老年糖尿病的诊疗进展

糖尿病呈流行之势,65岁以上的老年糖尿病患者亦呈逐年增加趋势.老年糖尿病患者的身体状况各有不同,而针对老年糖尿病患者的临床试验相对缺乏,这些问题对于管理老年糖尿病患者提出了挑战.临床医师应该根据共患病的情况、认知和功能状态确定不同的血糖控制目标.每一种药物在老年糖尿病患者中的应用有其特殊之处.了解不同降糖药物的优缺点有利于个体化治疗.与非糖尿病老年人相比,老年糖尿病患者更易发生影响生活质量的老年综合征,如认知功能障碍、抑郁、跌倒、营养不良、尿失禁等,及时发现并处理老年综合征有助于更好的管理老年糖尿病患者.     

老年糖尿病患者的饮食状况调查及干预对策

正饮食治疗是糖尿病综合治疗的一项重要的基础治疗措施〔1〕。本文通过调查老年糖尿病患者对糖尿病饮食相关知识的了解状况及日常饮食行为,旨在发现老年糖尿病患者在饮食治疗中存在的问题,并据此作出有效的干预对策,更好地提高老年糖尿病患者饮食治疗的效果。     

老年糖尿病患者的护理体会

目的探讨老年糖尿病患者的临床护理对策。方法收集并整理2010年2月—2014年10月期间住院治疗的144例老年糖尿病患者的临床资料及护理经验总结。结果有效地消除了老年糖尿病患者的心理问题,改善了老年糖尿病患者的生活质量。结论老年糖尿病患者接受治疗的同时,心理、饮食、药物护理及健康教育是树立其克服糖尿病困扰的信心,提高生活质量的有效途径。     

冬连胶囊治疗老年2型糖尿病及早期视网膜病变的临床研究

目的探究冬连胶囊治疗老年2型糖尿病及早期视网膜病变的临床疗效。方法选取2013年6月—2014年6月220例老年2型糖尿病及早期视网膜病变患者,通过随机分组的方式将其分为2组,实验组和对照组,每组患者110例,2组老年2型糖尿病及早期视网膜病变患者均接受基础治疗,实验组在基础治疗之上加以冬连胶囊治疗,对照组在基础治疗之上加以二甲双胍治疗,对2组老年2型糖尿病及早期视网膜病变患者经相关治疗之后的效果进行比较分析。结果实验组老年2型糖尿病及早期视网膜病变患者在基础治疗上加冬连胶囊进行治疗,其治疗的显效率为5.45%,有效率为47.28%,总有效率为52.73%,其治疗的效果明显优于在基础治疗上加二甲双胍治疗的对照组老年2型糖尿病及早期视网膜病变患者治疗的效果(P0.05)。结论给予老年2型糖尿病及早期视网膜病变患者冬连胶囊治疗的效果较好,其可以较好的改善患者的视网膜病变情况,降低患者的血糖,对改善老年2型糖尿病及早期视网膜病变患者的生活质量十分有益。     

牙周治疗对2型糖尿病合并牙周炎患者牙周改善的影响

目的 分析牙周治疗对2型糖尿病合并牙周炎(DMCP)患者的牙周及糖尿病的改善效果.方法 87例老年DMCP患者,分为治疗组和对照组,分析口腔卫生知识保健及牙周治疗对患者牙周指数、血糖及血清瘦素影响.结果 两组患者年龄、性别、婚姻、学历、饮酒、吸烟构成情况比较,差异无统计学意义(P＞0.05)；患者经治疗后牙石指数、菌斑指数、出血指数和社区牙周指数(CPI)总体呈下降趋势,而且治疗组的下降趋势明显高于对照组(P＜0.05)；治疗后血清瘦素总体呈现下降趋势,治疗组的下降趋势明显高于对照组(P＜0.05)；空腹血糖和餐后2h血糖没有呈现明显的下降趋势；两组患者的空腹血糖趋势没有明显差异；餐后2h血糖治疗组的下降趋势明显高于对照组(P＜0.05).结论 通过口腔卫生知识宣传和牙周治疗可以明显改善患者牙周健康、降低血清瘦素水平,改善糖尿病患者的生活质量.     

