van Mark Gesine, Tittel Sascha R, Sziegoleit Stefan, Putz Franz Josef, Durmaz Mesut, Bortscheller Michaela, Buschmann Ivo, Seufert Jochen, Holl Reinhard W, Bramlage Peter
Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany.
Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany.
Ther Adv Endocrinol Metab. 2020 Sep 20;11:2042018820958296. doi: 10.1177/2042018820958296. eCollection 2020.
The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age.
The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50-59 (middle-young), 60-69 (young-old), 70-79 (middle-old), 80-89 (old), and 90 years or more (oldest-old).
A total of 396,719 patients were analyzed, of which 17.7% were 50-59 years, 27.7% 60-69 years, 34.3% 70-79 years, 18.3% 80-89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% 8.0 ± 2.2%; < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 1.6%; < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications.
In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.
2型糖尿病（T2DM）老年患者和年轻患者的临床特征有所不同。我们基于一个大型真实世界数据库，探讨了不同年龄段患者的特征、疾病特点及实际治疗模式。
分析基于T2DM患者的DIVE和DPV登记数据。患者按年龄组分为50 - 59岁（中青年）、60 - 69岁（年轻老年）、70 - 79岁（中老年）、80 - 89岁（老年）以及90岁及以上（高龄老年）进行分析。
共分析了396,719例患者，其中50 - 59岁的占17.7%，60 - 69岁的占27.7%，70 - 79岁的占34.3%，80 - 89岁的占18.3%，90岁及以上的占2.0%。我们发现：（a）与年轻患者相比，老年和高龄老年T2DM患者中高血压、肥胖、血脂异常和吸烟等代谢危险因素的存在情况较少；（b）高龄老年患者的糖化血红蛋白（HbA1c）水平明显低于中青年患者（7.2±1.6%对8.0±2.2%；P<0.001），但严重低血糖患者的比例更高（7.0对1.6%；P<0.001）；（c）这可能与老年患者胰岛素使用率较高且呈上升趋势（从17.6%升至37.6%，P<0.001）以及这些患者的特殊合并症情况有关，例如慢性肾脏病（CKD）；（d）糖尿病发病较晚的患者HbA1c值较低、体重较轻且心血管危险因素较少；（e）糖尿病病程较长的患者大血管并发症尤其是微血管并发症显著增加。
对于高龄患者，需要进行频繁且仔细的常规评估以及量身定制的药物治疗，其中患者安全比降糖疗效更为重要。
