Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
Diabetes Res Clin Pract. 2020 Mar;161:108065. doi: 10.1016/j.diabres.2020.108065. Epub 2020 Feb 7.
Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.
衰弱症在老年人中作为糖尿病的一种新的并发症类别逐渐显现出来。临床上，衰弱症尚未得到很好的定义，大多数人认为它仅存在于身体领域。然而，衰弱症是一种多维综合征，新提出的“三损伤”（身体、认知和情感）概念可能更能代表衰弱症的广泛性质。三损伤的组成部分（TOI）通常共同存在，并表现出相互关系。老年糖尿病似乎增加了三损伤的风险，这可能最终导致残疾。因此，应该定期评估老年糖尿病患者是否存在这三个关键组成部分。充足的营养和定期的抗阻运动训练已被证明对该人群的长期预后有积极影响。然而，良好的血糖控制和使用当前的降糖药物在降低这种三损伤的发生率方面的作用尚不清楚。需要开展未来的研究，开发新型降糖药物，不仅要关注血糖控制和心血管安全性，还要降低三损伤的风险。