老年糖尿病并发低血糖症的临床分析

目的分析老年糖尿病患者并发低血糖症的原因、临床表现、实验室检查结果及临床治疗对策,以期为老年糖尿病低血糖症患者的临床治疗提供参考。方法选取2014年10月—2015年10月期间来该院进行治疗的糖尿病老年患者76例进行研究,对老年糖尿病患者并发低血糖症的原因、临床表现、发病前的用药情况、临床辅助检查结果及临床治疗对策进行分析。结果 76例患者经临床积极处理后,2例发生死亡,1例死于严重肝硬化,1例是由于误诊为脑血管意外导致病情延误而致死。结论对老年糖尿病患者要分析其诱发低血糖症的原因,并给予针对性的预防措施,以此来降低低血糖症的发生率。     

探讨老年2型糖尿病患者常见并发症的临床特点及治疗效果

目的研究和分析老年2型糖尿病患者常见并发症的临床特点及治疗效果。方法该次临床治疗实践研究主要选取了2014年5月—2015年5月期间,在该院接受治疗的102例老年2型糖尿病患者作为临床治疗研究的对象,对老年2型糖尿病患者的并发症状进行明确记录,并通过问卷调查的方式,对老年2型糖尿病患者致病的危险因素进行分析,并结合老年2型糖尿病患者的实际临床症状进行对症治疗。结果老年2型糖尿病患者心血管疾病、肾脏病变以及低血糖等并发症状的发生和患者的年龄密切相关,随着患者年龄的不断增长,老年2型糖尿病患者的心血管疾病、低血糖等问题的发生几率也在逐渐增高,差异有统计学意义(P0.05)。结论老年2型糖尿病患者常见并发症会随着年龄的增长而逐渐增加,在临床治疗的过程当中,需要结合老年2型糖尿病患者的实际临床表现对症治疗,进而全面缓解老年2型糖尿病患者的临床症状,为老年2型糖尿病患者的健康和生活质量带来更多的保障。     

中国老年糖尿病诊疗指南(2024版)

随着我国老龄化的加剧, 老年糖尿病的患病率明显增高, 其规范化管理对改善老年糖尿病患者的临床结局至关重要。2021年国家老年医学中心、中华医学会老年医学分会以及中国老年保健协会糖尿病专业委员会组织专家撰写了我国首部老年糖尿病指南, 即《中国老年糖尿病诊疗指南(2021年版)》, 强调老年糖尿病患者存在高度异质性, 需要综合评估, 采取分层和个体化的管理策略, 首次提出针对老年糖尿病患者的"简约治疗理念"和"去强化治疗策略"。这版指南为临床医师提供了实用的、可操作的临床指导, 对我国老年糖尿病患者全方位、全周期的规范化综合管理起到了极大的推动作用, 同时也推动了我国老年糖尿病及相关领域的临床和基础研究的广泛开展。指南发布近三年来, 国内外老年糖尿病及相关领域的循证医学证据进一步积累, 新的治疗理念、新型药物及治疗技术不断涌现, 指南编委会及时对第一版指南进行了更新, 对老年糖尿病的血糖管理路径进行了进一步细化和优化, 编写了《中国老年糖尿病诊疗指南(2024年版)》, 以期继续助力中国老年糖尿病患者的规范化管理及临床结局的改善。     

关注老年糖尿病患者的营养不良

老年糖尿病患者（特别是住院患者）发生营养不良的比例较高,却较易被忽视。老年糖尿病患者特殊的生理、社会因素,合并症及使用口服降糖药物等均可增加营养不良风险,从而使患者延长住院时间、提高危及生命并发症风险、增加死亡率。临床医生应强化对老年糖尿病患者的营养状况筛查,通过营养支持、减少有关口服降糖药物的应用、提倡应用胰岛素治疗等方式,制定个体化治疗方案,提高老年糖尿病人群的生活质量。     

老年糖尿病患者的心理状况分析

目的 分析研究老年糖尿病患者的心理特点。方法 采用谈话、随访的方式对10例老年患者及其家属进行调查，从而分析老年患者的心理状况。结果 对糖尿病患者的治疗应注重心理疏导、健康教育及饮食、药物综合治疗。结论 随着现代医学模式的转变，社会心理因素在糖尿病患者康复治疗中的作用已引起高度重视。     

