University of Florence, Viale Morgagni, 50 - 50134 Firenze, Italy.
University of Florence, Viale Morgagni, 50 - 50134 Firenze, Italy.
Diabetes Res Clin Pract. 2020 Dec;170:108498. doi: 10.1016/j.diabres.2020.108498. Epub 2020 Oct 15.
The Primary aim is to verify physicians' adherence to the 2016 Italian diabetes guidelines therapeutic targets, and their habits on deprescription in elderly persons with Type 2 Diabetes Mellitus (T2DM). Secondary aims are the assessment of the potential impact of the targets' changes in 2018 Italian guidelines, and the outcomes of deprescription in the management of T2DM.
Observational retrospective cohort study, enrolling persons with T2DM, aged > 75 years, who attended a visit throughout 2017, and a second visit 6 months later in our outpatient clinic.
Of the 387 patients included, 336 (87, 8%) were on target, according to 2016 guidelines. Deprescription was advisable in 62% of patients on target. Among those, 22% were deprescribed. In patients undergoing deprescription, during the following 6 months, no severe hypoglycemia occurred (versus 5 cases in the prior 6 months). Glycated Hemoglobin (HbA1c) increased (p < 0.05) from 47.0 [41.7-51.0] to 53.0 [45.4-59.5] mmol/mol). Applying to the sample the 2018 Italian Guidelines targets, 57.2% would have been on target, 18.5% above, and 24.3% below (needing deprescription).
In our study, a minority of suitable patients received deprescription. Deprescription led to a significant reduction in severe hypoglycemia rate, whereas HbA1c remained on target in the majority of cases.
主要目的是验证医生对 2016 年意大利糖尿病指南治疗目标的遵守情况，以及他们在 2 型糖尿病（T2DM）老年患者中减药的习惯。次要目的是评估 2018 年意大利指南中目标变化的潜在影响，以及在 T2DM 管理中减药的结果。
这是一项观察性回顾性队列研究，纳入了 2017 年在我们的门诊就诊并在 6 个月后进行第二次就诊的年龄 > 75 岁的 T2DM 患者。
在 387 名患者中，根据 2016 年指南，有 336 名（87.8%）患者达标。在目标人群中，62%的患者需要减药。其中，22%的患者进行了减药。在接受减药的患者中，在接下来的 6 个月内，没有发生严重低血糖（而在之前的 6 个月内有 5 例）。糖化血红蛋白（HbA1c）从 47.0 [41.7-51.0] mmol/mol 增加到 53.0 [45.4-59.5] mmol/mol）（p < 0.05）。如果应用 2018 年意大利指南的目标，57.2%的患者将会达标，18.5%的患者超标，24.3%的患者需要减药。
在我们的研究中，只有少数合适的患者接受了减药。减药显著降低了严重低血糖的发生率，而大多数情况下 HbA1c 仍保持在目标范围内。
