Lunt H
Diabetes Centre, Christchurch Hospital, New Zealand.
Drugs Aging. 1996 Jun;8(6):401-7. doi: 10.2165/00002512-199608060-00001.
Diabetes mellitus is a major health problem in the older population, where it is mainly of the non-insulin-dependent type [i.e. non-insulin-dependent diabetes mellitus (NIDDM)]. Epidemiological evidence and extrapolation of trial data from patients with insulin-dependent diabetes mellitus (IDDM) suggests that improving glycaemic control reduces the risk of developing microvascular complications (i.e. retinopathy, nephropathy and neuropathy) and also slows the rate of progression of these complications in patients with early disease. Macrovascular morbidity and mortality is, however, more common than microvascular disease in the older population and the evidence that improved glycaemic control significantly reduces the impact of macrovascular disease is weak. Thus, the overall benefits of tight glycaemic control are less well defined in older patients, who tend to have NIDDM, than in younger patients with IDDM. There are small but significant risks associated with tight glycaemic control in the older patient, including potentially fatal hypoglycaemia with sulphonyl-ureas and/or insulin, and fatal metformin-induced lactic acidosis. Patients at especially high risk of these complications can, however, be identified and inappropriate pharmacological intervention can be avoided.
糖尿病是老年人群中的一个主要健康问题，主要为非胰岛素依赖型[即非胰岛素依赖型糖尿病（NIDDM）]。流行病学证据以及来自胰岛素依赖型糖尿病（IDDM）患者试验数据的推断表明，改善血糖控制可降低发生微血管并发症（即视网膜病变、肾病和神经病变）的风险，并且还能减缓早期疾病患者这些并发症的进展速度。然而，在老年人群中，大血管发病率和死亡率比微血管疾病更为常见，且改善血糖控制能显著降低大血管疾病影响的证据并不充分。因此，与患有IDDM的年轻患者相比，血糖严格控制对往往患有NIDDM的老年患者的总体益处尚不明确。老年患者严格控制血糖存在一些虽小但显著的风险，包括使用磺脲类药物和/或胰岛素可能导致致命性低血糖，以及二甲双胍引起的致命性乳酸性酸中毒。然而，可以识别出这些并发症风险特别高的患者，并避免不适当的药物干预。
