研究证实血糖控制欠佳和糖尿病患者不断恶化与认知功能之间存在联系,根据临床和非临床研究,葡萄糖和胰岛素水平的变化、反复发作的低血糖和糖尿病脑血管并发症,极有可能改变大脑功能和结构.认知缺陷加剧了老年患者的功能障碍,增加的抑郁症的患病率,反复发作的低血糖的发生率也较高,对坚持治疗的依从性也较差,最后导致糖尿病患者的预后不佳.在大多数年老虚弱的糖尿病患者,主要的治疗策略应该包括控制血糖,以减少代谢功能紊乱,并避免低血糖的风险.同时采取教育措施,主要提供维护患者的自主权,避免住院,这些措施应该根据患者的认知功能状态不断调整.%Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients.Several processes are thought to promote cognitive decline and dementia in diabetics.Based on both clinical and nonclinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycemia.Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression related symptoms, greater incidence of recurrent hypoglycemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.In the most vulnerable patients, specific treatment strategies have been proposed for glycemic control to limit metabolic decompensation and avoid the risk of hypoglycemia.Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
展开▼
