高齡（65歲以上）第2型糖尿病患者之處置：文獻回顧

Type 2 Diabetes Mellitus in Older Adults: A Literature Review

黃萱(Hsuan Huang) ； 林毅欣(Yi-Hsin Lin)

《內科學誌》 29卷6期 (2018/12) Pp. 374-380

https://doi.org/10.6314/JIMT.201812_29(6).04

摘要

隨著全球人口快速老化，老年族群（65歲以上）佔所有糖尿病人口的40%以上，無疑是公共衛生上的一大挑戰。年齡老化後胰臟胰島素分泌不足、肌肉與肝臟胰島素阻抗上升，是高齡患者患罹第2型糖尿病相關的致病因素。高齡糖尿病患者的特點在於：一、與年輕族群相比，低血糖與血管併發症機率上升、二、老年症候群影響其預後。目前沒有太多針對高齡糖尿病的前瞻性臨床試驗，但根據其致病因素、健康狀態與身體功能、影響預後之共病症以及著重在神經認知功能的評估與低血糖的避免，去制訂老年人個別化控糖目標與治療策略。除了要衡量治療本身所帶來的好處與副作用，也要考量病患之接受程度與家庭社會支持度等多重因素。臨床醫師建議適當的生活方式介入之外，給予治療的糖尿病藥物應兼顧治療效益和安全兩面向。

關鍵字

糖尿病(Diabetes mellitus) ； 老年人(Older adults) ； 高齡(Advanced age) ； 抗糖尿病藥物(Antidiabetic medication)

並列摘要

As populations around the world are aging rapidly, more than 40 percent in diabetes population are people more than 65 year-old. The major etiologies of type 2 diabetes in older adults are progression of insulin insufficiency of pancreas and insulin resistance of muscles and liver. The characteristics of diabetes in older adults are (1) high risk of hypoglycemia associated with increasing cardiovascular complication, (2) poor outcome associated with geriatric syndrome. Although there are few prospective clinical trials focus on older adults with diabetes, we have to make individualized strategy for glycemic targets and treatment, depending on etiologies, personal health condition, activity of daily living, and comorbidities. It is more important to focus on early detection of neurocognitive impairment and avoiding hypoglycemia. Para-medically, Individual psychosocial issues and family support system also have to be concerned. Except for encouraing proper lifestyle modification, physicians need to take both efficacy and safety into consideration on antidiabetic medication.