Diabetes mellitus in the elderly

Diabetes mellitus is one of the most frequent chronic diseases of the elderly population with a high prevalence after the age of 65 years. In this group it is a serious cause of increased mortality and morbidity. More than 90% of patients suffer from type 2 diabetes mellitus. The disease takes frequently for a long time an asymptomatic course and if it persists for long it may lead to microvascular complications and is an important risk factor of cardiovascular and cerebrovascular diseases. The objective of treatment of diabetes in old age is in particular to restrict symptomatic hyperglycaemia, but at the same time we must not forget prevention of hypoglycaemia. It is also important to diagnose and treat diabetic complications. As elderly diabetic patients are usually polymorbid, diabetes mellitus in old age calls for a comprehensive approach not only to the treatment of hyperglycaemia but also of hypertension, dyslipidaemia and other associated diseases.     

Diabetes Mellitus in the Aging: Epidemiologic and Therapeutic Considerations

Diabetes mellitus is prevalent in older persons and a major risk factor for the development of cardiovascular disease. Impaired glucose tolerance without overt diabetes has also been shown to be associated with an increased risk of cardiovascular disease. Elderly patients with non-insulin-dependent diabetes mellitus are at increased risk for both symptomatic and asymptomatic myocardial infarction, and appear to have worse outcomes than nondiabetic persons with these same conditions. Older diabetic persons also have a greater risk than nondiabetics of developing systemic hypertension and stroke. Treatment of diabetes in the elderly can be divided into treatment of the hyperglycemia itself and treatment of other cardiovascular risk factors. It is unknown whether treatment of hyperglycemia in older patients will decrease the risk of cardiovascular and cerebrovascular disease, but it is proposed that treating diabetes along with other commonly associated risk factors for cardiovascular disease may provide the best outlook for such patients.     

Multimorbidität bei älteren Rheumapatienten Teil 2

While diseases, such as cardiovascular diseases and osteoporosis in the elderly are categorized as comorbidities of rheumatoid arthritis, elderly rheumatic patients are often additionally affected by thyroid dysfunctions and diabetes mellitus type 2, so that the risk of multimorbidity (coexistence of at least two chronic and/or acute diseases) will increase significantly in elderly patients already suffering from systemic rheumatic diseases. Restricted cognition, adherence or compliance may additionally complicate the treatment of elderly rheumatic patients. Furthermore, the pharmacokinetics of the elderly is another challenging task. Referring to selected aspects of geriatric pharmacotherapy, the use of certain substance classes is described in this context.     

子宫内膜癌并存心脑血管病老年患者的围手术期处理

目的　探讨子宫内膜癌并存心脑血管疾病老年患者的围手术期处理。方法　分析我院收治的 6 0例子宫内膜癌老年患者的临床资料及随访结果。术前并存心脑血管病为研究组 36例 ,无心脑血管病为对照组 2 4例。结果　6 0岁以上子宫内膜癌患者共 6 3例 ,3例因故未行手术 ,6 0例经以手术为主的综合治疗。研究组和对照组均无手术及术后近期死亡病例。平均住院天数分别为 2 9d和 19d (P<0 .0 5 ) ;手术及术后并发症分别为 14和 6例次 (P<0 .0 5 )。两组患者的平均手术时间 ,术中出血量及输血量 ,手术病理分期 ,肿瘤组织学类型 ,术后 3年及 5年生存率比较 ,差异无显著性意义。结论　子宫内膜癌伴心脑血管疾病的老年患者 ,在围手术期积极治疗并存病 ,可耐受较复杂的妇科手术     

老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

Cardiovascular aging in health

Major focuses of geriatric medicine are cardiovascular diseases with increases in prevalence in older people and how aging might modify the risk factors, clinical manifestations, treatment strategies, and prognoses of these diseases. Quantitative information on age-associated alterations in cardiovascular structure and function in health is essential to define and target the specific characteristics of the cardiovascular aging process that render it the major risk factor for cardiovascular diseases. Such information also is required to differentiate among the limitations of elderly individuals that relate to disease and limitations that may fall within expected normal limits. Differences in cardiovascular function between older and younger individuals have been described extensively in the literature, but confusion often arises in the interpretation of these differences because of a failure to acknowledge or to control for interactions among age, disease, and lifestyle. The Baltimore Longitudinal Study on Aging has made an effort to characterize the effects of aging on multiple aspects of cardiovascular structure and function. The concepts that have evolved from this and other studies are discussed.     

