Zhonghua Nei Ke Za Zhi. 2018 Sep 1;57(9):626-641. doi: 10.3760/cma.j.issn.0578-1426.2018.09.004.
According to the national survey data over the past five years, there are about 50.16 million elderly diabetic patients (≥60 years old) in China. With the increase in the total number of the elderly, this number will be expected to increase. Among the elderly patients, most of them are newly diagnosed, and are associated with a number of risk factors for cardiovascular diseases at the time of initial diagnosis. Those who were with young-onset have a long-term clinical course, and often complicated with diabetic chronic complications and potential organ dysfunctions. Most of the elderly diabetic patients in China are with poor glycemic control. The diabetes-related complications have become one of the major reasons for the senile death. It is well accepted that early diagnosis and reasonable treatment could reduce the occurrence of diabetic complications, and the disability and fatal cardiovascular and cerebrovascular events. Thus, it is recommended, in the consensus, to conduct a comprehensive assessment of the glycemic control, metabolic cardiovascular risk factors, diabetes complications, multiple organ functions of the elderly patients, as well as their intelligence and physical fitness. Personalized control targets on blood glucose, pressure, lipids, uric acid and body weight would be established based on the assessment of each patient and consideration of the balance between benefits and risks in order to achieve the goal of early detection, early diagnosis, early treatment and early target reaching. Moreover, it is also recommended, in the consensus, to focus on the basic treatments (diets, exercises, self-monitoring and management), initiate suitable hypoglycemic drugs with complementary mechanisms when needed, and take into consideration of management of multiple cardiovascular risk factors and drug usage together with the caution of mutual interactions of multiple drugs.
根据过去五年的全国调查数据,中国约有5016万老年糖尿病患者(≥60岁)。随着老年人口总数的增加,这一数字预计还会上升。在老年患者中,大多数为新诊断出的病例,且在初诊时伴有多种心血管疾病风险因素。那些年轻时发病的患者病程较长,常伴有糖尿病慢性并发症和潜在的器官功能障碍。中国大多数老年糖尿病患者血糖控制不佳。糖尿病相关并发症已成为老年人死亡的主要原因之一。人们普遍认为,早期诊断和合理治疗可减少糖尿病并发症的发生,以及致残和致命的心脑血管事件。因此,该共识建议对老年患者的血糖控制、代谢心血管危险因素、糖尿病并发症、多器官功能以及他们的智力和体能进行全面评估。基于对每位患者的评估并考虑获益与风险之间的平衡,制定个性化的血糖、血压、血脂、尿酸和体重控制目标,以实现早发现、早诊断、早治疗和早达标的目标。此外,该共识还建议关注基础治疗(饮食、运动、自我监测和管理),必要时启动机制互补的合适降糖药物,并考虑多种心血管危险因素的管理和药物使用,同时注意多种药物之间的相互作用。