Greene D A
Am J Med. 1986 May 16;80(5A):39-53. doi: 10.1016/0002-9343(86)90536-x.
The chronic complications of diabetes are thought to be caused by an interaction between hyperglycemia or other metabolic consequences of insulin deficiency and other poorly defined independent genetic or environmental factors. Several important biochemical sequelae to hyperglycemia are discussed. Macrovascular disease appears to be primarily age-related in diabetic patients. The clinical course, manifestations, and management of diabetic complications are significantly altered when they appear against a background of the degenerative changes of aging, greatly complicating diagnosis and management. In elderly patients, the acute complications of diabetes--ketoacidosis and hyperosmolar dehydration--often occur in the context of chronic complications that greatly compound their management and increase their morbidity and mortality.
糖尿病的慢性并发症被认为是由高血糖或胰岛素缺乏的其他代谢后果与其他定义不明确的独立遗传或环境因素之间的相互作用引起的。文中讨论了高血糖的几个重要生化后遗症。在糖尿病患者中，大血管疾病似乎主要与年龄相关。当糖尿病并发症出现在衰老的退行性变化背景下时，其临床病程、表现和管理会发生显著改变，这极大地增加了诊断和管理的复杂性。在老年患者中，糖尿病的急性并发症——酮症酸中毒和高渗性脱水——常常发生在慢性并发症的背景下，这极大地增加了其管理难度，并提高了发病率和死亡率。
