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衰弱与糖尿病相遇之处。

Where frailty meets diabetes.

机构信息

Department of Geriatrics, University of Antwerp, Antwerp, Belgium.

出版信息

Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:261-7. doi: 10.1002/dmrr.2743.

Abstract

Diabetes is a chronic illness that has an effect on multiple organ systems. Frailty is a state of increased vulnerability to stressors and a limited capacity to maintain homeostasis. It is a multidimensional concept and a dynamic condition that can improve or worsen over time. Frailty is either physical or psychological or a combination of these two components. Sarcopenia, which is the age-related loss of skeletal muscle mass and strength, is the main attributor to the physical form of frailty. Although the pathophysiology of diabetes is commonly focused on impaired insulin secretion, overload of gluconeogenesis and insulin resistance, newer insights broaden this etiologic horizon. Immunologic factors that create a chronic state of low-grade inflammation--'inflammaging'--have an influence on both the ageing process and diabetes. Persons with diabetes mellitus already tend to have an accelerated ageing process that places them at greater risk for developing frailty at an earlier age. The development of frailty--and sarcopenia--is multifactorial and includes nutritional, physical and hormonal elements; these elements are interlinked with those of diabetes. A lower muscle mass will lead to poorer glycaemic control through lower muscle glucose uptake. This leads to higher insulin secretion and insulin resistance, which is the stepping stone for diabetes itself.

摘要

糖尿病是一种影响多个器官系统的慢性疾病。虚弱是一种对压力源易感性增加和维持体内平衡能力有限的状态。它是一个多维的概念,是一种可以随着时间的推移而改善或恶化的动态状况。虚弱要么是身体上的,要么是心理上的,要么是这两个组成部分的结合。随着年龄的增长,骨骼肌质量和力量的丧失是导致身体虚弱的主要原因,这种现象被称为肌肉减少症。虽然糖尿病的病理生理学通常集中在胰岛素分泌受损、糖异生和胰岛素抵抗过载上,但新的见解拓宽了这一病因学的视野。导致慢性低度炎症状态的免疫因素——“炎症老化”,对衰老过程和糖尿病都有影响。糖尿病患者已经倾向于加速衰老过程,这使他们更早地面临虚弱的风险。虚弱和肌肉减少症的发生是多因素的,包括营养、身体和激素因素;这些因素与糖尿病的因素相互关联。肌肉量减少会导致肌肉葡萄糖摄取减少,从而导致血糖控制不佳。这会导致更高的胰岛素分泌和胰岛素抵抗,这是糖尿病本身的垫脚石。

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