Retornaz F, Grino M, Mari L, Oliver C
Dr Charles Oliver, Division of Geriatric Medicine, State Geriatric Centre, 176 Avenue de Montolivet, 13012 Marseille, Tel: 04 91 12 75 49, Fax: 04 91 12 75 52, e-mail:
J Nutr Health Aging. 2017;21(4):457-463. doi: 10.1007/s12603-016-0776-0.
To describe glycemic control in nursing home residents with diabetes and to evaluate the relevance of HbA1c in the detection of hypoglycemia risk.
Diabetes treatment, geriatric assessment, blood capillary glucose (n= 24,682), and HbA1c were collected from medical charts of 236 southern France nursing home residents during a 4-month period. Glycemic control was divided into four categories: tight, fair, and moderate or severe chronic hyperglycemia using the High Blood Glucose Index or the analysis of blood glucose frequency distribution. Hypoglycemia episodes were identified by medical or biological records.
Glucose control was tight in 59.3 % and fair in 19.1 % of the residents. Chronic exposure to hyperglycemia was observed in 21.6 % of the residents (severe in 9.7 % and moderate in 11.9 %). Hypoglycemia was noticed in 42/236 (17.8%), in all categories of glycemic control. Relative hypoglycemia risk was significantly (P = 0.0095) higher in residents with moderate chronic hyperglycemia compared with those with tight control. The majority of residents with hypoglycemia (39/42) or chronic hyperglycemia (45/51) were insulin-treated. The relative risk of hypoglycemia was not significantly associated with HbA1c values.
Hypoglycemia risk in nursing home residents is observed in all categories of glycemic control. In tight control, the potency of antidiabetic treatment should be reduced. In chronic hyperglycemia, diet and treatment should be reevaluated in order to reduce glucose variability. HbA1c is not sufficient for hypoglycemia risk detection; capillary blood glucose monitoring is warranted for nursing homes residents with diabetes.
描述养老院糖尿病患者的血糖控制情况，并评估糖化血红蛋白（HbA1c）在低血糖风险检测中的相关性。
在4个月期间，从法国南部236名养老院居民的病历中收集糖尿病治疗情况、老年评估、毛细血管血糖（n = 24,682）和HbA1c数据。使用高血糖指数或血糖频率分布分析，将血糖控制分为四类：严格、良好、中度或重度慢性高血糖。通过医疗或生物学记录确定低血糖发作情况。
59.3%的居民血糖控制严格，19.1%的居民血糖控制良好。21.6%的居民存在慢性高血糖暴露（9.7%为重度，11.9%为中度）。在所有血糖控制类别中，42/236（17.8%）的居民出现低血糖。与血糖控制严格的居民相比，中度慢性高血糖居民的相对低血糖风险显著更高（P = 0.0095）。大多数低血糖居民（39/42）或慢性高血糖居民（45/51）接受胰岛素治疗。低血糖的相对风险与HbA1c值无显著相关性。
在所有血糖控制类别中均观察到养老院居民存在低血糖风险。在严格控制血糖时，应降低降糖治疗的强度。对于慢性高血糖患者，应重新评估饮食和治疗方案，以减少血糖波动。HbA1c不足以检测低血糖风险；对于养老院糖尿病患者，有必要进行毛细血管血糖监测。
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