Köhler Ballan B, Tran C, Perrenoud L, Vischer U M
Service d'endocrinologie, diabétologie et nutrition, HUG, 1211 Genève 14.
Rev Med Suisse. 2011 Nov 9;7(316):2166-9.
Severe hypoglycemia is a feared complication of treatment in older diabetic patients (> 75 years) and a limiting factor for good glycemic control. Its real incidence is not well studied and probably underestimated. Cognitive impairment, malnutrition and/or cachexia, polypharmacy and a recent hospitalization are risk factors for severe hypoglycemia specific for older patients. Cognitive impairment screening can identify patients unable to manage their treatment. Simplification of treatment and/or transferring its execution to relatives must then be considered. Prevention also involves the detection of malnutrition and comorbidities, Age-adjusted therapeutic targets (HbA1c 7-8%) are important to avoid an exceedingly strict glycemic control. However, giving up on good glycemic control is not an adequate prevention strategy in itself.
严重低血糖是老年糖尿病患者（>75岁）治疗中令人担忧的并发症，也是良好血糖控制的限制因素。其实际发病率尚未得到充分研究，可能被低估了。认知障碍、营养不良和/或恶病质、多重用药以及近期住院是老年患者严重低血糖的特定危险因素。认知障碍筛查可以识别出无法自行管理治疗的患者。然后必须考虑简化治疗和/或将治疗执行转交给亲属。预防还包括检测营养不良和合并症，调整年龄的治疗目标（糖化血红蛋白7-8%）对于避免血糖控制过严很重要。然而，单纯放弃良好的血糖控制本身并不是一种充分的预防策略。
