素治疗有利于血糖的总体控制。多重心血管危险因素的综合控制,尤其是对血压和体重的管理不可忽视。

The elderly are more likely to develop diabetes mellitus. More than half of the diabetic patients are elderly individuals. The outcome of these patients differs greatly due to the complex of the condition, the variety of complicated diseases, and multiplicity of the influencing factors. So, it is very important to evaluate their accommodation ability, the function of the major organs, and the level of self-management to establish the individualized treatment strategy and blood glucose control target for different patients. The modification of life style is the basic treatment option for metabolic disorder. Early diagnosis and treatment are decisive to the patients＇ prognosis. Metformin, glycosidase inhibitors and dipeptidyl aminopeptidase inhibitors are the first-line oral antidiabetic drugs. The timely use of insulin is beneficial for the control of blood glucose. The comprehensive control of multiple cardio-vascular risk factors, especially the blood pressure and body weight control, should be emphasized.