Munshi Medha N, Slyne Christine, Segal Alissa R, Saul Nora, Lyons Courtney, Weinger Katie
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115.
Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215.
J Diabetes Complications. 2017 Jul;31(7):1197-1199. doi: 10.1016/j.jdiacomp.2017.02.014. Epub 2017 Mar 14.
Hemoglobin A1C is universally used as a marker for glycemic control and to establish glycemic goals in patients with diabetes. In the older population, experts recommend liberating A1C goals to decrease the risk of hypoglycemia. However, it's not clear which A1C level is optimal for this purpose. This study's aim was to understand the relationship between A1C levels and risk of hypoglycemia.
In a prospective study, we performed continuous glucose monitoring (CGM) on older adults on insulin. Hypoglycemia duration and A1C were measured at baseline while patients were on multiple insulin injections, and again after de-intensification to once-a-day basal insulin with non-insulin agents.
We assessed 65 patients; mean age76±6years with on average 3.7±1.3 insulin injections/day. At baseline, 26% of the patients had A1C<7% (53mmol/mol), 42% between 7.1% and 8% (54-64mmol/mol), 21% between 8.1% and 9% (65-75mmol/mol), and 11% >9% (76mmol/mol). The duration of hypoglycemia (<70mg/dl, <60mg/dl, <50mg/dl) was not different between the A1c groups, regardless of treatment intensity (multiple insulin injections or once-a-day-basal insulin with non-insulin agents).
A1C levels are not associated with hypoglycemia risk in older population with type-2 diabetes on insulin therapy. Higher A1C goals do not protect against hypoglycemia.
糖化血红蛋白A1C被广泛用作血糖控制的指标，并用于确定糖尿病患者的血糖目标。在老年人群中，专家建议放宽A1C目标以降低低血糖风险。然而，尚不清楚在此目的下哪个A1C水平最为适宜。本研究的目的是了解A1C水平与低血糖风险之间的关系。
在一项前瞻性研究中，我们对使用胰岛素的老年人进行了持续葡萄糖监测（CGM）。在基线时，当患者接受多次胰岛素注射时测量低血糖持续时间和A1C，在强化治疗改为每日一次基础胰岛素联合非胰岛素药物后再次测量。
我们评估了65例患者；平均年龄76±6岁，平均每天注射胰岛素3.7±1.3次。基线时，26%的患者A1C<7%（53mmol/mol），42%在7.1%至8%（54 - 64mmol/mol）之间，21%在8.1%至9%（65 - 75mmol/mol）之间，11%>9%（76mmol/mol）。无论治疗强度如何（多次胰岛素注射或每日一次基础胰岛素联合非胰岛素药物），A1C组之间低血糖持续时间（<70mg/dl、<60mg/dl、<50mg/dl）并无差异。
在接受胰岛素治疗的老年2型糖尿病患者中，A1C水平与低血糖风险无关。较高的A1C目标并不能预防低血糖。
