Mooradian Arshag D
Department of Medicine, University of Florida College of Medicine, 653-1 West 8th Street, 4th Floor, LRC, Jacksonville, FL, 32209, USA.
Drugs Aging. 2018 Dec;35(12):1065-1078. doi: 10.1007/s40266-018-0598-3.
The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower blood glucose levels and the optimal method of doing so, the goals of diabetes control in older people must be individualized. If the patient requires insulin therapy, the newer insulins, with their improved pharmacodynamic consistency and reduced risk of hypoglycemia, should be preferred. Several oral agents are preferable for people with sufficient endogenous insulin because they do not cause hypoglycemia when used as monotherapy. Some of these oral agents have been found to have cardioprotective effects. Older people with diabetes also require management of the other risk factors for cardiovascular disease, with antihypertensive drugs, cholesterol-lowering agents and low-dose aspirin. However, the precise targets for blood pressure control and low-density lipoprotein (LDL) cholesterol levels continue to evolve as more data become available. Diabetes care in older adults should focus on enhancing the individual's quality of life rather than trying to normalize blood glucose levels or reach predetermined blood pressure and LDL cholesterol targets.
全球范围内，老年糖尿病患者的数量正在迅速增加。多种因素导致糖尿病发病率随年龄增长而上升。该领域缺乏实证证据，使得管理指南大多基于专家意见。鉴于降低血糖水平的速率以及最佳方法存在不确定性，老年人糖尿病控制的目标必须因人而异。如果患者需要胰岛素治疗，应优先选择新型胰岛素，其具有更好的药效学一致性且低血糖风险降低。对于内源性胰岛素充足的患者，几种口服药物更可取，因为它们单药使用时不会引起低血糖。其中一些口服药物已被发现具有心脏保护作用。老年糖尿病患者还需要使用抗高血压药物、降胆固醇药物和低剂量阿司匹林来管理心血管疾病的其他风险因素。然而，随着更多数据的出现，血压控制和低密度脂蛋白（LDL）胆固醇水平的精确目标仍在不断演变。老年糖尿病护理应侧重于提高个人生活质量，而不是试图使血糖水平正常化或达到预定的血压和LDL胆固醇目标。
