Prevention and treatment of diabetes in the elderly follow the “four early” principle

This month is National Respect for the Aged Month. According to China’s seventh census data, in 2020, my country’s elderly population (≥60 years old) accounted for 18.7% (260.4 million) of the total population. The 2017 diabetes prevalence survey indicated that the prevalence of diabetes among the elderly in my country was as high as 30.0%. Based on this calculation, there are currently 78.13 million elderly diabetic patients in my country, of which more than 95% are type 2 diabetes. The “Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)” pointed out that the elderly diabetic population has grown rapidly and has become the mainstream population of diabetes. Complications caused by poorly controlled diabetes are increasingly becoming a major risk factor for the health of the elderly, and prevention and treatment of diabetes has become the top priority in maintaining the health of the elderly.

Li Jing, vice president of Zhu Xianyi Memorial Hospital of Tianjin Medical University, and Zhang Qiumei, director of the Department of Endocrinology, said that the “Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)” pointed out that the prevention and treatment of diabetes in the elderly should follow the “four early” principles, early prevention, early Diagnosis, early treatment, and early achievement of the target for early benefit. Early prevention means “preventing the disease”, advocating a healthy life for the elderly, and actively doing primary prevention of diabetes, that is, avoiding the occurrence of diabetes. Early diagnosis is recommended, and regular diabetes screening is recommended for high-risk groups. Not only fasting, 2-hour postprandial, or random blood glucose should be detected, but also glycated hemoglobin (HbA1c) and even a 75 g oral glucose tolerance test to reduce the rate of missed diagnosis. Early treatment advocates that once the blood glucose exceeds the normal value, that is, fasting blood glucose ≥ 6.1 mmol/L, or 2 hours after meals ≥ 7.8 mmol/L, or HbA1c ≥ 6.0%, it should be attached great importance, communicate with doctors, and seriously start lifestyle intervention.

40% of the elderly have pre-diabetes

Diet, exercise, drug intervention can be cured

“The age group with the highest incidence of diabetes reported at home and abroad is 65 to 79 years old. Entering old age is a high risk period for diabetes, and it tends to be flat after the age of 80. What is worrying is that more than half of all diabetes censuses in my country have diabetes. The patient was in an undiagnosed state before the census, the awareness rate, diagnosis rate, and treatment rate of elderly diabetic patients in my country were not high, and the overall blood sugar control level was not ideal. Diabetes is very common.” Li Jing said.

Li Jing said that the diagnostic criteria of diabetes are not affected by age. The criteria of the elderly and young people are the same as those of the young, and the criteria of the World Health Organization in 1999 are adopted. Fasting plasma glucose or 2-hour blood glucose value after 75g OGTT (glucose tolerance test) or random blood glucose and glycated hemoglobin are the main basis for the diagnosis of diabetes. The diagnostic criteria are fasting blood glucose ≥ 7.0 mmol/L; or typical symptoms of diabetes (polydipsia, polyuria, polyphagia, weight loss) plus random blood glucose ≥ 11.1 mmol/L; blood glucose ≥ 11.1 mmol/L 2 hours after taking sugar; Or glycosylated hemoglobin ≥6.5%. If the test index is abnormal, but there is no typical clinical symptoms of diabetes, it must be retested to confirm the diagnosis.

“What needs to be paid attention to is that statistics show that 45% to 47% of the elderly in my country are in a state of pre-diabetes. Pre-diabetes is a state where blood sugar levels are between normal blood sugar and diabetes. This stage is also the last step to prevent type 2 diabetes.” Li Jing said, “Pre-diabetic patients can be cured through diet, exercise and drug treatment under the guidance of doctors, and the reported cure rate is 19% to 80%. Pre-diabetes is divided into three conditions: impaired fasting glucose, impaired glucose tolerance, and a combination of the two. People with both are at higher risk of developing diabetes than those with only abnormal fasting glucose or abnormal postprandial glucose. “According to the World Health Organization’s 1999 diagnostic criteria, fasting blood sugar of 5.6 to 6.9 mmol/L is impaired fasting blood sugar, and blood sugar of 7.8 to 11.1 mmol/L two hours after taking sugar is abnormal glucose tolerance. Fasting here means that you have not eaten any calorie food for 8 hours. Pre-diabetes needs to be paid enough attention. Although the patient has no obvious symptoms, the damage of hyperglycemia has already occurred, which will also increase the risk of cardiovascular disease, microvascular disease, tumor, dementia, depression and other diseases.

There are six characteristics of diabetes in the elderly

Hypoglycemia is the most dangerous and needs more attention

Zhang Qiumei said that elderly diabetes in my country can be divided into two categories: pre-senior and post-senile diseases, both of which have their own conditions, clinical characteristics of diabetes, suffering from other diseases and existing organ function damage, etc. different. Compared with the onset at a young age, the onset of diabetes in the elderly has six characteristics.

“Three more and one less” is not obvious. There are not a lot of typical symptoms of diabetes in elderly diabetic patients, namely, polydipsia, polyuria, polyphagia, and weight loss, but the symptoms are not obvious. The organ sensing function of the elderly decreases, and the frequency of drinking and urinating decreases accordingly. However, some elderly people cannot remember how much water they drank and how many times they went to the bathroom, and they do not realize that their diet is gradually increasing. Weight is related to factors such as appetite and age, and weight loss in the elderly is also easily overlooked. Therefore, the elderly should be actively screened for diabetes every year.

