Fonds national de la recherche scientifique - F.R.S-FNRS, Brussels, Belgium.
Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), UCLouvain, Brussels, Belgium.
BMC Endocr Disord. 2019 Aug 5;19(1):85. doi: 10.1186/s12902-019-0411-2.
Older patients with type 2 diabetes mellitus represent a heterogeneous group in terms of metabolic profile. It makes glucose-lowering-therapy (GLT) complex to manage, as it needs to be individualised according to the patient profile. This study aimed to identify and characterize subgroups existing among older patients with diabetes.
Retrospective observational cohort study of outpatients followed in a Belgian diabetes clinic. Included participants were all aged ≥75 years, diagnosed with type 2 diabetes, Caucasian, and had a Homeostasis Model Assessment (HOMA2). A latent profile analysis was conducted to classify patients using the age at diabetes diagnosis and HOMA2 variables, i.e. insulin sensitivity (HOMA2%-S), beta-cell-function (HOMA2%-β), and the product between both (HOMA2%-βxS; as a measure of residual beta-cell function). GLT was expressed in defined daily dose (DDD).
In total, 147 patients were included (median age: 80 years; 37.4% women; median age at diabetes diagnostic: 62 years). The resulting model classified patients into 6 distinct cardiometabolic profiles. Patients in profiles 1 and 2 had an older age at diabetes diagnosis (median: 68 years) and a lesser decrease in HOMA2%-S, as compared to other profiles. They also presented with the highest HOMA2%-βxS values. Patients in profiles 3, 4 and 5 had a moderate decrease in HOMA2%-βxS. Patients in profile 6 had the largest decrease in HOMA2%-β and HOMA2%-βxS. This classification was associated with significant differences in terms of HbA1c values and GLT total DDD between profiles. Thus, patients in profiles 1 and 2 presented with the lowest HbA1c values (median: 6.5%) though they received the lightest GLT (median GLT DDD: 0.75). Patients in profiles 3 to 5 presented with intermediate values of HbA1c (median: 7.3% and GLT DDD (median: 1.31). Finally, patients in profile 6 had the highest HbA1c values (median: 8.4%) despite receiving the highest GLT DDD (median: 2.28). Other metabolic differences were found between profiles.
This study identified 6 groups among patients ≥75 years with type 2 diabetes by latent profile analysis, based on age at diabetes diagnosis, insulin sensitivity, absolute and residual β-cell function. Intensity and choice of GLT should be adapted on this basis in addition to other existing recommendations for treatment individualisation.
对于 2 型糖尿病老年患者，其代谢特征存在异质性。这使得降糖治疗（GLT）的管理变得复杂，需要根据患者的特征进行个体化。本研究旨在确定并描述糖尿病老年患者中存在的亚组。
本研究为回顾性观察性队列研究，纳入在比利时一家糖尿病诊所就诊的门诊患者。纳入标准为年龄≥75 岁、诊断为 2 型糖尿病、白种人以及具有稳态模型评估 2（HOMA2）。采用潜在剖面分析，根据糖尿病诊断时的年龄和 HOMA2 变量对患者进行分类，即胰岛素敏感性（HOMA2%-S）、β细胞功能（HOMA2%-β）和两者的乘积（HOMA2%-βxS；作为剩余β细胞功能的衡量标准）。GLT 以定义日剂量（DDD）表示。
共纳入 147 例患者（中位年龄：80 岁；37.4%为女性；糖尿病诊断时的中位年龄：62 岁）。该模型将患者分为 6 种不同的代谢特征。特征 1 和 2 的患者糖尿病诊断年龄较大（中位数：68 岁），HOMA2%-S 下降幅度较小。他们还表现出最高的 HOMA2%-βxS 值。特征 3、4 和 5 的患者 HOMA2%-βxS 下降幅度适中。特征 6 的患者 HOMA2%-β 和 HOMA2%-βxS 下降幅度最大。这种分类与各特征间的 HbA1c 值和 GLT 总 DDD 存在显著差异。因此，特征 1 和 2 的患者 HbA1c 值最低（中位数：6.5%），尽管 GLT 最轻（中位数 GLT DDD：0.75）。特征 3 至 5 的患者 HbA1c 值居中（中位数：7.3%和 GLT DDD（中位数：1.31）。最后，特征 6 的患者尽管接受了最高的 GLT DDD（中位数：2.28），但 HbA1c 值最高（中位数：8.4%）。各特征间还存在其他代谢差异。
本研究通过潜在剖面分析，根据糖尿病诊断时的年龄、胰岛素敏感性、绝对和残余β细胞功能，确定了 2 型糖尿病患者≥75 岁的 6 个亚组。在此基础上，应根据 GLT 的强度和选择进行调整，同时还应根据现有的个体化治疗建议进行调整。
