Borden Thomas J, Baker Danial E, Levien Terri L, Gates Brian J
Sr Care Pharm. 2020 Apr 1;35(4):176-181. doi: 10.4140/TCP.n.2020.176.
The prevalence and clinical impact of diabetes mellitus (DM) continues to increase in the United States and throughout the world. Older adults are at increased risk for adverse outcomes associated with hypoglycemia, particularly in situations where a lack of awareness may arise because typical symptoms are not necessarily present, serve to prompt medical intervention with oral glucose. Glucagon emergency kits that have been available to date require multiple-step reconstitution that may compromise timely and appropriate administration of lifesaving glucagon treatment during episodes of severe hypoglycemia. In settings such as long-term care facilities, trained medical professionals may not be readily available, meaning that glucagon must be administered by laypersons. Novel dosage forms of glucagon that have recently been approved for marketing in the United States allow glucagon to be delivered more easily, which may positively impact effective treatment of severe hypoglycemia among older people. Nasal glucagon and glucagon autoinjection "pens" are as effective as glucagon kits and increase the likelihood glucagon will be appropriately used by patient caregivers. The safety, efficacy, and convenience of these new devices may improve outcomes and reduce health care costs of older people with diabetes.
在美国及全球范围内，糖尿病（DM）的患病率及其对临床的影响持续上升。老年人发生与低血糖相关不良后果的风险增加，尤其是在可能因缺乏典型症状而未引起警觉的情况下，而典型症状本可促使采用口服葡萄糖进行医疗干预。迄今为止可用的胰高血糖素急救药盒需要多步骤重构，这可能会在严重低血糖发作期间影响及时且恰当地给予挽救生命的胰高血糖素治疗。在诸如长期护理机构等环境中，可能无法随时获得训练有素的医疗专业人员，这意味着必须由非专业人员给予胰高血糖素。最近在美国获批上市的新型胰高血糖素剂型使胰高血糖素的给药更加容易，这可能对老年人严重低血糖的有效治疗产生积极影响。鼻用胰高血糖素和胰高血糖素自动注射“笔”与胰高血糖素药盒一样有效，并且增加了患者护理人员正确使用胰高血糖素的可能性。这些新设备的安全性、有效性和便利性可能改善糖尿病老年人的治疗效果并降低医疗成本。
