Department of Geriatrics, Medical University of Bialystok, Fabryczna str. 27; 15-471, Bialystok, Poland.
Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland.
BMC Geriatr. 2019 Sep 2;19(1):242. doi: 10.1186/s12877-019-1256-2.
Glycemic control targets in older patients should be individualized according to functional status and comorbidities. The aim of the study was to identify high-risk patients who had evidence of tight glycemic control and thus at risk of serious hypoglycemia.
Retrospective cross-sectional study of type 2 diabetes patients admitted to the geriatric ward receiving diabetes medications. Patients' hospital records were analyzed. The high risk of hypoglycemia group constituted patients who were aged 80+ years, diagnosed with dementia, with end- stage renal disease, or with a history of macrovascular complications. The primary outcome measure was hemoglobin A (HbA) ≤ 7.0% [53 mmol/mol].
Two hundred thirteen patients were included (77.5% women; 49.3% 80+ year-old). 65.3% received sulfonylurea, 39,4%- metformin, 32.9%- insulin, and 4.2%- acarbose (in 61.5% as monotherapy, and in 38.5% combination therapy). We identified 130 patients (60%) as the denominator for the primary outcome measure; 73.1% had a HbA value ≤7.0% [53.3 mmol/mol], but 55.4% ≤6,5% [48.8 mmol/mol], and 40.8% ≤6.0% [42 mmol/mol].
The results show a very high rate of tight glycemic control in older patients admitted to the geriatric ward, for whom higher HbA targets are recommended. This indicates the high probability of diabetes overtreatment in this group, associated with a high risk of recurrent hypoglycemia. This is all the more likely because most of them received medications known to cause hypoglycemia. This points to the need of paying more attention to specific difficulties in diabetes treatment in older people, especially those suffering from various geriatric syndromes and diseases worsening their prognosis.
老年患者的血糖控制目标应根据其功能状态和合并症进行个体化。本研究的目的是确定存在严格血糖控制证据且因此有发生严重低血糖风险的高危患者。
这是一项回顾性的 2 型糖尿病老年患者的横断面研究，这些患者在老年病房接受糖尿病药物治疗。分析患者的住院病历。低血糖高风险组包括年龄 80 岁以上、诊断为痴呆、终末期肾病或有大血管并发症病史的患者。主要结局指标为糖化血红蛋白（HbA）≤7.0%[53mmol/mol]。
共纳入 213 例患者（77.5%为女性；49.3%为 80 岁以上）。65.3%的患者接受磺脲类药物治疗，39.4%接受二甲双胍治疗，32.9%接受胰岛素治疗，4.2%接受阿卡波糖治疗（61.5%为单药治疗，38.5%为联合治疗）。我们确定了 130 例患者（60%）作为主要结局指标的分母；73.1%的患者 HbA 值≤7.0%[53.3mmol/mol]，但 55.4%≤6.5%[48.8mmol/mol]，40.8%≤6.0%[42mmol/mol]。
研究结果显示，老年患者住院期间血糖控制非常严格，建议对该人群采用更高的 HbA 目标值。这表明该组人群糖尿病治疗过度的可能性很高，与反复发生低血糖的风险增加相关。鉴于大多数患者使用的药物都可能导致低血糖，这种情况更有可能发生。这表明有必要更加关注老年人糖尿病治疗中的特殊困难，尤其是患有各种老年综合征和疾病、导致预后变差的患者。
