Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Geriatr Gerontol Int. 2022 Aug;22(8):560-567. doi: 10.1111/ggi.14415. Epub 2022 Jun 30.
To investigate the achievement of individualized target HbA1c based on the Japanese guideline after geriatric assessment with the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) and to evaluate patient characteristics acting as barriers to achieving the target HbA1c in elderly outpatients with diabetes.
This cross-sectional study enrolled 303 Japanese outpatients aged ≥65 years with diabetes. Their health status was measured using the DASC-8. The target HbA1c was optimized for each patient by the guideline based on the DASC-8 score and use of drugs potentially associated with severe hypoglycemia. Patient characteristics related to the agreement between measured HbA1c and target HbA1c were extracted by multivariate logistic regression analysis.
The mean age was 73.0 years and the mean body mass index (BMI) was 24.2 kg/m . The agreement between measured HbA1c and target HbA1c was 43.9% (95% confidence interval: 38.4%-50.0%). In multivariate logistic regression analysis, the agreement in patients with drugs potentially associated with severe hypoglycemia was significantly lower than in those without these drugs (37.8% vs. 60.5%, P = 0.0004). In patients with these drugs, higher BMI (P = 0.0271) and higher fasting plasma glucose (P = 0.0034) were independent related factors for measured HbA1c being higher than target HbA1c. Vulnerable elderly patients (P = 0.0116) and not taking sodium glucose co-transporter-2 (SGLT2) inhibitor (P = 0.0186) were independent related factors for inappropriately lower HbA1c.
The agreement between measured HbA1c and target HbA1c was low in elderly patients with diabetes. Geriatr Gerontol Int 2022; 22: 560-567.
通过使用社区综合护理系统 8 项痴呆评估表（DASC-8）进行老年综合评估，根据日本指南调查基于个体化目标 HbA1c 的达标情况，并评估作为老年糖尿病门诊患者达到目标 HbA1c 障碍的患者特征。
本横断面研究纳入了 303 名年龄≥65 岁的日本糖尿病门诊患者。使用 DASC-8 评估他们的健康状况。根据 DASC-8 评分和可能与严重低血糖相关的药物的使用情况，通过指南为每位患者优化目标 HbA1c。通过多变量逻辑回归分析提取与实测 HbA1c 和目标 HbA1c 之间一致性相关的患者特征。
患者的平均年龄为 73.0 岁，平均体重指数（BMI）为 24.2 kg/m 。实测 HbA1c 和目标 HbA1c 之间的一致性为 43.9%（95%置信区间：38.4%-50.0%）。在多变量逻辑回归分析中，与可能导致严重低血糖的药物相关的患者的一致性明显低于无这些药物的患者（37.8%与 60.5%，P=0.0004）。在使用这些药物的患者中，较高的 BMI（P=0.0271）和较高的空腹血糖（P=0.0034）是实测 HbA1c 高于目标 HbA1c 的独立相关因素。脆弱的老年患者（P=0.0116）和未服用钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂（P=0.0186）是 HbA1c 不适当降低的独立相关因素。
老年糖尿病患者实测 HbA1c 和目标 HbA1c 的一致性较低。老年医学与老年健康学杂志 2022；22：560-567。
