Type 2 Diabetes in the Elderly: Challenges in a Unique Patient Population.
Type 2 Diabetes in the Elderly: Challenges in a Unique Patient Population.
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DOI：
10.23937/2469-5858/1510014
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发表时间：
2016-01-01
期刊：
影响因子：
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通讯作者：
Hsueh, Willa
中科院分区：
文献类型：
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作者：
Bradley, David;Hsueh, Willa
在老年患者群体中，2型糖尿病（T2D）和肥胖症的发病率正在达到流行病的程度。事实上，在大多数发达国家，老年患者将很快成为T2D患者的主要组成部分。老年个体中T2D的患病率较高，在男性和女性以及不同种族和族裔群体中均可见。然而，某些族裔群体受到不成比例的影响，成功的战略必须考虑到这些根本差异。老年T2D与传统的糖尿病相关并发症（包括微血管和大血管疾病）有关，但也与许多其他合并症密切相关，包括认知障碍、尿失禁、肌肉减少症和跌倒风险增加。慢性炎症和免疫系统失调的整体状态可能是这些风险增加的基础；然而，我们对衰老过程中免疫代谢的理解仍然不完整。此外，由于缺乏相关的高质量研究，老年人糖尿病的最佳识别和治疗受到阻碍，因为大多数建立风险概况、血糖目标和T2D治疗干预措施的临床试验数据并不适用于大部分老年患者。仅仅承认这一差距是不够的。我们需要强有力的基于证据的数据，以成功识别糖尿病患者，然后以针对老年T2D患者异质群体中的特定个体的方式进行干预。
In the older patient population, rates of Type 2 Diabetes (T2D) and obesity are reaching epidemic proportions. In fact, older patients will soon constitute the majority of patients with T2D in most developed countries. The higher prevalence of T2D in older individuals is seen in both men and women and across racial and ethnic groups. However, certain ethnic groups are disproportionately affected and successful strategies must account for these fundamental differences. T2D in old age is associated with traditional diabetes-associated complications including micro- and macro vascular disease, but is also closely related to numerous other comorbidities including cognitive impairment, urinary incontinence, sarcopenia, and increased fall risk. An overall state of chronic inflammation and dysregulated immune system may underlie these increased risks; yet our understanding of immunometabolism during the aging process remains incomplete. In addition, optimal recognition and treatment of diabetes in the elderly is hampered by a lack of relevant, high-quality studies, as the majority of clinical trial data establishing risk profiles, glycemic targets, and therapeutic interventions for T2D are not applicable for large segments of the older patient population. Simply acknowledging this gap is inadequate. We need strong evidence-based data upon which to successfully identify diabetic patients and then intervene in ways that are targeted to specific individuals within a heterogeneous group of elderly patients with T2D.