Alzheimer's Disease Clinic, ASL Frosinone, Atina, Italy.
University of Turin, Geriatric Section, Department of Medical Sciences, San Giovanni Battista Hospital, Turin, Italy.
Metabolism. 2015 Nov;64(11):1500-6. doi: 10.1016/j.metabol.2015.07.018. Epub 2015 Jul 29.
There is growing evidence that tight glycemic control may be more harmful than beneficial in older persons with Type 2 diabetes (T2DM). It remains controversial if tight glycemic control (lower glycated hemoglobin A1c (A1c)) is associated with functional impairments in older frail patients with T2DM. We explored associations between A1c and losses in Activities of Daily Living (ADLs) in diabetic nursing home (NH) patients and tested for differences according to anti-diabetic treatment: diet, anti-diabetic oral drug (AOD), insulin, combined insulin+AOD.
We conducted a cross-sectional study on 1845 older NH patients with T2DM from 150 sites across Italy. Complete evaluations on ADLs, glycemic control, anti-diabetic treatments, comorbidities, and clinical data were recorded. ANOVA was applied to compare clinical characteristics across A1c tertiles. Multivariate regression models evaluated associations between A1c and ADL losses.
Patients had a mean age [SD]=82 [8] years; BMI=25.5 kg/m(2) [4.7]; Fasting Plasma Glucose (FPG)=7.4 [3.0] mmol/l; Post-prandial glucose (PPG)=10.3 [3.6] mmol/l; A1c=7.0% (54 mmol/mol), ADL losses=3.7 [1.8]. Compared to higher A1c tertiles, patients in the lower tertile had greater ADL losses, were more likely to use AODs, while less likely to use insulin or insulin+AOD. After adjusting for multiple confounders, impairments in ADLs were associated with tighter A1c levels (B=-0.014; p=0.002). Regression models according to anti-diabetic treatment showed that tighter A1c levels continued as independent determinants of ADL losses in patients using AODs (B=-0.023; p=0.001), particularly in those using sulfonylureas (B=-0.043; p<0.001) or mitiglinides (B=-0.044; p=0.050).
Tighter glycemic control was associated with ADL physical dependency losses, especially in those using sulfonylureas and mitiglinides.
越来越多的证据表明，对于 2 型糖尿病（T2DM）老年患者，严格的血糖控制可能弊大于利。对于血糖控制严格（糖化血红蛋白 A1c 较低）是否与 2 型糖尿病虚弱老年患者的日常生活活动（ADL）丧失相关，目前仍存在争议。我们探讨了 T2DM 老年疗养院患者的 A1c 与 ADL 丧失之间的关系，并根据抗糖尿病治疗方法（饮食、口服降糖药、胰岛素、胰岛素+口服降糖药联合治疗）进行了差异检验。
我们对来自意大利 150 个地点的 1845 名 T2DM 老年疗养院患者进行了一项横断面研究。记录了关于 ADL、血糖控制、抗糖尿病治疗、合并症和临床数据的完整评估。采用方差分析比较 A1c 三分位组的临床特征。多元回归模型评估了 A1c 与 ADL 丧失之间的关联。
患者平均年龄为 82 [8] 岁；体重指数为 25.5 kg/m2 [4.7]；空腹血糖为 7.4 [3.0]mmol/L；餐后血糖为 10.3 [3.6]mmol/L；A1c 为 7.0%（54mmol/mol），ADL 丧失率为 3.7 [1.8]。与较高的 A1c 三分位组相比，较低的 A1c 三分位组患者 ADL 丧失更严重，更可能使用口服降糖药，而更不可能使用胰岛素或胰岛素+口服降糖药。在调整了多个混杂因素后，ADL 受损与更严格的 A1c 水平相关（B=-0.014；p=0.002）。根据抗糖尿病治疗的回归模型显示，在使用口服降糖药的患者中，更严格的 A1c 水平仍然是 ADL 丧失的独立决定因素（B=-0.023；p=0.001），尤其是在使用磺酰脲类药物（B=-0.043；p<0.001）或米格列奈类药物（B=-0.044；p=0.050）的患者中。
更严格的血糖控制与 ADL 身体依赖丧失相关，尤其是在使用磺酰脲类药物和米格列奈类药物的患者中。
