Abbatecola A M, Paolisso G, Sinclair A J
Italian National Research Center on Aging (I.N.R.C.A.), Via S. Margherita n.5, Ancona, Italy 60100.
Curr Pharm Des. 2015;21(13):1665-71. doi: 10.2174/1381612821666150130120747.
There is a rapidly growing number of persons reaching extreme age limits. Indeed, the fastest growth is found in those over the age of 80 years or octogenarians. Along with this continuous rise, there is a significant increase in type 2 diabetes in this population. Unfortunately, individuals living past 80 years of age are often accompanied by numerous comorbidities and geriatric conditions, all which render anti-diabetic treatment options challenging. Indeed the principles of managing type 2 diabetes are similar to younger patients. Special considerations in this delicate group are essential due to the increased prevalence of comorbidities and relative inability to tolerate adverse effects of medication and severe hypoglycemia. It is important to recall that octogenarians have shown to have a greater prevalence for cognitive impairment, physical disability, ren al and hepatic dysfunction, and syndromes, such as frailty compared to younger elders. The frailty syndrome is considered one of the most important limitations when treating octogenarians with type 2 diabetes in polypharmacy. Due to the lack of evidence for specific targets of glucose and glycated hemoglobin (A1C) levels in the elderly, available treatment guidelines are based on data extrapolation from younger adults and expert opinion citing reliable evidence. Overall, the most important conclusion emerging from these groups is to accomplish a moderate glycemic control (A1C levels between 7 -8%) in complex elderly patients. However, the risk of hypoglycemia from some treatments may present the greatest significant barrier to optimal glycemic control for the very old. The present review discusses the highlights from the latest guidelines for treating older persons and underlines the need for specific considerations when treating the very old in order to maintain a balance between treating comorbidities and maintaining quality of life.
达到极高年龄界限的人数正在迅速增加。事实上，增长最快的是80岁以上的人群，即八旬老人。随着这一人数的持续上升，该人群中2型糖尿病的发病率也显著增加。不幸的是，80岁以上的人往往伴有多种合并症和老年疾病，所有这些都使得抗糖尿病治疗选择具有挑战性。的确，2型糖尿病的管理原则与年轻患者相似。由于合并症的患病率增加以及相对无法耐受药物不良反应和严重低血糖，对这个脆弱群体进行特殊考虑至关重要。重要的是要记住，与年轻老年人相比，八旬老人的认知障碍、身体残疾、肾和肝功能障碍以及衰弱等综合征的患病率更高。在多药治疗中，衰弱综合征被认为是治疗八旬老人2型糖尿病时最重要的限制因素之一。由于缺乏关于老年人血糖和糖化血红蛋白（A1C）水平具体目标的证据，现有的治疗指南是基于从年轻成年人的数据外推以及引用可靠证据的专家意见制定的。总体而言，从这些群体中得出的最重要结论是在复杂的老年患者中实现适度的血糖控制（A1C水平在7%-8%之间）。然而，某些治疗导致的低血糖风险可能是最年长者实现最佳血糖控制的最大障碍。本综述讨论了最新老年人治疗指南的要点，并强调在治疗最年长者时需要进行特殊考虑，以便在治疗合并症和维持生活质量之间保持平衡。
