Department of Medicine, Division of Endocrinology, Emory University, Atlanta, Georgia, USA
Department of Medicine, Division of Endocrinology, Emory University, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2022 Jul;10(4). doi: 10.1136/bmjdrc-2021-002705.
The number of patients with diabetes is increasing among older adults in the USA, and it is expected to reach 26.7 million by 2050. In parallel, the percentage of older patients with diabetes in long-term care facilities (LTCFs) will also rise. Currently, the majority of LTCF residents are older adults and one-third of them have diabetes. Management of diabetes in LTCF is challenging due to multiple comorbidities and altered nutrition. Few randomized clinical trials have been conducted to determine optimal treatment for diabetes management in older adults in LTCF. The geriatric populations are at risk of hypoglycemia since the majority are treated with insulin and have different levels of functionality and nutritional needs. Effective approaches to avoid hypoglycemia should be implemented in these settings to improve outcome and reduce the economic burden. Newer medication classes might carry less risk of developing hypoglycemia along with the appropriate use of technology, such as the use of continuous glucose monitoring. Practical clinical guidelines for diabetes management including recommendations for prevention and treatment of hypoglycemia are needed to appropriately implement resources in the transition of care plans in this vulnerable population.
美国老年人群中糖尿病患者的数量正在增加，预计到 2050 年将达到 2670 万。与此同时，长期护理机构（LTCF）中患有糖尿病的老年患者比例也将上升。目前，大多数 LTCF 居民是老年人，其中三分之一患有糖尿病。由于多种合并症和营养改变，LTCF 中的糖尿病管理具有挑战性。很少有随机临床试验来确定 LTCF 中老年人糖尿病管理的最佳治疗方法。老年人群由于大多数人接受胰岛素治疗且功能和营养需求水平不同，因此有发生低血糖的风险。应该在这些环境中实施有效的方法来避免低血糖，以改善结果并减轻经济负担。新型药物类别在适当使用技术（如连续血糖监测）的情况下，可能具有较低的低血糖风险。需要制定实用的临床糖尿病管理指南，包括预防和治疗低血糖的建议，以便在这一脆弱人群的护理计划过渡中适当利用资源。
