作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Interpretation on Clinical Guidelines for Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition)
-
摘要: 根据我国第七次人口普查数据，2020年我国老年(≥60岁)人口占全国总人口的18.7%，其中约30%(7813万)的老年人患有糖尿病，且95%以上为2型糖尿病。目前我国老年2型糖尿病防治现状不佳，且存在弱化和消极趋势，其所带来的并发症成为危害老年人健康的主要原因。《中国老年2型糖尿病防治临床指南(2022年版)》汇总了国内外老年糖尿病相关研究信息，为优化我国老年糖尿病防治理念、促进临床诊疗规范化、提高老年糖尿病总体管理水平提供了循证医学证据。本文对其重要内容进行解读，以期更好地指导临床实践。Abstract: According to the data of China's seventh national population census, the elderly population (≥60 years old) accounted for 18.7% of the total population in 2020. About 30%(78.13 million)of them suffer from diabetes mellitus, among which more than 95% have type 2 diabetes mellitus. However, current prevention and treatment of type 2 diabetes mellitus in the elderly is unsatisfactory, and there is a tendency of weakening and negativity. Complications caused by poorly controlled blood glucose are the main risk factors jeopardizing the health and survival of the elderly. The Clinical Guidelines of Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition) that summarizes the domestic and foreign relevant guidelines and research on elderly diabetic patients, aims to establish and optimize the concept of prevention and treatment in the elderly with diabetes mellitus, promote the implementation of standardized measures of prevention and treatment, and constantly improve the overall management level of diabetes mellitus in the elderly. Therefore, it is necessary to interpret its important contents.
-
Key words:
- elderly /
- type 2 diabetes mellitus /
- prevention /
- diagnosis /
- treatment /
- guideline interpretation
利益冲突：作者声明不存在利益冲突 -
表 1 老年2型糖尿病血糖控制推荐标准及适宜人群[1]
指标 良好控制标准 中间过度阶段 可接受标准 HbA1c (%) ≤7.0 ＞7.0~＜8.0 8.0~8.5 FPG (mmol/L) 4.4~7.0 5.0~7.5 5.0~8.5 2 hPBG (mmol/L) ＜10.0 ＜11.1 ＜13.9 治疗目标 预防并发症发生 减缓并发症进展 避免高血糖的急性损害 适宜人群 适用于新诊断、病程短、低血糖风险低、以非胰岛素促泌剂类降糖药物治疗为主、自理能力好或有良好辅助生活条件的老年糖尿病患者 适用于预期生存期＞5年、中等程度并发症及伴发疾病、有低血糖风险、应用胰岛素促泌剂类降糖药物或以多次胰岛素注射治疗为主、自我管理能力欠佳的老年糖尿病患者，希望在治疗调整中转向良好控制 适用于预期寿命＜5年、伴有影响寿命的疾病、有严重低血糖发生史、反复合并感染、急性心脑血管病变、急性病入院治疗期间、完全丧失自我管理能力、缺少良好护理的患者，需避免高血糖造成的直接损害 HbA1c：同图 1；FPG：空腹血糖；2 hPBG：餐后2 h血糖 
下载: 导出CSV
-
[1] 中国老年2型糖尿病防治临床指南编写组. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志, 2022, 30: 2-51. doi: 10.3969/j.issn.1006-6187.2022.01.002 [2] Li Y, Teng D, Shi XG, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997. [3] Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group[J]. Diabetes Care, 1997, 20: 1664-1669. doi: 10.2337/diacare.20.11.1664 [4] Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China[J]. N Engl J Med, 2010, 362: 1090-1101. doi: 10.1056/NEJMoa0908292 [5] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310: 948-959. doi: 10.1001/jama.2013.168118 [6] Wang L, Gao P, Zhang M, et al. Prevalence and Ethnic Pattern of Diabete and Prediabetes in China in 2013[J]. JAMA, 2017, 317: 2515-2523. doi: 10.1001/jama.2017.7596 [7] 国家统计局. 