Chin M H, Su A W, Jin L, Nerney M P
Section of General Internal Medicine, Department of Medicine, University of Chicago, Illinois 60637, USA.
J Gerontol A Biol Sci Med Sci. 2000 Oct;55(10):M601-6. doi: 10.1093/gerona/55.10.m601.
The American Diabetes Association (ADA) clinical practice recommendations have been widely promoted, but they lack a geriatric-specific approach to care. We aimed to determine the style of care that endocrinologists, general internists, and geriatricians provided to their elderly patients with diabetes and to what extent these medical professionals adhered to the ADA standards.
We performed a retrospective cohort study of a stratified sample of 531 diabetic patients aged 65 years and older from the endocrinology, general internal medicine, and geriatrics clinics of an urban academic medical center.
Patients of geriatricians were older, had higher comorbidity, and were more likely to be demented. The average number of diabetic complications was similar across the specialties, although patients of endocrinologists had higher prevalence of neuropathy and retinopathy compared with patients of geriatricians. Endocrinologists were more likely to use insulin, multiple types of insulin, and combined oral hypoglycemic and insulin therapies. Most patients had hemoglobin A1c measured, and average values were similarly high across specialties at 8.6%. Blood pressures were above 130/85 mm Hg in 85% of the patients. All specialties rarely measured urine microalbumin; geriatricians seldom performed fractionated cholesterol tests, and ophthalmology visits occurred in only half of the patients.
Endocrinologists had the most aggressive, complex diabetes treatment regimens, although geriatricians had older patients with more dementia and lower prevalence of microvascular complications. Average hemoglobin A1c levels and blood pressures were higher than recommended among patients of all three specialties. Screening for diabetic complications and hyperlipidemia was lower than advised.
美国糖尿病协会（ADA）的临床实践指南得到了广泛推广，但缺乏针对老年人的特定护理方法。我们旨在确定内分泌科医生、普通内科医生和老年病科医生为老年糖尿病患者提供的护理方式，以及这些医学专业人员遵守ADA标准的程度。
我们对一家城市学术医疗中心的内分泌科、普通内科和老年病科门诊的531名65岁及以上糖尿病患者的分层样本进行了回顾性队列研究。
老年病科医生的患者年龄更大，合并症更多，且更易患痴呆症。各专科的糖尿病并发症平均数量相似，不过与老年病科医生的患者相比，内分泌科医生的患者神经病变和视网膜病变的患病率更高。内分泌科医生更倾向于使用胰岛素、多种类型的胰岛素，以及联合口服降糖药和胰岛素疗法。大多数患者都进行了糖化血红蛋白测量，各专科的平均值同样较高，为8.6%。85%的患者血压高于130/85 mmHg。所有专科都很少检测尿微量白蛋白；老年病科医生很少进行胆固醇分级检测，只有一半的患者进行过眼科检查。
内分泌科医生的糖尿病治疗方案最为积极、复杂，尽管老年病科医生的患者年龄更大，痴呆症更多，微血管并发症的患病率更低。所有三个专科的患者糖化血红蛋白平均水平和血压均高于推荐值。糖尿病并发症和高脂血症的筛查低于建议水平。
