Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.
Prev Chronic Dis. 2010 Jan;7(1):A08. Epub 2009 Dec 15.
Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults.
We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged >or=65 y) who self-reported having type 2 diabetes at baseline.
Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point.
Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control.
很少有研究前瞻性地评估人口统计学因素、临床情况、治疗方式和一般生活方式行为对 2 型糖尿病中老年患者血糖控制的解释作用。我们分层检查了这些因素，特别关注可改变因素（即一般生活方式行为）的影响，并比较了中老年患者的预测模式。
我们使用了 1998 年和 2000 年健康与退休研究（HRS）以及 HRS 2003 糖尿病研究的全国代表性数据。我们分析了基线时自我报告患有 2 型糖尿病的 379 名中年成年人（年龄 51-64 岁）和 430 名老年成年人（年龄≥65 岁）的数据。
在中年成年人中，人口统计学因素和临床情况是血红蛋白 A1c（HbA1c）水平的最强预测因素。然而，在老年成年人中，治疗方式（仅饮食、口服药物或胰岛素，或与其他方案联合使用）显著影响 HbA1c 水平。生活方式（体力活动、吸烟、饮酒和体重控制），独立于人口统计学、临床情况和治疗方式的影响，显著影响 HbA1c 水平。每增加一项健康行为，HbA1c 水平就会降低超过 1 个百分点。
我们的研究结果为当前的糖尿病指南提供了支持，该指南建议在整个糖尿病治疗过程中采用生活方式方案，并强调需要帮助 2 型糖尿病中社会经济地位和临床状况不利的中年成年人以及表现出药物治疗建议依从性差的老年成年人实现更好的血糖控制。
