老年第二型糖尿病患者低血糖與失智症之關聯

Hypoglycemia and Dementia in Elderly Patients with Type 2 Diabetes

林建良(Jiann-Liang Lin) ； 許惠恒(Wayne Huey-Herng Sheu) ； 沈宜靜(Yi-Jing Sheen)

《台灣老年醫學暨老年學雜誌》 12卷3期 (2017/08) Pp. 151-165

https://doi.org/10.29461/TGG.201708_12(3).0001

摘要

全世界的第二型糖尿病的盛行率快速增加，尤其是在老年族群，更是急遽攀升。老年第二型糖尿病患面臨的，除了大家熟知的心血管腦血管疾病及腎臟病變等各種大血管和小血管慢性併發症之外，還存在著罹患失智症的風險。此外，低血糖是接受糖尿病藥物治療最常見的副作用，也被認為是造成失智症的獨立風險因子之一。臨床上，低血糖和失智症都容易被忽略與低估，且兩者都會嚴重影響老年糖尿病患的生活品質，甚至造成壽命的減損。低血糖與失智症之間有「雙向性」的關聯：低血糖會導致失智症發生與惡化風險增加；而失智症也會使老年第二型糖尿病患發生低血糖風險上升，進而形成一種惡性循環。過去的研究提出了一些機轉與證據，驗證支持低血糖造成失智症的說法。本文回顧探討糖尿病患低血糖與失智症關聯之相關文獻，並提供老年糖尿病患預防低血糖造成失智症的相關策略，包括：跨專業的照護團隊、周全性的醫療評估；自我血糖監測，病患支持系統的整合及參與；適當的藥物治療選擇，設定個人最佳的血糖控制目標值，以盡量減少低血糖的風險；針對認知功能的評估與早期失智症篩檢。以期減少因為低血糖造成的認知障礙，與後續惡化形成失智症，造成的龐大社會經濟負荷。

關鍵字

第二型糖尿病 ； 低血糖 ； 失智症

並列摘要

The prevalence of type 2 diabetes has been on the rise globally, with a rapidly increasing trend observed especially in elderly people who are at a much higher risk of chronic complications of type 2 diabetes, including dementia. Moreover, hypoglycemia, the common side effect of antidiabetic medications, is considered to be associated with poorer cognitive ability, accelerated cognitive decline and dementia. Hypoglycemia and dementia, easily overlooked and underestimated, can seriously affect the quality of life of elderly patients with diabetes and even cause reduced life expectancy. There is a bidirectional association between dementia and hypoglycemia, in which hypoglycemia can lead to the development of dementia and an increased risk of deterioration, while dementia in elderly patients with type 2 diabetes can also increase the risk of hypoglycemia, resulting in a vicious cycle. To help reduce hypoglycemia-induced cognitive dysfunction in elderly patients with type 2 diabetes and ease the enormous social and economic burden caused by subsequent deterioration and dementia, we reviewed previous studies and provided relevant strategies specifically for preventing hypoglycemia-induced dementia in elderly patients with type 2 diabetes, including early screening for dementia in high-risk populations, blood glucose monitoring, appropriate and flexible medication regimens, establishment of individual glycemic goal, and integration of resources among patients and their diabetes care team, family and social support systems.

並列關鍵字

type 2 diabetes mellitus ； hypoglycemia ； dementia