Professor Tian Hui: Current Situation and Improvement Measures of Diabetes Management in the Elderly in China

This article is published with the authorization of Professor Tian Hui, please do not reprint without permission
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Introduction: On January 16, 2022, the "Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly in China" co-sponsored by the Endocrinology and Metabolism Branch of the Chinese Geriatrics Society, the Endocrinology and Metabolism Branch of the China Geriatrics Medical Research Association, and the Geriatrics Committee of the Beijing Medical Award Foundation (2022 Edition)" conference ended successfully in Beijing, and Medical Pulse was invited to participate in the conference report
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At the meeting, Professor Tian Hui from the Department of Geriatric Endocrinology of the People's Liberation Army General Hospital gave a wonderful academic lecture on the topic of "Current Situation and Improvement Measures of Diabetes Management in the Elderly in China"
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Professor Tian Hui gave a speech.
Expert introduction: Professor and Chief Physician of the Department of Geriatric Endocrinology, PLA General Hospital
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He has been engaged in clinical, scientific research and teaching work in endocrinology and metabolism for 40 years; he has participated in a number of international multi-center large-scale clinical studies and more than 20 clinical trials of new drugs; he is also the executive director of the Chinese Society of Geriatrics and the former president of the first Geriatric Endocrinology and Metabolism Branch.
He is currently the honorary president of the 2nd Geriatric Endocrinology and Metabolism Branch; serves as the editorial board member of the Chinese Journal of Diabetes, the Chinese Journal of Chronic Disease Prevention and Control, and the deputy editor-in-chief of the Chinese Journal of Healthcare Medicine; undertakes 6 scientific research projects of Beijing Municipal Science and Technology Committee, the Military Science and Technology Committee, and the National Ministry of Science and Technology.
He has won 1 third prize of the Military Science and Technology Progress Award (the first author) and 2 second prizes (the third author), and has written more than 60 papers as the first author and corresponding author
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 The status quo of diabetes in the elderly in China: the prevalence rate is rising, the awareness rate and treatment rate are less than half, and disease management is facing challenges.
Professor Tian Hui pointed out that according to the clinical research data conducted by the National Health Commission, compared with 2013, the elderly in China in 2018.
Type 2 diabetes The prevalence of diabetes rose by 4.
9 percentage points to 25.
0%; the prevalence of prediabetes rose by 3.
1 percentage points to 48.
7%
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In contrast, the prevalence among 18-29 year olds has remained at 5% over the past five years
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In terms of disease management, the overall blood sugar control of elderly diabetes is not ideal, and the awareness rate and treatment rate of diabetes are less than 50%.
The management level needs to be improved urgently
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Table 1 Comparison of the prevalence of type 2 diabetes in different populations in China in 2013 and 2018 At the same time, with the development of the aging population in China, the "little old people", that is, people aged 60-64, account for nearly one third of the current elderly population.
, is about to enter the high incidence period of diabetes between 65 and 79 years old.
It is conceivable that the prevalence of diabetes in the elderly will continue to rise in the next 30 years
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The management of diabetes in the elderly is facing "internal and external difficulties" At present, the awareness rate, treatment rate and treatment compliance rate of diabetes among the elderly are low
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More importantly, the clinical characteristics of diabetes in the elderly also make the impact of diabetes on the clinical outcomes of the elderly more obvious
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The elderly themselves are in the stage of life changing from prosperity to decline, and the decline of intelligence, physical fitness and functions of various organs is the norm, which undoubtedly increases the difficulty of comprehensive management of patients
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In addition to abnormal glucose metabolism, many elderly people are also accompanied by many underlying diseases
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40% to 70% of the elderly people with abnormal glucose metabolism are accompanied by hypertension, 30% to 50% are accompanied by abnormal blood lipid metabolism, and only 10% of the population do not have the above problems
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When abnormal glucose metabolism, high blood pressure, and abnormal lipid metabolism coexist, the risk of cardiovascular and cerebrovascular death will increase threefold, and cardiovascular and cerebrovascular diseases are one of the main causes of death in the elderly
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Correspondingly, elderly people often need to take multiple drugs to treat various diseases
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Statistics show that 71.
3% of the elderly people with diabetes over the age of 65 take 5 or more drugs at the same time, which undoubtedly increases the risk of adverse drug reactions and drug interactions
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In addition, in the elderly population, poor glycemic control not only directly increases the risk of cardiovascular events, but also reduces the patient's ability to self-regulate the disease and reduce stress adaptability
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Professor Tian Hui cited the results of a clinical trial on red blood cell reperfusion in mice with induced myocardial ischemia
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Experiments have shown that red blood cells from healthy and well-controlled diabetics can improve cardiac function and infarct size in mice with myocardial ischemia, while red blood cells from poorly controlled diabetics completely lose this function
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After a long life, the elderly have different living environments, economic conditions, medical conditions, education levels and other factors, resulting in very large individual differences, and their compliance with disease treatment is also very different
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However, the current domestic and foreign guidelines for diabetes often use age as the framework to relax the management standards for elderly diabetes as a whole, and lack of individualized guidance for elderly groups at different stages of diabetes development, making the management of elderly diabetes "internal and external difficulties"
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Overall, the elderly diabetes in China has the following clinical characteristics: ➤Affected by abnormal glucose metabolism, >75% of the group; ➤Clinical characteristics of two groups of patients with diabetes before old age (30%) and newly diagnosed diabetes after old age (70%).
