Dornan T L, Peck G M, Dow J D, Tattersall R B
Diabetes Unit, University Hospital, Nottingham.
Diabet Med. 1992 Nov;9(9):860-5. doi: 10.1111/j.1464-5491.1992.tb01906.x.
All 98 elderly patients who were known to have diabetes on the lists of two inner-city general practices were interviewed and examined in their own homes. They were characterized in terms of their prevalence of vascular complications, metabolic control, perceived health (measured by the Nottingham Health Profile), frequency of hospital and general practice contacts and use of domiciliary 'support services' and compared to 98 control subjects with an identical age/gender distribution. Mean haemoglobin A1 in the diabetic patients was 9.9 +/- 2.5%, few of them had suffered severe hyperglycaemia (10%) or hypoglycaemia (5%) and they were little more obese than controls (mean body mass index 26.2 +/- 4.2 vs 24.6 +/- 4.1 kg m-2; 95% confidence interval for the difference 0.4-2.8; p < 0.01). All complications were more prevalent in diabetic patients and the difference was statistically significant for visual impairment, strokes, impaired mental test scores, absent vibration sense, and absent leg pulses. Cataract was more common than retinopathy as a cause of visual disability. Diabetic patients perceived their health to be much worse than controls and were more often depressed. No measure of perceived health correlated with haemoglobin A1. We conclude that care of the diabetic elderly should not be too narrowly focused on 'metabolic' goals.
对来自两家市中心全科诊所名单上已知患有糖尿病的98名老年患者进行了家访，对他们进行了访谈和检查。根据他们血管并发症的患病率、代谢控制情况、自我感知健康状况（通过诺丁汉健康量表测量）、住院和全科诊所就诊频率以及使用家庭“支持服务”的情况进行了特征描述，并与98名年龄/性别分布相同的对照受试者进行了比较。糖尿病患者的平均糖化血红蛋白A1为9.9±2.5%，很少有人发生严重高血糖（10%）或低血糖（5%），他们比对照组略胖（平均体重指数26.2±4.2 vs 24.6±4.1 kg/m²；差异的95%置信区间为0.4 - 2.8；p<0.01）。所有并发症在糖尿病患者中更为普遍，在视力障碍、中风、心理测试分数受损、振动觉缺失和下肢脉搏消失方面差异具有统计学意义。作为视力残疾的原因，白内障比视网膜病变更常见。糖尿病患者认为自己的健康状况比对照组差得多，且更常出现抑郁情绪。自我感知健康状况的各项指标与糖化血红蛋白A1均无相关性。我们得出结论，对老年糖尿病患者的护理不应过于狭隘地专注于“代谢”目标。
