Altuntaş Yüksel
Department of Endocrinology and Metabolism, University of Health Sciences Sisli Hamidiye Etfal Training and Resarch Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Jun 25;53(2):96-102. doi: 10.14744/SEMB.2019.00868. eCollection 2019.
Concomitant diseases in elderly individuals with diabetes (renal failure, heart failure, ischemic heart disease, stroke, urinary incontinence, cognitive impairment, dementia, sarcopenia, and osteoporosis) make diabetes management difficult. Therefore, other comorbid conditions should be taken into account in elderly diabetics when considering a treatment approach. The use of oral antidiabetic agents in individuals older than 75 years may be limited. Although the diabetes treatment is not any different in healthy elderly patients, hypoglycemia is one of the most feared conditions, especially in the elderly. Therefore, metformin, DPP-IV inhibitors, and SGLT2 inhibitors should be considered in the first place with less risk of hypoglycemia. Low-dose sulfonylureas may also be used in selected cases. The use of new antidiabetic drugs, such as GLP-1 anologues and SGLT2 inhibitors, has strengthened our ability to cope with the risk of hypoglycemia and cardiovascular events, which are the two most important drawbacks in the treatment of elderly people with diabetes. Insulin treatment should be individualized, and the most rare injection regimens should be used. In case of failure of OAD, basal insulin should be added to the current treatment, and if necessary, a basal + plus regimen should be planned by adding bolus insulin 1/2/3 times per day to the meals. As a result, in elderly diabetics, an inadequate treatment or excessive treatment and individualizing the treatment should be the most appropriate approach.
老年糖尿病患者的合并症(肾衰竭、心力衰竭、缺血性心脏病、中风、尿失禁、认知障碍、痴呆、肌肉减少症和骨质疏松症)使得糖尿病管理变得困难。因此,在考虑治疗方法时,老年糖尿病患者应考虑其他合并症。75岁以上人群口服降糖药的使用可能受到限制。虽然健康老年患者的糖尿病治疗并无不同,但低血糖是最令人担忧的情况之一,尤其是在老年人中。因此,应首先考虑使用低血糖风险较低的二甲双胍、二肽基肽酶-4(DPP-IV)抑制剂和钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂。在特定情况下也可使用小剂量磺脲类药物。新型降糖药物如胰高血糖素样肽-1(GLP-1)类似物和SGLT2抑制剂的使用,增强了我们应对低血糖风险和心血管事件的能力,这是老年糖尿病患者治疗中两个最重要的缺点。胰岛素治疗应个体化,并应采用最简便的注射方案。如果口服降糖药治疗失败,应在当前治疗基础上加用基础胰岛素,如有必要,可通过每天1/2/3次在进餐时加用餐时胰岛素来制定基础加餐时胰岛素方案。因此,对于老年糖尿病患者,不充分治疗或过度治疗以及个体化治疗应是最合适的方法。