Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba City, Chiba, Japan.
Geriatric Medical Center, Chiba University Hospital, Chiba City, Chiba, Japan.
J Diabetes Investig. 2018 Jan;9(1):69-74. doi: 10.1111/jdi.12676. Epub 2017 May 24.
AIMS/INTRODUCTION: The incidence of type 2 diabetes is higher in elderly patients, in whom this disease is associated with dementia, falling, stroke and death. We utilized a continuous glucose monitoring device to analyze the relationship between hypoglycemia and diabetes treatments to identify risk factors for hypoglycemia (defined as a blood glucose level <70 mg/dL).
We classified 170 patients aged ≥65 years with type 2 diabetes who were receiving steady-state medication (29 of whom were inpatients) into hypoglycemic and non-hypoglycemic groups, and compared their glycosylated hemoglobin levels, treatment types, continuous glucose monitoring data and other parameters. We carried out univariate analyses to identify variables associated with hypoglycemia risk, followed by multivariate analyses of drug class and other factors. The accuracy of the continuous glucose monitoring data was confirmed by calibration.
Hypoglycemia risk was higher in the patients using insulin (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.16-4.08, P = 0.015), and lower in patients who were being treated with dipeptidyl peptidase-4 inhibitors (OR 0.47, 95% CI: 0.25-0.89, P = 0.019). Patients with lower variability in blood glucose had a significantly lower hypoglycemia risk (OR 0.87, 95% CI: 0.83-0.91, P < 0.0001), and those with a lower average blood glucose level had a significantly higher risk (OR 1.09, 95% CI: 1.06-1.12, P < 0.0001).
In patients aged ≥65 years with type 2 diabetes, higher glucose variability and lower average glucose levels indicate a greater hypoglycemia risk. It is therefore necessary to ensure comprehensive blood glucose control in such patients to prevent hypoglycemia.
目的/引言：2 型糖尿病在老年患者中的发病率较高，此类患者易并发痴呆、跌倒、中风和死亡。我们利用连续血糖监测仪分析了低血糖与糖尿病治疗之间的关系，以确定低血糖的危险因素（定义为血糖水平<70mg/dL）。
我们将 170 名年龄≥65 岁且正在接受稳态药物治疗（其中 29 名住院患者）的 2 型糖尿病患者分为低血糖组和非低血糖组，并比较了他们的糖化血红蛋白水平、治疗类型、连续血糖监测数据和其他参数。我们进行了单变量分析以确定与低血糖风险相关的变量，然后进行了药物类别和其他因素的多变量分析。通过校准确认了连续血糖监测数据的准确性。
使用胰岛素的患者发生低血糖的风险更高（优势比 [OR] 2.17，95%置信区间 [CI] 1.16-4.08，P=0.015），使用二肽基肽酶-4 抑制剂的患者发生低血糖的风险更低（OR 0.47，95% CI：0.25-0.89，P=0.019）。血糖波动较小的患者发生低血糖的风险显著降低（OR 0.87，95% CI：0.83-0.91，P<0.0001），而平均血糖水平较低的患者发生低血糖的风险显著升高（OR 1.09，95% CI：1.06-1.12，P<0.0001）。
在年龄≥65 岁的 2 型糖尿病患者中，血糖波动较大且平均血糖水平较高表明低血糖风险较高。因此，有必要在这些患者中确保全面的血糖控制，以预防低血糖。
