从指南共识看老年糖尿病降糖药物的应用

Applications of anti-diabetic drugs in elderly diabetic patients： a review based on guidelines and consensuses

老年患者已成为糖尿病（DM）的高发人群，具有器官功能衰退、病情复杂、个体差异性大、并发症发病风险高等特点，其血糖控制目标和降糖方案强调个体化。无论是国际糖尿病联盟（IDF）、美国糖尿病学会（ADA）的指南，还是我国老年DM专家共识，均建议对身体虚弱、合并症多的老年患者，适当放宽其血糖控制目标，同时需选择针对性强、安全、合理、便于操作的降糖方案。目前各指南均将降糖的安全性放在非常重要的位置，在众多降糖药物中，二甲双胍是老年DM患者首选、初始的治疗药物，对肾小球滤过率（GFR）在45～60ml/（min·1.73m2）之间的患者可减量继续使用。α？糖苷酶抑制剂发生低血糖的风险较少，用于以碳水化合物为主要能量来源的老年DM患者。胰岛素制剂种类较多，可根据老年患者血糖具体情况选用。

The elderly has become the population at high risk for diabetes mellitus （DM）. Since the old people are characterized by organ function decline, complex co-morbidities, individual differences, high risk of complications and so on, individualized treatment strategy and blood glucose target should be established for different patients. No matter the guidelines of the International Diabetes Federation （IDF） and the American Diabetes Association （ADA）, or our expert consensus on senile DM, all recommend that the blood glucose target should be kept in a wider range for the frail elderly patients with multiple comorbidities, and the treatment needs to be well-targeted, safe, reasonable, and easy to operate. At present all these guidelines emphasize the importance of hypoglycemic safety. Among all the anti-diabetic agents, metformin is the first choice and initial medication for the elderly, and can be continuously used after dose decrement for those with glomerular filtration rate of 45？60ml/（min·1.73m2）. Since α-glycosidase inhibitor causes less hypoglycemia than other anti-diabetic drugs, it should be used in the elderly with carbohydrates as the main energy source. More types of insulin preparations can be selected according to the blood glucose in the elderly.