Malone M L, Gennis V, Goodwin J S
University of Wisconsin Medical School, Milwaukee.
J Am Geriatr Soc. 1992 Nov;40(11):1100-4. doi: 10.1111/j.1532-5415.1992.tb01797.x.
To describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults.
Retrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n = 338).
Three urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990.
Two hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty-seven cases were in patients > or = age 65; 193 cases were in patients < age 65.
The older patients were less likely to have been using insulin before hospitalization (55.6% vs 80.2%, P = 0.004) and less likely to have had a prior episode of diabetic ketoacidosis (8.0% vs 51.4%, P = 0.001). The presenting laboratory data were not significantly different between older and younger subjects. There was a trend toward a higher mean insulin dosage to bring the patient's blood glucose to < or = 300 mg/dL for those age 65 or older; 69.1 units vs 44.9 units (P = 0.06). The time required to obtain a glucose < 300 mg/dL was greater in older patients (10.5 vs 7.7 hours, P = 0.01). The average length of stay for those age 65 or older was 12.4 days vs 6.7 days (P = 0.001). Thirdly, of those age 65 or older, 7% vs 29% of younger subjects had a blood glucose or Accucheck < or = 49 mg/dL at some time during their hospital course. The hypoglycemic episodes were more likely to be asymptomatic in older patients (P = 0.03). The mortality rate was 22% for those age 65 or older vs 2% for younger subjects (P = 0.001). The mortality rate for those in age groups 60-69 years, 70-79 years, and > or = 80 years was 8%, 27%, and 33%, respectively. In patients > or = 65, mortality was confined to those with coexisting renal disease or infection.
Older patients with diabetic ketoacidosis are less likely to have been using insulin before hospitalization. They tend to receive more insulin therapy during their acute management, have a longer average length of hospital stay, and have a higher mortality rate.
描述65岁及以上人群的糖尿病酮症酸中毒与年轻成年人的糖尿病酮症酸中毒有何不同。
对所有主要或次要出院诊断为糖尿病酮症酸中毒的成年患者（n = 338）进行回顾性病历审查。
1987年1月1日至1990年5月31日期间，威斯康星州密尔沃基市的三家城市教学医院。
150名患者中的220例符合纳入研究的疾病严重程度标准。27例患者年龄≥65岁；193例患者年龄＜65岁。
老年患者在住院前使用胰岛素的可能性较小（55.6%对80.2%，P = 0.004），且既往有糖尿病酮症酸中毒发作的可能性较小（8.0%对51.4%，P = 0.001）。老年和年轻受试者的初始实验室数据无显著差异。对于65岁及以上的患者，将血糖降至≤300mg/dL所需的平均胰岛素剂量有升高趋势；69.1单位对44.9单位（P = 0.06）。老年患者血糖降至＜300mg/dL所需时间更长（10.5小时对7.7小时，P = 0.01）。65岁及以上患者的平均住院时间为12.4天，而年龄＜65岁患者为6.7天（P = 0.001）。第三，在65岁及以上患者中，7%的患者在住院期间某个时间血糖或指尖血糖≤49mg/dL，而年轻受试者为29%。老年患者的低血糖发作更可能无症状（P = 0.03）。65岁及以上患者的死亡率为22%，而年轻受试者为2%（P = 0.001）。60 - 69岁、70 - 79岁和≥80岁年龄组的死亡率分别为8%、27%和33%。在年龄≥65岁的患者中，死亡仅限于伴有肾病或感染的患者。
老年糖尿病酮症酸中毒患者在住院前使用胰岛素的可能性较小。他们在急性治疗期间往往接受更多胰岛素治疗，平均住院时间更长，死亡率更高。
