Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA.
Curr Diab Rep. 2019 Jul 19;19(8):59. doi: 10.1007/s11892-019-1172-z.
A patient's prognosis and risk of adverse drug effects are important considerations for individualizing care of older patients with diabetes. This review summarizes the evidence for risk assessment and proposes approaches for clinicians in the context of current clinical guidelines.
Diabetes guidelines vary in their recommendations for how life expectancy should be estimated and used to inform the selection of glycemic targets. Readily available prognostic tools may improve estimation of life expectancy but require validation among patients with diabetes. Treatment decisions based on prognosis are difficult for clinicians to communicate and for patients to understand. Determining hypoglycemia risk involves assessing major risk factors; models to synthesize these factors have been developed. Applying risk assessment to individualize diabetes care is complex and currently relies heavily on clinician judgment. More research is need to validate structured approaches to risk assessment and determine how to incorporate them into patient-centered diabetes care.
患者的预后和药物不良反应风险是个体化治疗老年糖尿病患者的重要考虑因素。本综述总结了风险评估的证据，并针对当前临床指南提出了临床医生的处理方法。
糖尿病指南在如何估计预期寿命以及如何将其用于指导血糖目标选择方面的建议有所不同。现有的预后工具可能会改善预期寿命的估计，但需要在糖尿病患者中进行验证。基于预后的治疗决策对临床医生来说难以沟通，对患者来说难以理解。确定低血糖风险涉及评估主要危险因素；已经开发出综合这些因素的模型。将风险评估应用于个体化糖尿病治疗非常复杂，目前严重依赖于临床医生的判断。需要更多的研究来验证结构化的风险评估方法，并确定如何将其纳入以患者为中心的糖尿病护理中。
