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入住医院急诊科的2型糖尿病患者的临床和药物治疗概况

Clinical and Pharmacotherapeutic Profile of Patients with Type 2 Diabetes Mellitus Admitted to a Hospital Emergency Department.

作者信息

Lopes António Cabral, Lourenço Olga, Roque Fátima, Morgado Manuel

机构信息

Pharmaceutical Services of Unity Local of Health of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal.

Health Sciences Faculty, University of Beira Interior (FCS-UBI), 6200-506 Covilhã, Portugal.

出版信息

Biomedicines. 2023 Jan 18;11(2):256. doi: 10.3390/biomedicines11020256.

Abstract

Type 2 diabetes mellitus (T2DM) is closely associated with other pathologies, which may require complex therapeutic approaches. We aim to characterize the clinical and pharmacological profile of T2DM patients admitted to an emergency department. Patients aged ≥65 years and who were already using at least one antidiabetic drug were included in this analysis. Blood glycemia, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and hemoglobin were analyzed for each patient, as well as personal pathological history, diagnosis(s) at admission, and antidiabetic drugs used before. Outcome variables were analyzed using Pearson's Chi-Square, Fisher's exact test, and linear regression test. In total, 420 patients were randomly selected (48.6% male and 51.4% female). Patients with family support showed a lower incidence of high glycemia at admission ( = 0.016). Higher blood creatinine levels were associated with higher blood glycemia ( = 0.005), and hyperuricemia (HU) ( = 0.001), as well as HU, was associated with a higher incidence of acute cardiovascular diseases (ACD) ( = 0.007). Hemoglobin levels are lower with age ( = 0.0001), creatinine ( = 0.009), and female gender ( = 0.03). The lower the AST/ALT ratio, the higher the glycemia at admission ( < 0.0001). Obese patients with ( = 0.021) or without ( = 0.027) concomitant dyslipidemia had a higher incidence of ACD. Insulin ( = 0.003) and glucagon-like peptide-1 agonists (GLP1 RA) ( = 0.023) were associated with a higher incidence of decompensated heart failure, while sulfonylureas ( = 0.009), metformin-associated with dipeptidyl peptidase-4 inhibitors (DPP4i) ( = 0.029) or to a sulfonylurea ( = 0.003) with a lower incidence. Metformin, in monotherapy or associated with DPP4i, was associated with a lower incidence of acute kidney injury ( = 0.017) or acute chronic kidney injury ( = 0.014). SGLT2i monotherapy ( = 0.0003), associated with metformin ( = 0.026) or with DPP4i ( = 0.007), as well as insulin and sulfonylurea association ( = 0.026), were associated with hydroelectrolytic disorders, unlike GLP1 RA ( = 0.017), DPP4i associated with insulin ( = 0.034) or with a GLP1 RA ( = 0.003). Insulin was mainly used by autonomous and institutionalized patients ( = 0.0008), while metformin ( = 0.003) and GLP1 RA ( < 0.0001) were used by autonomous patients. Sulfonylureas were mostly used by male patients ( = 0.027), while SGLT2 ( = 0.0004) and GLP1 RA ( < 0.0001) were mostly used by patients within the age group 65-85 years. Sulfonylureas ( = 0.008), insulin associated with metformin ( = 0.040) or with a sulfonylurea ( = 0.048), as well as DPP4i and sulfonylurea association ( = 0.031), were associated with higher blood glycemia. T2DM patients are characterized by great heterogeneity from a clinical point of view presenting with several associated comorbidities, so the pharmacotherapeutic approach must consider all aspects that may affect disease progression.

摘要

2型糖尿病(T2DM)与其他病理状况密切相关,这可能需要复杂的治疗方法。我们旨在描述急诊科收治的T2DM患者的临床和药理学特征。纳入分析的患者年龄≥65岁且已在使用至少一种抗糖尿病药物。对每位患者的血糖、肌酐、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和血红蛋白进行了分析,同时分析了个人病理史、入院诊断以及之前使用的抗糖尿病药物。使用Pearson卡方检验、Fisher精确检验和线性回归检验对结果变量进行分析。总共随机选取了420例患者(男性占48.6%,女性占51.4%)。有家庭支持的患者入院时高血糖发生率较低(P = 0.016)。较高的血肌酐水平与较高的血糖水平相关(P = 0.005),与高尿酸血症(HU)相关(P = 0.001),并且HU与急性心血管疾病(ACD)的较高发生率相关(P = 0.007)。血红蛋白水平随年龄增长(P = 0.0001)、肌酐升高(P = 0.009)以及女性性别(P = 0.03)而降低。AST/ALT比值越低,入院时血糖越高(P < 0.0001)。伴有(P = 0.021)或不伴有(P = 0.027)合并血脂异常的肥胖患者ACD发生率较高。胰岛素(P = 0.003)和胰高血糖素样肽-1激动剂(GLP1 RA)(P = 0.023)与失代偿性心力衰竭的较高发生率相关,而磺脲类药物(P = 0.009)、二甲双胍与二肽基肽酶-4抑制剂(DPP4i)联合使用(P = 0.029)或与磺脲类药物联合使用(P = 0.003)时发生率较低。二甲双胍单药治疗或与DPP4i联合使用与急性肾损伤(P = 0.017)或急性慢性肾损伤(P = 0.014)的较低发生率相关。钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)单药治疗(P = 0.0003)、与二甲双胍联合使用(P = 0.026)或与DPP4i联合使用(P = 0.007),以及胰岛素与磺脲类药物联合使用(P = 0.026)均与水电解质紊乱相关,而GLP1 RA(P = 0.017)、DPP4i与胰岛素联合使用(P = 0.034)或与GLP1 RA联合使用(P = 0.003)则不然。胰岛素主要由自主生活和机构养老的患者使用(P = 0.0008),而二甲双胍(P = 0.003)和GLP1 RA(P < 0.0001)由自主生活的患者使用。磺脲类药物大多由男性患者使用(P = 0.027),而SGLT2(P = 0.0004)和GLP1 RA(P < 0.0001)大多由65 - 85岁年龄组的患者使用。磺脲类药物(P = 0.008)、胰岛素与二甲双胍联合使用(P = 0.040)或与磺脲类药物联合使用(P = 0.048),以及DPP4i与磺脲类药物联合使用(P = 0.031)均与较高的血糖水平相关。从临床角度来看,T2DM患者具有很大的异质性,伴有多种相关合并症,因此药物治疗方法必须考虑所有可能影响疾病进展的因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eec0/9953569/709f24168083/biomedicines-11-00256-g001.jpg

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