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首页> 外文期刊>Drugs and aging >Suitable Use of Injectable Agents to Overcome Hypoglycemia Risk, Barriers, and Clinical Inertia in Community-Dwelling Older Adults with Type 2 Diabetes Mellitus
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Suitable Use of Injectable Agents to Overcome Hypoglycemia Risk, Barriers, and Clinical Inertia in Community-Dwelling Older Adults with Type 2 Diabetes Mellitus

机译：适当使用可注射剂以克服社区住宅患者中的低血糖风险，屏障和临床惯性，其中2型糖尿病2型糖尿病

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摘要

The management of type 2 diabetes mellitus in older adults requires a comprehensive understanding of the relationship between the disease (medical) and the functional, psychological/cognitive, and social geriatric domains, to individualize both glycemic targets and therapeutic approaches. Prevention of hypoglycemia is a major priority that should be addressed as soon as its presence or risk is detected, adjusting the target and therapeutics accordingly. Nonetheless, treatment intensification should not be neglected when applicable, consistent with recommendations from organizations such as the American Geriatrics Society and the American Diabetes Association, to reduce not only long-term macrovascular and microvascular complications (individualization), but also short-term complications from hyperglycemia (polyuria, volume depletion, urinary incontinence). Such complications can negatively impact the physical and cognitive function of older adults, worsen their quality of life, and additionally affect their families and society. We emphasize individualization, utilizing the multiple classes of antihyperglycemic agents available. Metformin remains as first-line therapy, and additional agents offer advantages and disadvantages that ought to be considered when developing a patient-centric plan of care. For selected cases, injectable therapies such as long-acting basal insulin analogs and glucagon-like peptide-1 receptor agonists can offer advantages to counter hypoglycemia risk, patient-related barriers, and clinical inertia. Furthermore, some injectable agents could potentially simplify regimens while providing safe and effective glycemic control. In this review, we discuss the use of injectable therapies for selected community-dwelling older adults, barriers to transition to injectable therapy, and measures aimed at removing these barriers and assisting physicians and their teams to transition older patients to injectable therapies when appropriate.
机译：在老年人的2型糖尿病的管理需要全面了解疾病（医学）和功能，心理/认知和社会老年域之间的关系，以使血糖目标和治疗方法进行个性化。预防低血糖是在检测到其存在或风险的主要优先权，并相应地调整目标和治疗方法。尽管如此，在适用时，应忽略治疗加剧，与美国老年教学协会和美国糖尿病协会等组织的建议一致，不仅减少长期大血管和微血管并发症（个体化），而且是短期并发症高血糖（聚尿，体积耗尽，尿失禁）。这种并发症可以对老年人的身体和认知功能产生负面影响，恶化他们的生活质量，并对他们的家人和社会造成影响。我们强调个体化，利用多种阶类抗血性药剂可用。二甲双胍仍然是一线治疗，另外的代理商提供了在开发以患者为中心的护理计划时考虑的优缺点。对于选定的病例，可注射疗法，例如长效的基础胰岛素类似物和胰高血糖素样肽-1受体激动剂可以提供利用低血糖风险，患者相关的障碍和临床惯性的优势。此外，一些可注射剂可能会潜在地简化方案，同时提供安全有效的血糖控制。在本综述中，我们讨论了对选定的社区住宅的可注射疗法，过渡到可注射治疗的障碍，以及旨在消除这些障碍和协助医生及其团队的措施，以在适当时将老年患者转换为可注射疗法。

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  • 来源
    《Drugs and aging》 |2019年第12期|共14页
  • 作者

    Valencia Willy M.; Florez Hermes J.; Palacio Ana M.;

  • 作者单位

    Miami VA Healthcare Syst GRECC 1201 NW 16th St 11 GRC CLC 207 A2 Miami FL 33125 USA;

    Miami VA Healthcare Syst GRECC 1201 NW 16th St 11 GRC CLC 207 A2 Miami FL 33125 USA;

    Miami VA Healthcare Syst GRECC 1201 NW 16th St 11 GRC CLC 207 A2 Miami FL 33125 USA;

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  • 正文语种 eng
  • 中图分类 药学;
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