Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan.
Geriatr Gerontol Int. 2019 Oct;19(10):1030-1035. doi: 10.1111/ggi.13765. Epub 2019 Sep 4.
It is important to consider hypoglycemia for glycemic control in elderly patients with type 2 diabetes. Continuous blood glucose monitoring system is an effective method to investigate blood glucose fluctuation. This study examined hypoglycemia frequency using continuous blood glucose monitoring system in older patients with type 2 diabetes.
A total of 70 patients with type 2 diabetes aged >65 years, receiving oral treatment only and having a glycated hemoglobin (HbA1c) level of <8% were enrolled. Flash glucose monitoring system was used for the device. Patients were classified into three groups according to the type of medicine administered, in addition to other oral hypoglycemics, and were compared: (i) those taking sulfonylureas (SU); (ii) those taking glinides; and (iii) those who did not take either SU or glinides.
There was a significant positive correlation between the coefficient of variation and hypoglycemic frequency in all the patients, and a significant negative correlation between HbA1c and hypoglycemia in those receiving SU. When hypoglycemia was defined as glucose levels <54 mg/dL and <70 mg/dL, the cut-off HbA1c values for developing hypoglycemia were 6.3% and 6.7%, sensitivity was 75.0% and 76.2%, and specificity was 90.9% and 77.6%, respectively.
In older patients with type 2 diabetes receiving SU, hypoglycemic frequency increases with decreases in HbA1c level. In particular, in patients with HbA1c levels of <6.3% receiving SU, it is necessary to consider medication modification. Geriatr Gerontol Int 2019; 19: 1030-1035.
对于 2 型糖尿病老年患者，考虑血糖控制时低血糖症很重要。连续血糖监测系统是研究血糖波动的有效方法。本研究通过连续血糖监测系统检查了老年 2 型糖尿病患者的低血糖症发生频率。
共纳入 70 例年龄>65 岁、仅接受口服治疗且糖化血红蛋白（HbA1c）水平<8%的 2 型糖尿病患者。使用瞬感葡萄糖监测系统。根据患者服用的药物类型（除其他口服降糖药外）将患者分为三组：（i）服用磺脲类药物（SU）的患者；（ii）服用格列奈类药物的患者；（iii）未服用 SU 或格列奈类药物的患者。
所有患者的变异系数与低血糖症发生频率呈显著正相关，服用 SU 的患者的 HbA1c 与低血糖症呈显著负相关。当低血糖症定义为血糖水平<54mg/dL 和<70mg/dL 时，发生低血糖症的 HbA1c 临界值分别为 6.3%和 6.7%，灵敏度分别为 75.0%和 76.2%，特异性分别为 90.9%和 77.6%。
在接受 SU 治疗的老年 2 型糖尿病患者中，低血糖症发生频率随 HbA1c 水平降低而增加。特别是在接受 SU 治疗且 HbA1c 水平<6.3%的患者中，有必要考虑药物调整。老年医学与老年病学杂志 2019；19：1030-1035。
