medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-11-53-62medsovet-5753Research ArticleНЕВРОЛОГИЯNEUROLOGYДиабетическая невропатия у лиц старшего возрастаDiabetic neuropathy in the elderlyhttps://orcid.org/0000-0002-9054-0881ЧердакМ. А.CherdakMaria А.

Чердак Мария Алексеевна, к.м.н., ассистент кафедры болезней старения факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, д. 1

Maria А. Cherdak, Cand. of Sci. (Med.), Teaching Assistant, Chair for Aging Associated Diseases, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997

maria.cherdak@yandex.ruhttps://orcid.org/0000-0003-2597-981XМхитарянЭ. А.MkhitaryanE. А.

Мхитарян Элен Араиковна, к.м.н., доцент кафедры болезней старения факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, д. 1

129226, Москва, ул. Леонова 1-я, д. 16

Elen А. Mkhitaryan, Cand. of Sci. (Med.), Associate Professor, Chair for Aging Associated Diseases, Faculty of Additional Professional Education

1, Ostrovityanov St., Moscow, 117997

16, Leonova 1 St., Moscow, 129226

Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова; Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University; Russian Clinical and Research Center of GerontologyRussian Federation2020060820200115362Copyright © Чердак М.А., Мхитарян Э.А., 20202020Чердак М.А., Мхитарян Э.А.Cherdak M.А., Mkhitaryan E.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5753

Рост распространенности и заболеваемости сахарным диабетом (СД) принял черты эпидемии. Особенно часто СД встречается у лиц пожилого и старческого возраста, при этом не менее половины случаев СД в данной популяции остаются недиагностированными. СД способствует резкому усугублению качества жизни больных, является причиной формирования зависимости, прогрессирования различных гериатрических синдромов и приводит к повышенной смертности. Пожилой возраст является независимым фактором риска развития диабетической невропатии. Наиболее часто она представлена хронической сенсомоторной и вегетативной формами, к осложнениям которых относятся нарушение сердечно-сосудистой деятельности, работы желудочно-кишечного тракта и органов мочеполовой сферы, а также хронический невропатический болевой синдром. По мере прогрессирования диабетическая невропатия способствует усугублению нарушений ходьбы и равновесия, повышает риск падений и утраты мобильности, значительно повышает риск неблагоприятных исходов СД. В статье подробно обсуждаются факторы риска, патогенез, дифференциальный диагноз и возможности клинического и неклинического обследования больных с подозрением на диабетическую невропатию. Внимание уделено особенностям оценки болевого синдрома у лиц пожилого возраста со снижением коммуникативных способностей или сопутствующими расстройствами когнитивной сферы. Представлен алгоритм ведения пожилых пациентов с диабетической невропатией, перечислены подходы к оптимизации соотношения риска и выгоды терапии. Обсуждаются возможности этиопатогенетической и симптоматической терапии болевого синдрома, вегетативных нарушений и профилактики поздних осложнений СД с учетом особенностей данной популяции, а также область применения препаратов альфа-липоевой кислоты при ведении пациентов с неврологическими осложнениями СД.

The increase in the diabetes mellitus (DM) prevalence and incidence has taken on the features of the epidemic. Particularly often, DM occurs in the elderly and senile patients, while at least half of the cases of diabetes in this population remain undiagnosed. DM contributes to the deterioration of the quality of life, causes formation of dependence and progression of various geriatric syndromes leading to increased mortality. Elderly age is an independent risk factor for diabetic neuropathy. The main clinical forms of which are represented by chronic sensorimotor and autonomic impairments, complicated by impaired cardiovascular, gastrointestinal and urogenital functions, as well as chronic neuropathic pain syndrome. Progression of diabetic neuropathy aggravates walking and balance disorders, increases the risk of falls and loss of mobility, and significantly increases the risk of adverse diabetes outcomes. The article discusses in detail risk factors, pathogenesis, differential diagnosis and the possibilities of clinical and non-clinical evaluation of patients with suspected diabetic neuropathy. Possibilities for pain assessment in elderly people with communicative disorders or concomitant cognitive impairment are demonstrated. The article presents an algorithm for management of diabetic neuropathy in elderly ones, ways for optimization of risk and benefit balance, as well as the possibility of etiopathogenetic and symptomatic treatment of pain, autonomic disorders and prevention of late complications of diabetes with use of alpha-lipouc acid, taking into account key characteristics of discussed population.

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The authors declare that there are no conflicts of interest present.