Arinzon Zeev, Fidelman Zeev, Berner Yitshal N, Adunsky Abraham
Department of Geriatric Medicine, Meir Medical Center, Kfar Saba 44281, Israel.
Arch Gerontol Geriatr. 2007 Sep-Oct;45(2):191-200. doi: 10.1016/j.archger.2006.10.010. Epub 2006 Dec 13.
Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics (p=0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.
低血糖在社区居住的老年患者中很常见，且可能伴随急性感染发作。我们分析了临床变量与机构化痴呆老年患者（无论有无糖尿病）感染相关低血糖（IRH）及其结局之间的相互关系。这是一项涉及大型长期护理机构居民的回顾性队列研究。我们测量了人口统计学、临床、功能、营养和认知数据以及血细胞计数和化学分析。我们确定了65例患有IRH的老年患者，并比较了33例糖尿病患者和32例非糖尿病患者的数据。患者的平均年龄为77.7岁，平均简易精神状态评分为1.8。与非糖尿病患者相比，糖尿病患者更年轻，认知障碍更严重，功能评分更低（差异无统计学意义），但合并症更多（p = 0.004）。糖尿病患者和非糖尿病患者的平均血糖水平分别为53.2和54.3mg/dl。只有22%的患者出现提示低血糖的临床体征。多变量分析表明，在各组中，合并症和功能状态、肌酐、白蛋白、C反应蛋白（CRP）和总胆固醇均与IRH相关。在6个月期间，58%（38/65）的患者死亡，其中47%（18/38）在记录IRH后的一个月内死亡。糖尿病患者和非糖尿病患者的短期和晚期死亡率无统计学显著差异。我们得出结论，机构化痴呆老年人中的无症状IRH在糖尿病和非糖尿病患者中均常与常见的呼吸道和泌尿系统感染相关。IRH似乎表明总体健康状况较差，而非死亡原因。在普通感染期间，该人群（包括非糖尿病患者）均需筛查血糖，以识别高危患者。