第七次全国人口普查公报(第五号)[EB/OL ]. (2021-05-11)[2022-04-11]. http://www.stats.gov.cn/tjsj/tjgb/rkpcgb/qgrkpcgb/202106/t20210628_1818824.html. [8] Yan ST, Li CX, Li CL, et al. Promotive effect of comprehensive management on achieving blood glucose control in senile type 2 diabetics[J]. Genet Mol Res, 2015, 14: 3062-3070. [9] Tinsley LJ, Kupelian V, D'Eon SA, et al. Association of Glycemic Control With Reduced Risk for Large-Vessel Disease After More Than 50 Years of Type 1 Diabetes[J]. J Clin Endocrinol Metab, 2017, 102: 3704-3711. doi: 10.1210/jc.2017-00589 [10] Thompson TJ, Engelgau MM, Hegazy M, et al. The onset of NIDDM and its relationship to clinical diagnosis in Egyptian adults[J]. Diabet Med, 1996, 13: 337-340. doi: 10.1002/(SICI)1096-9136(199604)13:4<337::AID-DIA71>3.0.CO;2-A [11] Hou JN, Bi YF, Xu M, et al. The change points of HbA(1C) for detection of retinopathy in Chinese type 2 diabetic patients[J]. Diabetes Res Clin Pract, 2011, 91: 401-405. doi: 10.1016/j.diabres.2010.11.029 [12] Lindström J, Peltonen M, Eriksson JG, et al. Improved lifestyle and decreased diabetes risk over 13years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS)[J]. Diabetologia, 2013, 56: 284-293. doi: 10.1007/s00125-012-2752-5 [13] Kawamori R, Tajima N, Iwamoto Y, et al. Voglibose for prevention of type 2 diabetes mellitus: a randomised, double-blind trial in Japanese individuals with impaired glucose tolerance[J]. Lancet, 2009, 373: 1607-1614. doi: 10.1016/S0140-6736(09)60222-1 [14] Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes[J]. N Engl J Med, 2008, 358: 580-591. doi: 10.1056/NEJMoa0706245 [15] Gæde P, Oellgaard J, Carstensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21years follow-up on the Steno-2 randomised trial[J]. Diabetologia, 2016, 59: 2298-2307. doi: 10.1007/s00125-016-4065-6 [16] ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2008, 358: 2560-2572. doi: 10.1056/NEJMoa0802987 [17] Gerstein HC, Riddle MC, Kendall DM, et al. Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial[J]. Am J Cardiol, 2007, 99: 34i-43i. [18] van Hateren KJ, Landman GW, Kleefstra N, et al. Glycae-mic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20)[J]. Int J Clin Pract, 2011, 65: 415-419. doi: 10.1111/j.1742-1241.2010.02596.x [19] American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetesd 2018[J]. Diabetes Care, 2018, 41: S55-S64. [20] Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus Statement by The American Association of Clinical Endocrinologists and American College of Endocrinology on The Comprehensive Type 2 Diabetes Management ALGORITHM-2017 Executive Summary[J]. Endocr Pract, 2017, 23: 207-238. [21] Araki E, Haneda M, Kasuga M et al. New glycemic targets for patients with diabetes from the Japan Diabetes Society[J]. J Diabetes Investig, 2017, 8: 123-125. doi: 10.1111/jdi.12600 [22] Lu JY, Ma XJ, Zhou J, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes[J]. Diabetes Care, 2018, 41: 2370-2376. doi: 10.2337/dc18-1131 [23] 戴冬君, 陆静毅, 张磊, 等. 应用葡萄糖在目标范围内时间评价2型糖尿病血糖控制情况的适宜切点分析[J]. 