Sugimoto Kazuhiro, Tanaka Yuji, Sozu Takashi, Nishiyama Hiroshi, Hoshino Takehiko, Watanabe Yuko, Tamura Akira, Ohta Setsu, Yamazaki Toshiro, Suzuki Susumu, Shimbo Takuro
Diabetes Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
Department of Management Science, Tokyo University of Science Graduate School of Engineering, Tokyo, Japan.
Diabetes Ther. 2020 May;11(5):1179-1190. doi: 10.1007/s13300-020-00814-0. Epub 2020 Apr 9.
Persons with type 2 diabetes (T2D) are known to experience impaired physical ability even at the early stages of the disease. However, less attention has been paid to increasing physical ability than to increasing physical activity in the treatment of T2D. The aim of this study was to assess whether improved physical ability parameters are associated with the discontinuation of injectable medications once glycemic targets have been achieved among inpatients with inadequately controlled T2D across a wide range of ages.
Forty-three patients with glycated hemoglobin levels of ≥ 7.5% (58 mmol/mol) aged between 19 and 82 years who received insulin, glucagon-like peptide-1 receptor agonists or both at admission were enrolled in the study. Muscle strength for knee extension, one-leg standing time with eyes open test(OLST), whole-body reaction time and maximal oxygen uptake were assessed as parameters of physical ability.
At admission, patients who during hospitalization discontinued injectable medications (n = 29; Discontinued group) had a shorter duration of diabetes, lower fat mass and higher skeletal muscle mass and performed better on all of the physical ability test parameters than those who continued on injectable medications during hospitalization (n = 14; Continued group). At discharge, patients in the Discontinued group had achieved better glycemic control than those in the Continued group, as indicated by lower mean plasma glucose levels according to the 7-point profile. Stepwise logistic regression analysis that included those variables that were significantly different between the Continued group and the Discontinued group, with the aim to identify candidate(s) of explanatory variables, revealed that only OLST was significantly associated with the discontinuation of injectable medication. Patients with an OLST of ≥ 60 s were more likely to discontinue injectable medication than those with an OLST of < 60 s (odds ratio 18.9; 95% confidence interval 2.0-178.8; p = 0.011).
Among inpatients with inadequately controlled T2D diabetes, longer OLST appear to be associated with discontinuing injectable medications during hospitalization. OLST could possibly be useful as a novel patient factor to consider in de-intensifying injectable medication.
众所周知，2型糖尿病（T2D）患者即使在疾病早期也会出现身体能力受损的情况。然而，在T2D治疗中，相较于增加身体活动，提高身体能力受到的关注较少。本研究的目的是评估在广泛年龄范围内，血糖目标达成后，身体能力参数的改善是否与住院治疗中未得到充分控制的T2D患者停用注射药物有关。
纳入43例糖化血红蛋白水平≥7.5%（58 mmol/mol）、年龄在19至82岁之间、入院时接受胰岛素、胰高血糖素样肽-1受体激动剂或两者联合治疗的患者。评估膝关节伸展肌力、睁眼单腿站立时间测试（OLST）、全身反应时间和最大摄氧量作为身体能力参数。
入院时，住院期间停用注射药物的患者（n = 29；停用组）糖尿病病程较短，脂肪量较低，骨骼肌量较高，并且在所有身体能力测试参数上的表现均优于住院期间继续使用注射药物的患者（n = 14；继续组）。出院时，停用组患者的血糖控制情况优于继续组，根据7点血糖谱，其平均血浆葡萄糖水平更低。逐步逻辑回归分析纳入了继续组和停用组之间存在显著差异的变量，旨在确定解释变量的候选因素，结果显示只有OLST与停用注射药物显著相关。OLST≥60秒的患者比OLST<60秒的患者更有可能停用注射药物（比值比18.9；95%置信区间2.0 - 178.8；p = 0.011）。
在未得到充分控制的T2D住院患者中，较长的OLST似乎与住院期间停用注射药物有关。OLST可能作为一种新的患者因素，在减少注射药物使用强度时加以考虑。
