Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester.
West Norfolk Clinical Commissioning Group, King's Lynn, Norfolk.
Diabet Med. 2017 Sep;34(9):1219-1227. doi: 10.1111/dme.13380. Epub 2017 Jun 5.
AIM: To evaluate potential overtreatment with sulfonylurea and insulin therapies amongst older people with Type 2 diabetes, including those with chronic kidney disease or dementia. METHODS: Using the ECLIPSE Live software tool, we developed a search to examine data on older people (age ≥ 70 years) with Type 2 diabetes, who were prescribed sulfonylurea or insulin therapies over the previous 90 days. Sixteen Norfolk general practices participated, representing a population of 24 661 older people, including 3862 (15.7%) with Type 2 diabetes. Of these, 1379 (35.7%) people were prescribed sulfonylurea or insulin therapies. Data extracted included age, sex, last recorded HbA value, renal function and dementia codes. RESULTS: The median age of the study cohort was 78 years. A total of 644 people (47.8%) had chronic kidney disease (estimated GFR < 60 mL/min/1.73m ) and 60 people (4.35%) had dementia. The median (interquartile range) HbA concentration for the entire cohort was 58 (51-69) mmol/mol [7.5 (6.8-8.5)%], with no difference in median HbA between those with or without either chronic kidney disease or dementia. In total, 400 older people (29.9%) had an HbA concentration < 53 mmol/mol (7%), of whom 162 (12.1%) had HbA < 48 mmol/mol (6.5%). Stratified by prescription for sulfonylurea, insulin or combined insulin and sulfonylurea therapies, 282 (35.2%), 93 (24.2%) and 25 people (16.3%), respectively, had HbA < 53 mmol/mol (7.0%). Treatment to an HbA target of < 53 mmol/mol (7.0%) was as prevalent in those with chronic kidney disease or dementia as in those without. CONCLUSION: In the present cohort of older people with Type 2 diabetes prescribed sulfonylurea or insulin therapies, overtreatment was common, even in the presence of comorbidities known to increase hypoglycaemia risk.
目的:评估患有 2 型糖尿病的老年人(包括患有慢性肾病或痴呆症的患者)中磺酰脲类药物和胰岛素治疗的过度治疗情况。
方法:使用 ECLIPSE Live 软件工具,我们开发了一项搜索,以检查过去 90 天内接受磺酰脲类药物或胰岛素治疗的年龄≥70 岁的 2 型糖尿病患者的数据。16 家诺福克全科诊所参与了研究,代表了 24661 名老年人的人群,其中 3862 人(15.7%)患有 2 型糖尿病。在这些人中,有 1379 人(35.7%)接受了磺酰脲类药物或胰岛素治疗。提取的数据包括年龄、性别、上次记录的 HbA 值、肾功能和痴呆症代码。
结果:研究队列的中位年龄为 78 岁。共有 644 人(47.8%)患有慢性肾病(估计肾小球滤过率<60mL/min/1.73m ),60 人(4.35%)患有痴呆症。整个队列的 HbA 中位数(四分位距)为 58(51-69)mmol/mol[7.5(6.8-8.5)%],慢性肾病或痴呆症患者的 HbA 中位数无差异。共有 400 名老年人(29.9%)HbA 浓度<53mmol/mol(7%),其中 162 名(12.1%)HbA<48mmol/mol(6.5%)。按磺酰脲类药物、胰岛素或胰岛素和磺酰脲类药物联合处方分层,分别有 282 人(35.2%)、93 人(24.2%)和 25 人(16.3%)HbA<53mmol/mol(7.0%)。HbA<53mmol/mol(7.0%)的治疗目标在患有慢性肾病或痴呆症的患者中与没有这些疾病的患者一样普遍。
结论:在本队列中,接受磺酰脲类药物或胰岛素治疗的患有 2 型糖尿病的老年人中,过度治疗很常见,即使存在已知会增加低血糖风险的合并症也是如此。
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