Diabetes complications and comorbidities are different, and multiple factors affect the prognosis; ➤The prevalence of diabetes in the elderly is higher in urban areas than in rural areas, but the increased risk of death in rural patients is more obvious; ➤There are many risk factors associated with CVD and CKD, and cardiovascular and cerebrovascular Diseases, malignant tumors, lung infections, and renal failure are the main causes of death; ➤ Poor blood sugar control accompanied by a decrease in the ability to adjust the underlying self-disease, a decrease in stress adaptability, and an increased risk of death
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Optimizing strategies for comprehensive management of diabetes in the elderly: Advocating "four early days", managing "four highs", and setting management goals individually The following questions: ➤ "Early prevention and early treatment, good blood sugar control, and comprehensive control of multiple metabolic abnormalities" are the ideal treatment principles for diabetic patients
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But in reality most patients fail to follow this principle, one of the reasons is the lack of awareness or condition of diabetes screening
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➤Most guidelines uniformly "wear a frame" for "elderly people", which blurs the concepts of "diagnostic criteria" and "control criteria" for diabetes, and delays the initiation of disease prevention and treatment for elderly diabetic patients
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➤The quality of diabetes control is closely related to the patient's self-management ability.
In the management of "four highs", blood sugar fluctuation is most affected by changes in daily life.
Attention should be paid to the improvement of the concept and level of patients' personal diet management
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➤The elderly in China have some advantages for disease prevention and treatment: most of them have no work pressure, and after mastering the knowledge of disease prevention, the compliance with treatment is higher than that of young and middle-aged patients
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➤Diabetes education, patient self-management and blood glucose monitoring, diet management, and exercise therapy are the basic treatments for diabetes
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2.
Advocate "four early" and strengthen tertiary prevention In response to the above problems, the new version of the guideline puts forward the "four early" principle of "early prevention, early detection, early treatment, and early compliance", which corresponds to the tertiary level of type 2 diabetes in the elderly.
Prevention, and pointed out that diabetes screening should be a must-check item in the health examination of the elderly, and HbA1c detection should be combined with conditions to reduce the rate of missed diagnosis
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General principles for "glycemic management in hospitalized older adults" are proposed
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3.
Comprehensive evaluation should be carried out for elderly patients who have been diagnosed with diabetes.
Professor Tian Hui pointed out that for elderly patients who have been diagnosed with diabetes, a comprehensive evaluation should be carried out to clarify patient positioning, treatment focus and management goals, and take highly targeted and effective measures.
Measures to control blood sugar and reduce the disability and death rate of cardiovascular and cerebrovascular diseases
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4.
Manage the "four highs" and formulate control targets according to individual differences.
The "four highs" of high blood sugar, high hematuria, high blood lipids, and high uric acid that are often combined in the elderly are important risk factors for cardiovascular disease.
Rational use of diabetes management "five drivings" Carriage", formulating individualized strategies and goals, and striving for optimal outcomes are the core of diabetes management in the elderly
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Professor Tian Hui showed us the control targets for different elderly groups in the new "Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)"
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The principle of setting blood sugar goals: The goal of blood sugar management cannot be generalized.
The ideal level of blood sugar control should not only prevent and reduce the vascular complications of diabetes, but also reduce the risk of hypoglycemia as much as possible, so as to maximize the benefits
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Table 2 Glycemic control goals in elderly patients with diabetesTable 3 Comprehensive control goals for ASCVD risk factors in elderly patients with diabetes
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The first 4 items are the basic treatment of diabetes, and hypoglycemic drugs are important supportive treatments
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➤Diabetes education: Paying attention to the education and management of elderly patients, and strengthening the introductory education and early positioning management of diabetes patients (fixed medical units and doctors) can help improve prognosis
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➤ Patient self-management and blood sugar monitoring: According to the patient's blood sugar control level, go to the hospital to detect HbA1c in 3-6 months to understand the overall blood sugar control situation, and communicate with the doctor to adjust the blood sugar treatment plan.
Home blood sugar monitoring is to understand the blood sugar control status and improve the patient's blood sugar control.
Necessary measures for self-management of blood glucose levels
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➤Dietary therapy: According to the metabolic level of different nutrients of the patient, rationally allocate the dietary structure (carbohydrates account for 50%-55%, eat more foods rich in dietary fiber and low glycemic index, and choose protein according to the kidney condition.
intake), and pay attention to meal patterns (eating smaller meals more often, eating slowly, soup first and then staple food)
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➤Exercise therapy: It is necessary to take into account the two aspects of helping blood sugar control and maintaining good physical fitness (body mass and flexibility)
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Exercise management needs to be individualized, scheduling physical and conditioning exercises based on exercise capacity and disease status
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➤Drug treatment: The development of hypoglycemic drugs for 100 years has formed the current new drug use pattern - hypoglycemic drugs are started early, the blood sugar at the starting point of hypoglycemic may not be very high, and non-insulin hypoglycemic drugs are mainly used.
The following table is used to develop a drug treatment strategy for diabetes in the elderly
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In the end, Professor Tian Hui summarized the lecture: Diabetes is developing rapidly in China, affecting 1/2 of the Chinese people and 3/4 of the elderly, and needs close attention in the past 30 years; the physiological changes in old age are the largest, There are great individual differences among the elderly.
Cardiovascular and cerebrovascular diseases are the main threat of death in the elderly, and poor management of diabetes is one of the important factors.
The treatment of diabetes requires a comprehensive evaluation of five aspects, and individualized treatment requires clear positioning and treatment of patients.
Concerns and management goals; the whole-process management of diabetes includes three levels of islet function protection, blood sugar control, and complication prevention.
The principle of 'four early' should be advocated, and attention should be paid to the promotion of healthy life>
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Related reading: The press conference of "China's Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition)" was successfully held in Beijing!