Yamamoto-Honda Ritsuko, Takahashi Yoshihiko, Mori Yasumichi, Yamashita Shigeo, Yoshida Yoko, Kawazu Shoji, Iwamoto Yasuhiko, Kajio Hiroshi, Yanai Hidekatsu, Mishima Shuichi, Handa Nobuhiro, Shimokawa Kotaro, Yoshida Akiko, Watanabe Hiroki, Ohe Kazuhiko, Shimbo Takuro, Noda Mitsuhiko
Department of Diabetes Research and Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Japan.
Health Management Center, Toranomon Hospital, Japan.
Intern Med. 2018 May 1;57(9):1229-1240. doi: 10.2169/internalmedicine.9481-17. Epub 2017 Dec 27.
Objective To analyze the changes in the pharmacotherapy and glycemic control trends in elderly patients with type 2 diabetes mellitus (T2DM) in Japan. Methods We extracted the data of 7,590 patients (5,396 men and 2,194 women; median year of birth: 1945) with T2DM registered in the National Center Diabetes Database for the years 2005 to 2013, and conducted age-stratified (<65, 65-74, and ≥75 years of age) analyses. Results The hemoglobin A1c (HbA1c) levels declined from 2005 to 2013, and for those who received antihyperglycemic drug prescription, the HbA1c levels were lower in the older age group than in the younger age group. In the ≥75 age group, dipeptidyl peptidase-4 inhibitors (DPP4i) became the most frequently prescribed drug (49.1%) in 2013, and sulfonylureas remained the second-most frequently prescribed drug (37.8%) with decreased prescribed doses. The prescription ratio of oral drugs associated with a risk of hypoglycemia was higher in patients ≥75 years of age than in those <75 years of age (40.5% and 26.4%, respectively in 2013), although it showed a downward trend. The prescription rates of insulin for patients ≥75 years of age increased during the study period. Conclusion The pharmacotherapy trends for elderly patients with T2DM changed dramatically in Japan with the launch of DPP4i in 2009. Glycemic control in a considerable portion of the ≥75 age group in Japan was maintained at the expense of potential hypoglycemia by the frequent, although cautious, use of sulfonylureas, glinides and insulin.
目的 分析日本老年2型糖尿病（T2DM）患者药物治疗及血糖控制趋势的变化。方法 我们提取了2005年至2013年在日本国立糖尿病数据库中注册的7590例T2DM患者（5396例男性和2194例女性；出生年份中位数：1945年）的数据，并进行了年龄分层（<65岁、65 - 74岁和≥75岁）分析。结果 2005年至2013年糖化血红蛋白（HbA1c）水平下降，接受降糖药物处方的患者中，老年组的HbA1c水平低于年轻组。在≥75岁年龄组中，2013年二肽基肽酶 - 4抑制剂（DPP4i）成为最常用药物（49.1%），磺脲类药物仍是第二常用药物（37.8%），但其处方剂量有所减少。≥75岁患者中与低血糖风险相关的口服药物处方率高于<75岁患者（2013年分别为40.5%和26.4%），尽管呈下降趋势。在研究期间，≥75岁患者的胰岛素处方率有所增加。结论 2009年DPP4i在日本上市后，老年T2DM患者的药物治疗趋势发生了巨大变化。日本相当一部分≥75岁年龄组患者的血糖控制是以频繁（尽管谨慎）使用磺脲类药物、格列奈类药物和胰岛素导致潜在低血糖为代价维持的。
