Individualising treatment for older people with diabetes

摘要

Consensus on the management of diabetes mellitus in older people has recommended an HbAlc target range of 7.0-7.5% (53-59 mmol/mol). The American Diabetes Association and European Association for the Study of Diabetes recommend that in frail people the goal should be 7.5-8.0% (59-64 mmol/mol) or possibly even slightly higher, although they have not defined how frailty should be assessed. The hazards of aggressive treatment in older people with diabetes are now well recognised. An HbAlc concentration of around 7.5% (59 mmol/mol) is in keeping with a UK General Practice Research Database retrospective study which reported that the HbAlc concentration associated with the lowest hazard for all-cause mortality was 7.5% (59 mmol/mol). In patients with frailty and comorbidity, aggressive therapy of disease states and associated polyphar-macy need to be reduced; efforts should be focused on decreasing sarcopenia with therapeutic exercise and possibly enhanced protein intake. This approach is in keeping with Yao and colleagues' findings, which suggest that, in frail elderly people, an HbAlc concentration between 8% and 8.9% (64-74 mmol/mol) was most effective at slowing physical decline. An international consortium of geriatric medicine societies has suggested that all people aged 70 years or older should be screened for frailty with a simple questionnaire that assists diagnosis in objective terms, and that therapy should be appropriately tailored to those who are identified as frail.