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老年 2 型糖尿病患者降糖治疗管理:挑战与机遇。

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities.

机构信息

Department of Polyvalent Internal Medicine, Saint Julien Hospital, Rouen University Hospital, Rouen, France.

Department of Diabetology, Toulouse University Hospital, Toulouse, France.

出版信息

Clin Interv Aging. 2023 Oct 9;18:1687-1703. doi: 10.2147/CIA.S423122. eCollection 2023.

Abstract

The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.

摘要

患有 2 型糖尿病(T2DM)的老年患者(≥65 岁)人群具有多样性,包括具有不同功能能力、居住安排、合并症和预期寿命的个体。因此,将他们分为不同的患者特征(即健康良好、健康中等、健康状况较差)可能有助于在确定血糖目标和药物治疗策略时做出临床决策。通过跨学科合作进一步细化评估每个患者特征,也可以为治疗和监测决策提供更精确的依据。在这篇综述中,我们将采用多学科方法讨论如何根据每个患者特征,为患有 T2DM 的老年患者提供最佳的先进糖尿病治疗和技术获益。然而,对于患有 T2DM 的老年患者,仍有几个领域值得进一步研究,包括连续血糖监测和自动胰岛素输注系统的疗效和安全性、向每周一次胰岛素的转换、多学科护理模式的有效性,以及在最年长(≥85 岁)的老年人中使用支持远程医疗和远程血糖监测,这些老年人特别需要他人的帮助。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f14/10573466/caabd8a42c5c/CIA-18-1687-g0001.jpg

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