Combined with hypertension, hyperlipidemia and uric acid. The elderly often coexist with multiple diseases, and a considerable number of diabetic patients will have hypertension and dyslipidemia. The coexistence of the three will increase the risk of cardiovascular and cerebrovascular death by three times. It is recommended that elderly patients with diabetes also measure blood pressure every time they measure blood sugar, monitor blood lipids regularly, and follow the doctor’s advice to actively reduce lipids. Many elderly people find that their blood lipids are increased during physical examination. Often because they are worried about the side effects of lipid-lowering drugs, they think that diet control is enough, or they take the medicine for a short time.

Oral problems are serious. The oral mucosa of elderly diabetic patients is prone to dryness and the oral barrier function is reduced, so oral problems such as tooth loss, periodontitis, gingivitis, oral bleeding, and dry oral mucosa will also be more serious. With bad teeth, people tend to choose some soft and chewable foods, and these foods are absorbed quickly, which will cause blood sugar fluctuations after meals. Elderly diabetic patients should not only control their blood sugar, but also do regular oral examinations, do a good job of oral hygiene, and actively treat oral diseases.

More prone to hypoglycemia. Hypoglycemia is a major concern for elderly diabetic patients. With the increase of age, the sympathetic nervous response is significantly weakened. When the elderly diabetic patients have hypoglycemia, the elderly often do not have symptoms such as palpitation, tremors, sweating, etc. When they feel it, they may have hypoglycemic encephalopathy, which may cause disturbance of consciousness or even endangerment. life. In addition, some medicines for treating heart disease will slow down the heart rate, and once hypoglycemia occurs, there will be no symptoms of palpitation, and it is easy to be ignored. Therefore, the elderly must not lower their blood sugar too low, and they should pay attention to and remind themselves of the risk of hypoglycemia.

Postprandial blood sugar is high. Compared with young people, elderly diabetic patients are more prone to postprandial hyperglycemia. Fasting blood sugar values ​​may not change much as you age, while postprandial blood sugar increases. If only focusing on fasting blood glucose, 70% of elderly diabetic patients with elevated postprandial blood glucose will be missed. Moreover, when blood sugar rises after a meal, most patients do not feel obvious. It is generally recommended that the elderly should check postprandial blood sugar when the fasting blood sugar is about 6mmol/L.

Blood sugar “difficult to reach”. Some elderly people are too obsessed with reaching the blood sugar standard, thinking that if their blood sugar is too high, complications will occur, and they must be reduced to the same level as normal people. This is not necessary, and there is also the risk of hypoglycemia. The blood sugar level of the elderly is more individualized, and relaxing the requirements is safer for the elderly. It is recommended that elderly diabetic patients jointly determine individualized blood glucose control goals and treatment strategies after a comprehensive assessment of their health status by doctors.

Daily monitoring adopts “7-point blood sugar” mode

3 to 6 months to check the glycated hemoglobin

“Self-health management of elderly diabetic patients can not only reduce the dosage of drugs, but also make blood sugar more stable, ultimately reduce diabetes complications and prolong life. Blood sugar monitoring is an extremely important part of patient self-management. The monitoring standard is based on the patient Depending on your condition and your own characteristics, you can choose a monitoring method that suits you, not only can you give yourself hints, but you can also help doctors determine the diagnosis and treatment plan.” Li Jing said.

Zhang Qiumei said that the “China Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)” recommends that the blood glucose monitoring of the elderly should take the “7 o’clock blood sugar” before three meals, 2 hours after three meals and before going to bed at night as the standard mode, combined with and record each meal. Food intake and postprandial exercise were analyzed to analyze the influencing factors of blood sugar changes and to correct the lifestyle habits that were not conducive to blood sugar control. According to the blood sugar control situation and the improvement of the patient’s self-management ability, “7-point blood sugar” has a variety of combination modes according to the purpose of blood sugar monitoring, and the patient can choose the corresponding mode after communicating with the doctor.

In the process of self-monitoring blood glucose, the elderly need to pay special attention, read the manual of the blood glucose meter carefully, and measure blood glucose according to the operating procedures. The household rapid blood glucose meter uses peripheral capillary blood to measure blood glucose, which may have errors with the serum or plasma blood glucose values ​​that are usually measured by venous blood collection in hospitals. It is recommended that after using any blood glucose meter for the first time, it is necessary to compare it with the blood glucose measured by the vein to understand the approximate difference. At the same time of home self-monitoring, 3 to 6 months should also go to high-level hospitals to measure glycosylated hemoglobin, understand the overall blood sugar control, and communicate with doctors to adjust the hypoglycemic treatment plan and monitoring mode.

In addition, diet and exercise are also important contents of self-health management of elderly patients. Zhang Qiumei said that the diet of elderly diabetic patients emphasizes balanced nutrition, control of total calories, and carbohydrates, proteins, fats and vegetables in every meal. Among them, carbohydrates should account for 50% to 55% of the nutrients in the whole day, and protein intake should be mainly high-quality protein, which can improve insulin resistance and reduce age-related muscle loss. .

Li Jing said that the goal of exercise therapy for elderly patients with diabetes is to maintain good physical fitness while helping to control blood sugar. It is recommended to exercise for 30 to 45 minutes a day. For elderly diabetic patients without walking difficulties, it is recommended to do appropriate short-distance activities after three meals a day, which is beneficial to relieve postprandial hyperglycemia. Do preparatory activities before exercising, and pay attention to prevent falls and fractures during exercise. (Host Zhao Jin)