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??Abstract??The incidence and prevalence of end-stage renal disease in elderly patients have been increasing rapidly in recent years.Previous studies have pointed out special physiopathological characteristics and clinical manifestations in elderly patients.These patients often suffer from malnutrition and multiple extra-renal comorbidities such as cardiovascular and cerebrovascular diseases.Most studies showed that the quality of life and survival of the elderly dialyzed patients were worse than those of younger patients because of multiple comorbidities.However??hemodialysis??peritoneal dialysis and kidney transplantation are elective model for the elderly??and the choice of treatment model depends on the individual??clinical??economic conditions and social factors.     

Comprehensive geriatric assessment and treatment of elderly diabetic patients

Because of diversities of physical, mental, and psychological functions as well as clinical and social backgrounds, comprehensive geriatric assessment (CGA) is of great importance in treating elderly diabetic patients. We addressed three issues as to functions important for the CGA. First, we assessed several domains of cognitive function in 213 elderly diabetic patients. Attention and visual memory in diabetic patients without vascular disease were impaired compared with non-diabetic controls after adjusting for age and sex using analysis of covariance. Multivariate analysis revealed that age, hyperglycemia, and the presence of cerebral infarction were independent determinants for the impairment of attention in the diabetic patients. The results suggest that glucose control is important for the maintenance of cognitive function in elderly diabetic patients. Secondly, we assessed positive well-being as a measure of psychological function using a PGC morale scale in 197 elderly diabetic patients without cerebrovascular disease at baseline and examined whether the low well-being affect the development of cerebrovascular disease in a 3-year longitudinal study. The results indicate that low well-being was an independent risk factor for cerebrovascular disease after adjusting conventional risk factors in elderly diabetic patients. Thirdly, as a physical function, we assessed 5-m walking speed for both usual and maximum walking in 64 diabetic patients. The walking speed decreased with age and correlated significantly with the knee extension power and functional reach. The result suggests that muscle-strength exercise and balance training as well as endurance exercises are necessary to improve age-related decreases in walking speed and for effective exercise in elderly patients. From a gerontological point of view, new strategies of elderly diabetes treatment including muscle strength exercise and psychological approaches should be established to improve physical, mental, psychological, and social functions as assessed by the CGA.     

对老年糖尿病更应给予高度关注

老年人群糖尿病发病率高,起病隐匿,往往多病并存、应用多种药物且容易忘记服药,对于高血糖、低血糖的敏感性和反应能力都差,严重的低血糖和高血糖都会引起严重事件。老年的年龄跨度大,个体差异明显,医疗保障水平、经济承受能力以及自我管理能力差别极大。因此,临床上对于老年糖尿病需要高度重视：及早筛查、及早诊断、及早治疗和科学安全治疗;注意治疗的个体化,包括达标值的个体化和选用降糖药物的个体化;重视系统化管理。     

老年急诊患者心脑血管常见疾病分析

目的对老年急诊患者心脑血管常见疾病进行分析,为老年心脑血管病的预防和救治提供参考资料。方法回顾分析2008年1月～2010年12月在我院老年急诊科就诊的老年心脑血管病患者1292例,根据年龄分为60～79岁组335例,≥80岁组957例,分析比较2组心脑血管病的差异。结果所有患者中心血管病发生率(65.48%)明显高于脑血管病(34.52%,P<0.05),但2组患者心血管病和脑血管病比较,差异无统计学意义(P>0.05)。60～79岁组患者疾病排名依次为短暂性脑缺血发作(TIA)、心绞痛、高血压、心房颤动、其他心律失常;≥80岁组患者疾病排名依次为TIA、心绞痛、心房颤动、高血压、脑梗死。≥80岁组惠心肌梗死、心力衰竭、脑梗死明显高于60～79岁组,而高血压患病明显低于60～79岁组(P<0.05)。结论 TIA、心绞痛、心房颤动、高血压是老年急诊患者常见的心脑血管病,对年龄≥80岁的老年患者,更应加强对心肌梗死、心力衰竭、脑梗死等疾病的预防和救治。