As the elderly, it is even more important to learn how to live with chronic diseases.

As the elderly, it is even more important to learn how to live with chronic diseases.

On a certain morning in August, I saw three elderly patients in a row, which was very interesting and also had a significant educational significance. I specially wrote this article to share with the readers.

Case 1: Does the hypoglycemic drug cause cancer?

Case 1 is a female, a retired worker, 63 years old, suffering from diabetes for 20 years, with hypertension and dyslipidemia. She has been adhering to a controlled diet and moderate exercise, taking metformin sitagliptin tablets (each tablet contains 50 milligrams of sitagliptin/0.85 grams of metformin) 1 tablet, twice a day. She has been using statins and antihypertensive drugs, and her blood sugar, blood pressure, and blood lipids are well controlled. Currently, she has no discomfort and often goes out for travel. Recently, the patient heard that sitagliptin contains carcinogenic components and is very concerned. In the past three months, her weight has decreased by a total of 2 kilograms, especially in the last month, it has decreased by 1 kilogram. Therefore, she is a bit worried, even affecting sleep, and the quality of life has decreased. This time, the consultation asked two questions: whether oral sitagliptin will cause cancer, whether it is necessary to stop taking sitagliptin or change to other hypoglycemic drugs? Does a 1-kilogram weight loss in the last month indicate a malignant change?

In response to the patient's doubts, I made the following answers.

Sitagliptin does not cause cancer. Sitagliptin is a safe and effective oral hypoglycemic drug, which usually does not cause weight gain and hypoglycemia. On August 9, the official website of the US Food and Drug Administration (FDA) issued a drug statement, stating that the agency recently found nitrosamine impurities Nitroso-STG-19 (NTTP) in some samples of sitagliptin used to treat type 2 diabetes.

According to laboratory tests, this nitrosamine impurity contains some substances that may lead to cancer. At the same time, the US Food and Drug Administration also pointed out that sitagliptin will not be banned, nor does it advocate patients to stop taking the drug rashly. After seeing this statement, Chinese drug experts and diabetes experts believe that taking the drug within the specified dosage range according to medical advice is safe. It should be pointed out that this time the monitoring was some samples of sitagliptin in the US market. Another important point is that whether the carcinogenic components can really cause cancer is obviously related to the amount taken and the duration of use.

In fact, our daily living environment (including air and water) may have some carcinogenic substances. This does not affect us to continue living in such an environment. The statement from the US Food and Drug Administration is more of a reminder to pay attention to the supervision of drugs like sitagliptin. If there is a basis for sitagliptin to cause cancer, the US Food and Drug Administration will issue a warning or withdraw the drug from the market.

If there is a problem with the drug, the country will recall it in time. For example, in 2018, the European Medicines Agency found a potentially carcinogenic impurity in the valsartan raw materials produced by Zhejiang Huahai Pharmaceutical Co., Ltd. Further investigation showed that there was a problem with the raw materials of one batch of drugs, and the other batches were no problem. The problematic batches of drugs have been recalled by the country, and the valsartan currently sold on the market is no problem. It is not recommended for hypertensive patients to change their medication casually, so patients taking valsartan can continue to take it with confidence and do not have to worry about the problem of cancer.

Correctly understand the drug statement. For this patient's confusion and worry, I asked her to correctly understand this type of drug statement. If the concern is too great to affect the quality of life, in order to reduce and avoid concerns, sitagliptin can be stopped and other hypoglycemic drugs can be changed. If you listen to my explanation and relieve the ideological concerns, considering that the current blood sugar control is good and the medication is very convenient, and there is no discomfort caused by taking the medicine, it is appropriate to continue the current treatment plan.

The weight standard for the elderly can be appropriately relaxed. The patient is 63 years old, with a height of 153 centimeters and a weight of 54 kilograms, and the body mass index is 23.1 kilograms per square meter, which belongs to the high value within the normal range. The normal range of body mass index is 18.5 to 23.9 kilograms per square meter, more than 24 kilograms per square meter is overweight, and more than 28 kilograms per square meter belongs to obesity. For 63-year-old elderly, the weight within the normal range is high or even slightly overweight, which is appropriate. Clinical practice has proven that once a major disease occurs, the mortality rate of thin elderly people (body mass index less than 18.5 kilograms per square meter) is often higher. To put it simply, thin elderly people can't stand the toss. Although the weight has decreased by 2 kilograms in the past three months, including a decrease of 1 kilogram in the past month, this amount of weight loss is not much.

Pay attention to the relationship between weight loss and other factors. It is necessary to consider whether there are other clinical manifestations, such as fatigue, gastrointestinal discomfort, or other special discomfort; whether it is related to the recent large amount of exercise or eating less, etc. A weight loss of 2 kilograms in 3 months is likely to be related to sweating a lot in summer, eating less, or poor sleep. If there is no other discomfort and there is a reason, there is no need to worry at all, just continue to observe. According to the results of my daily weight monitoring, a weight change of 1 kilogram within a week is also normal. The patient added that her appetite has decreased recently, and the amount of food intake has been significantly reduced.

Case 2: Do memory decline and poor sleep need medication?

Case 2 is a female scientist from the Chinese Academy of Sciences, 85 years old, taking two hypoglycemic drugs, and using basic insulin once a night, blood sugar control is very satisfactory, fasting blood sugar is basically between 6.0 and 7.0 mmol/L, occasionally lower than 6.0 mmol/L or higher than 7.0 mmol/L, glycated hemoglobin is below 7.0%, and there has never been hypoglycemia. Taking antihypertensive and lipid-lowering drugs, blood pressure and blood lipids are all controlled to meet the standard. She handed me a piece of paper, on which she wrote the results of blood sugar and blood pressure monitoring at home and the situation of medication. She came to see me mainly because of two problems, one is memory decline, and the second is that sleep is worse than before, and the time for sleeping at night is shorter. She asked me whether these problems need further examination or changing medication.

I said to her: "You are 85 years old, you can walk to the hospital to talk to me, and you can clearly tell me your condition, medication, and home examination, which shows that your memory and communication ability are very good. I may not be as good as you at your age. As for the poor sleep, this is a common problem for the elderly, which is related to age. The elderly often can't sleep at night and are prone to doze off during the day, sometimes dozing off while watching TV. Your situation does not need further examination, nor does it need to change medication, and there is no medicine available. I can prescribe some sleeping pills, but I advocate using less medicine, because multiple drugs have been used for hypoglycemia, antihypertensive, and lipid-lowering. The current problem is mainly related to old age itself, realizing this, there is no need to worry too much, calm down. Don't worry if you can't sleep, and take a rest if you feel sleepy during the day." The old man was relieved and happy to go back after hearing what I said.

Elderly diabetic patients find it difficult to accept frequent blood sugar monitoring and insulin injection plans, and may also damage their ability to follow medical advice due to the occurrence or aggravation of some diseases. In elderly patients with complex or very complex diseases, plans for intensive blood sugar control, including insulin and sulfonylurea drugs, are not suitable, and even increase the risk of medical treatment. It is necessary to seek safe, effective, and easy diabetes treatment plans as much as possible.

If it is found that the patient's insulin treatment plan is too complex and exceeds the patient's self-management ability, it is not a simple problem of reducing the dose of insulin. The insulin treatment plan should be simplified to match the individual's self-management ability, available social and medical support. This has been proven to reduce the risk of hypoglycemia and disease-related pain while helping to control blood sugar. The emergence of some new hypoglycemic drugs has given doctors and patients more, better, and
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