实时连续血糖监测对65岁及以上患者的影响。
The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older.
作者信息
Polonsky William H, Peters Anne L, Hessler Danielle
机构信息
University of California, San Diego, CA, USA Behavioral Diabetes Institute, San Diego, CA, USA
University of Southern California, Los Angeles, CA, USA.
出版信息
J Diabetes Sci Technol. 2016 Jun 28;10(4):892-7. doi: 10.1177/1932296816643542. Print 2016 Jul.
BACKGROUND
Older adults with type 1 diabetes (T1D) or insulin-using type 2 diabetes (iT2D) are at high risk for severe hypoglycemic episodes. Real-time continuous glucose monitoring (RT-CGM) in this population may reduce this risk, but when patients switch to Medicare at age 65, RT-CGM is no longer a covered benefit. We developed a survey to examine health and quality of life (QOL) benefits of RT-CGM in seniors (age ≥ 65).
METHODS
Two groups of seniors with T1D or iT2D-current RT-CGM users (n = 210) and RT-CGM "hopefuls" (patients who wanted but could not obtain RT-CGM due to lack of insurance coverage; n = 75)-completed an online survey. The survey examined history of hypoglycemic experiences as well as current quality of life (QOL), including generic and diabetes-specific measures.
RESULTS
Current users reported fewer moderate (P < .01) and fewer severe hypoglycemic episodes (P < .01) over the past 6 months than "hopefuls" and greater reductions over time in hypoglycemic events requiring the assistance of another, ER visits, and paramedic visits to the home (in all cases, P < .01). Regarding QOL, current users reported significantly better well-being (P < .001), less hypoglycemic fear (P < .05), and less diabetes distress (P < .05) than "hopefuls."
CONCLUSIONS
These data suggest that RT-CGM use in seniors is associated with reductions in episodes of severe hypoglycemia and improved QOL, suggesting that restrictive access to RT-CGM in the Medicare age population may have deleterious health, economic, and QOL consequences.
背景
1型糖尿病（T1D）或使用胰岛素的2型糖尿病（iT2D）老年患者发生严重低血糖事件的风险较高。该人群使用实时连续血糖监测（RT-CGM）可能会降低这种风险，但当患者65岁转为医疗保险时，RT-CGM不再是一项涵盖的福利。我们开展了一项调查，以研究RT-CGM对老年人（年龄≥65岁）健康和生活质量（QOL）的益处。
方法
两组患有T1D或iT2D的老年人——当前的RT-CGM使用者（n = 210）和RT-CGM“渴望者”（因缺乏保险覆盖而想要但无法获得RT-CGM的患者；n = 75）——完成了一项在线调查。该调查考察了低血糖经历史以及当前的生活质量（QOL），包括一般和糖尿病特异性指标。
结果
与“渴望者”相比，当前使用者在过去6个月中报告的中度低血糖事件（P < .01）和严重低血糖事件较少（P < .01），并且随着时间推移，在需要他人协助的低血糖事件、急诊就诊以及护理人员上门就诊方面的减少幅度更大（在所有情况下，P < .01）。关于生活质量，当前使用者报告的幸福感明显更好（P < .001），低血糖恐惧更少（P < .05），糖尿病困扰更少（P < .05）。
结论
这些数据表明，老年人使用RT-CGM与严重低血糖事件发作减少和生活质量改善相关，这表明医疗保险年龄人群对RT-CGM的限制使用可能会对健康、经济和生活质量产生有害影响。
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