患有2型糖尿病的年老体弱者的胰岛素——治疗的低门槛

艾伦 ·辛
WC2R2LS国王学院

摘要

目的:由于预期寿命的延长，全球糖尿病和虚弱合并症的患病率正在增加。虚弱似乎是一种代谢异质性疾病，可能会影响关于最合适血糖目标的临床决策以及为每个个体选择最合适的降血糖药物。衰弱的代谢特征似乎跨越了一个谱系，一端是厌食性营养不良(AM)衰弱表型，另一端是肌肉减少性肥胖(SO)表型。与SO表型相比，AM表型的特点是体重显著减轻和胰岛素抵抗较少，SO表型的特点是显著肥胖和胰岛素抵抗增加。因此，由于体重减轻，胰岛素治疗可被视为AM虚弱表型的早期选择。胰岛素相关的体重增加和胰岛素的合成代谢特性可能是这种厌食表型的优势。有新的证据支持胰岛素可以改善老年糖尿病患者肌肉功能的观点，尽管这一证据仍需要在未来的大规模前瞻性研究中进一步证实。与中效胰岛素相比，长效胰岛素类似物发生低血糖的风险较低。此外，他们简单的每日一次方案使其更适合虚弱的老年患者。未来对新的每周一次的胰岛素类似物可用性的研究很有吸引力。治疗的目标是达到放松的目标，避免低血糖，并专注于维持这些易受伤害患者的生活质量。

关键词

老年人;糖尿病;管理;胰岛素治疗;虚弱;少肌症

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