中华医学杂志, 2020, 100: 2990-2996. doi: 10.3760/cma.j.cn112137-20200619-01895 Dai DJ, Lu JY, Zhang L, et al. The appropriate cut-off point of time in range (TIR) for evaluating glucose control in type 2 diabetes mellitus[J]. Zhognhua Yixue Zazhi, 2020, 100: 2990-2996. doi: 10.3760/cma.j.cn112137-20200619-01895 [24] Lu J, Wang C, Shen Y, et al. Time in Range in Relation to All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes: A Prospective Cohort Study[J]. Diabetes Care, 2021, 44: 549-555. doi: 10.2337/dc20-1862 [25] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range[J]. Diabetes Care, 2019, 42: 1593-1603. [26] 中国老年保健医学研究会老年内分泌与代谢病分会, 中国毒理学会临床毒理专业委员会. 老年人多重用药安全管理专家共识[J]. 中国全科医学, 2018, 21: 3533-3544. doi: 10.12114/j.issn.1007-9572.2018.00.225 [27] Norwood P, Liutkus JF, Haber H, et al. Safety of exenatide once weekly in patients with type 2 diabetes mellitus treated with a thiazolidinedione alone or in combination with metformin for 2 years[J]. Clin Ther, 2012, 34: 2082-2090. [28] Kadowaki T, Nangaku M, Hantel S, et al. Empagliflozin and kidney outcomes in Asian patients with type 2 diabetes and established cardiovascular disease: Results from the EMPA-REG OUTCOMEⓇ trial[J]. J Diabetes Investig, 2019, 10: 760-770. [29] Mosenzon O, Wiviott SD, Cahn A, et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial[J]. Lancet Diabetes Endocrinol, 2019, 7: 606-617. [30] Gomes MB, Rathmann W, Charbonnel B, et al. Treatment of type 2 diabetes mellitus worldwide: Baseline patient characteristics in the global DISCOVER study[J]. Diabetes Res Clin Pract, 2019, 151: 20-32. [31] Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis[J]. Lancet, 2016, 387: 435-443. [32] 高尿酸血症相关疾病诊疗多学科共识专家组. 中国高尿酸血症相关疾病诊疗多学科专家共识[J]. 中华内科杂志, 2017, 56: 235-248. [33] 中华医学会内分泌学分会. 中国高尿酸血症与痛风诊疗指南(2019)[J]. 中华内分泌代谢杂志, 2020, 36: 1-13. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202007023.htm [34] Ferrari SL, Abrahamsen B, Napoli N, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge[J]. Osteoporos Int, 2018, 29: 2585-2596. [35] 吴芸杨, 陈晓宏, 季晶俊, 等. 肌肉衰减综合征的诊断和治疗进展[J]. 医学综述, 2020, 26: 4499-4503. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202022025.htm Wu YY, Chen XH, Ji JJ, et al. Research Progress of Diagnosis and Treatment of Sarcopenia[J]. Yixue Zongshu, 2020, 26: 4499-4503. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202022025.htm [36] Boccardi V, Murasecco I, Mecocci P. Diabetes drugs in the fight against Alzheimer's disease[J]. Ageing Res Rev, 2019, 54: 100936. [37] Lee AA, Piette JD, Heisler M, et al. Diabetes self-management and glycemic control: The role of autonomy support from informal health supporters[J]. Health Psychol, 2019, 38: 122-132. [38] Lee AA, Heisler M, Trivedi R, et al. Autonomy support from informal health supporters: links with self-care activi-ties, healthcare engagement, metabolic outcomes, and cardiac risk among Veterans with type 2 diabetes[J]. J Behav Med, 2021, 44: 241-252. [39] Koetsenruijter J, Eikelenboom Nv, Lieshout Jv, et al. Social support and self-management capabilities in diabetes patients: An international observational study[J]. Patient Educ Couns, 2016, 99: 638-643. -
点击查看大图
图(2) / 表(1)
计量
- 文章访问数: 670
- HTML全文浏览量: 61
- PDF下载量: 188
- 被引次数: 0
