自己管理能力が低下した高齢糖尿病患者の糖尿病ケアは誰が行うべきか？

[Who should provide diabetes care to elderly diabetic patients with decreased self-management skills?]

• Hajime M Koyano

抄録

急速な高齢化社会の進展に伴い、日本では自己管理能力が低下した高齢者の糖尿病患者が増加している。現在、これらの処置を必要とする患者さんに対しては、家族が主に自宅で注射を行い、血糖値を測定しています。しかし、高齢化が進み、少子化がさらに進むと、家族からの援助を受けることが困難になることが予想される。そのため、国レベルでの議論と早急な対応策の策定が求められている。今後は、現行法制を大きく変えなくても、医療資格者の関与の拡大や多職種連携の強化、具体的には、訪問看護の頻度の増加、薬剤師による在宅注射の促進、「地域包括ケアシステム」の活用などが、在宅注射や血糖値測定を家族が行うことを強化・代替する上で何よりも重要である。コストを最優先するのであれば、在宅での注射と非医療・非介護者による血糖値測定が最良の選択肢と思われる。ただし、慎重な検討が必要である。

As a result of the rapid aging of society, the number of elderly diabetic patients with a decreased self-management ability in Japan is increasing. At present, family members primarily perform injection at home and measure the blood glucose levels for patients who require these procedures. However, as aging progresses and the birthrate further declines, it is expected that it will become difficult for such patients to receive assistance from their family members. Therefore, a discussion at the national level and development of urgent measures are required. In the future, the expanded involvement of those with medical qualifications and augmented multi-occupational collaboration-specifically, increasing the frequency of visiting nursing services, facilitating injections at home by pharmacists and making the most of "community-based integrated care systems", without major changes in the current legislation, will be foremost in reinforcing or taking the place of family members performing injections at home and measuring blood glucose levels. If cost is given the highest priority, injection at home and measurement of blood glucose levels by non-medical and non-nursing care workers seems to be the best option. However, careful deliberation is required.