Maltese Giuseppe, McAuley Sybil A, Trawley Steven, Sinclair Alan J
Department of Diabetes and Endocrinology, Epsom & St Helier University Hospitals NHS Trust, Surrey, UK.
School of Cardiovascular Medicine & Sciences, King's College London, London, UK.
Diabetologia. 2024 Oct;67(10):2085-2102. doi: 10.1007/s00125-024-06240-2. Epub 2024 Aug 13.
Over the past two decades there has been a substantial rise in the adoption of diabetes therapeutic technology among children, adolescents and younger adults with type 1 diabetes, and its use is now also advocated for older individuals. Older people with diabetes are more prone to experience hypoglycaemia because of numerous predisposing factors and are at higher risk of hypoglycaemic events requiring third-party assistance as well as other adverse sequelae. Hypoglycaemia may also have long-term consequences, including cognitive impairment, frailty and disability. Diabetes in older people is often characterised by marked glucose variability related to age-associated changes such as variable appetite and levels of physical activity, comorbidities and polypharmacotherapy. Preventing hypoglycaemia and mitigating glucose excursions may have considerable positive impacts on physical and cognitive function and general well-being and may even prevent or improve frailty. Technology for older people includes continuous glucose monitoring systems, insulin pumps, automated insulin delivery systems and smart insulin pens. Clinical trials and real-world studies have shown that older people with diabetes benefit from technology in terms of glucose management, reductions in hypoglycaemic events, emergency department attendance and hospital admissions, and improvement in quality of life. However, ageing may bring physical impairments and other challenges that hinder the use of technology. Healthcare professionals should identify older adults with diabetes who may benefit from therapeutic technology and then adopt an individualised approach to education and follow-up for individuals and their caregivers. Future research should explore the impact of diabetes technology on outcomes relevant to older people with diabetes.
在过去二十年中，1型糖尿病儿童、青少年及年轻成年人对糖尿病治疗技术的采用率大幅上升，目前也提倡老年个体使用该技术。老年糖尿病患者由于众多易感因素更容易发生低血糖，发生需要第三方协助的低血糖事件以及其他不良后果的风险更高。低血糖还可能产生长期后果，包括认知障碍、身体虚弱和残疾。老年糖尿病往往表现为与年龄相关变化（如食欲和身体活动水平变化、合并症和多种药物治疗）相关的显著血糖波动。预防低血糖和减轻血糖波动可能对身体和认知功能以及总体健康产生相当大的积极影响，甚至可能预防或改善身体虚弱状况。适用于老年人的技术包括连续血糖监测系统、胰岛素泵、自动胰岛素输送系统和智能胰岛素笔。临床试验和实际研究表明，老年糖尿病患者在血糖管理、低血糖事件减少、急诊就诊和住院次数减少以及生活质量改善方面受益于这些技术。然而，衰老可能带来身体损伤和其他阻碍技术使用的挑战。医疗保健专业人员应识别可能从治疗技术中受益的老年糖尿病患者，然后针对患者及其护理人员采取个性化的教育和随访方法。未来的研究应探讨糖尿病技术对老年糖尿病患者相关结局的影响。
