Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Sci Rep. 2020 Mar 5;10(1):4095. doi: 10.1038/s41598-020-60818-5.
Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucose-lowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA-values <42 mmol/mol (<6%), and 1% had critically low Hba values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA-values suggesting overtreatment.
治疗 2 型糖尿病 (T2D) 的指南建议避免老年患者发生低血糖和更严格的血糖控制。我们研究了在丹麦首都地区 2012-2016 年住院的 2 型糖尿病诊断年龄>80 岁的患者队列中，血糖控制与降糖药物使用之间的关系。我们从医院记录中提取了药物使用、诊断和生物化学数据。我们确定了 5172 名患有高度合并症的 T2D 患者，其中 17%的患者 HbA 处于建议用于虚弱、合并症较多的老年 2 型糖尿病患者的范围内 (58-75 mmol/mol (7.5-9%))。一半的患者 (n = 2575) 的 HbA <48 mmol/mol (<6.5%)，其中大多数 (所有患者的 36%) 不符合 2 型糖尿病的诊断标准。在接受一种或多种降糖药物治疗的患者中 (n = 1758)，20%的患者 HbA 值<42 mmol/mol (<6%)，1%的患者 HbA 值<30 mmol/mol (<4.9%)，提示存在严重低血糖。总之，在这些住院的 2 型糖尿病患者中，很少有患者的 HbA 在一般推荐的血糖目标范围内。三分之一的患者不符合 2 型糖尿病的诊断标准，在接受降糖药物治疗的患者中，五分之一的患者 HbA 值提示过度治疗。
