Department of General Medicine, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan.
Diabetes Ther. 2013 Dec;4(2):473-86. doi: 10.1007/s13300-013-0049-4. Epub 2013 Dec 10.
One consequence of population aging is an increase in the number of elderly patients with diabetes mellitus. These elderly patients often experience atherosclerotic complications, and diabetes prevention and management are strongly desired to promote health and reduce the financial burden on the healthcare system. In this study, we conducted an age-specific evaluation of the effectiveness and safety of comprehensive management with newly initiated insulin therapy over a 1-year period in elderly (≥65 years) compared with non-elderly (≤64 years) Japanese patients with uncontrolled diabetes [glycated hemoglobin (HbA1c) ≥ 8% for ≥ 3 months].
This retrospective single-center cohort study was conducted in Japan. We screened all outpatients with diabetes mellitus who visited the clinic for diabetes treatment between December 2006 and March 2011. Of these patients, 132 with type 2 diabetes who were newly initiated on insulin therapy for continued poor glycemic control and undergoing comprehensive management through self-monitoring of blood glucose (SMBG) were registered to the study.
Thirty-two of 132 registered patients were excluded from the analysis. Among the 100 patients (67 non-elderly, 33 elderly) included in the analysis, median age and proportion of male patients was 69 years and 66.7%, respectively, among the elderly, and 52 years and 68.7%, respectively, among the non-elderly patients. After initiation of insulin therapy, median HbA1c levels improved from 9.6% to 7.2% in elderly patients, and from 10.8% to 7.3% in non-elderly patients at baseline and 12 months. Severe hypoglycemic events were not observed in either patient group; however, uncontrolled diabetes was ongoing in 31.8% of non-elderly and 15.4% of elderly patients, and obesity was associated with poor glycemic control.
Our results indicate that the effectiveness and safety of newly initiated insulin therapy are similar between elderly and non-elderly Japanese patients with uncontrolled diabetes, and highlight the importance of comprehensive management using SMBG to avoid hypoglycemia. Better glycemic control supported by adequate intensive management is required to improve mortality and morbidity.
人口老龄化的一个后果是糖尿病患者中老年人的数量增加。这些老年患者常经历动脉粥样硬化并发症，强烈希望进行糖尿病预防和管理，以促进健康并减轻医疗保健系统的经济负担。在这项研究中，我们对 1 年内新开始胰岛素治疗的综合管理在年龄较大（≥65 岁）和年龄较小（≤64 岁）的日本未控制糖尿病[糖化血红蛋白（HbA1c）≥3 个月，≥8%]患者中的有效性和安全性进行了特定年龄的评估。
这是一项在日本进行的回顾性单中心队列研究。我们筛选了 2006 年 12 月至 2011 年 3 月期间在诊所就诊的所有糖尿病门诊患者。在这些患者中，有 132 名患有 2 型糖尿病的患者新开始胰岛素治疗以持续控制血糖不佳，并通过自我监测血糖（SMBG）进行综合管理，被纳入该研究。
在注册的 132 名患者中，有 32 名被排除在分析之外。在纳入分析的 100 名患者（67 名年龄较大，33 名年龄较小）中，年龄较大的患者的中位年龄和男性患者比例分别为 69 岁和 66.7%，年龄较小的患者分别为 52 岁和 68.7%。在开始胰岛素治疗后，老年患者的 HbA1c 水平从中位数 9.6%改善至 7.2%，基线和 12 个月时非老年患者的 HbA1c 水平从中位数 10.8%改善至 7.3%。两组患者均未观察到严重低血糖事件；然而，在非老年患者中，有 31.8%的患者和老年患者中 15.4%的患者仍患有未控制的糖尿病，肥胖与血糖控制不佳有关。
我们的结果表明，新开始胰岛素治疗在年龄较大和年龄较小的日本未控制糖尿病患者中的有效性和安全性相似，强调了使用 SMBG 进行综合管理以避免低血糖的重要性。需要更充分的强化管理来改善血糖控制，以降低死亡率和发病率。
