Huang Elbert S
Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA.
BMJ. 2016 Jun 15;353:i2200. doi: 10.1136/bmj.i2200.
Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.
糖尿病是一种与衰老相关的慢性疾病，影响着超过20%的65岁以上人群。在老年糖尿病患者中，合并症非常普遍，其存在可能会改变糖尿病治疗的相对重要性、有效性和安全性。随机对照试验表明，强化血糖控制可带来微血管和心血管方面的益处，但通常需要较长的治疗期（五至九年），并且存在短期风险，如死亡（在一项试验中）和低血糖。决策分析、卫生经济学和观察性研究有助于说明在设定糖尿病治疗目标时，考虑预期寿命、低血糖和治疗负担的重要性。指南建议医生根据预后（例如，根据合并症和功能障碍分为三个等级）和个体患者的偏好，对血糖控制强度和治疗进行个体化调整。很少有研究试图在临床实践中正式实施和研究这些概念。为了更好地满足老年糖尿病合并症患者的治疗需求，需要更多的研究来确定在该人群中强化、维持或弱化治疗的风险和益处。这项研究工作应扩展到决策支持工具的开发和研究以及针对性的护理管理。
