Idrees T, Zabala Z E, Moreno E M, Gerges A, Urrutia M A, Ruiz J G, Vaughan C, Vellanki P, Pasquel F J, Peng L, Umpierrez G E
Emory University School of Medicine, Atlanta, GA, United States.
Emory University School of Medicine, Atlanta, GA, United States.
Diabetes Res Clin Pract. 2023 Apr;198:110603. doi: 10.1016/j.diabres.2023.110603. Epub 2023 Mar 5.
Older adults with diabetes in the hospital are generally managed similarly to younger adults, however, it is unknown if the degree of frailty can affect glucose control among hospitalized patients.
We examined glycemic parameters derived from continuous glucose monitoring (CGM) in older adults with type 2 diabetes and frailty who were hospitalized in non-acute settings. Data was pooled from 3 prospective studies using CGM including 97 patients wearing Libre CGM sensors and 166 patients wearing Dexcom G6 CGM. Glycemic parameters (time in range (TIR) 70-180; time below range (TBR) <70 and 54 mg/dl) by CGM were compared between 103 older adults ≥60 years and 168 younger adults <60 years. Frailty was assessed using validated laboratory and vital signs frailty index FI-LAB (n = 85), and its effect on hypoglycemia risk was studied.
Older adults, as compared to younger adults, had significantly lower admission HbA1c (8.76% ± 1.82 vs. 10.25% ± 2.29, p < 0.001), blood glucose (203.89 ± 88.65 vs. 247.86 ± 124.17 mg/dl, p = 0.003), mean daily BG (173.9 ± 41.3 vs. 183.6 ± 45.0 mg/dl, p = 0.07) and higher percent TIR 70-180 mg/dl (59.0 ± 25.6% vs. 51.0 ± 26.1%, p = 0.02) during hospital stay. There was no difference in hypoglycemia occurrence between older and younger adults. Higher FI-LAB score was associated with higher % CGM < 70 mg/dl (0.204) and % CGM < 54 mg/dl (0.217).
Older adults with type 2 diabetes have better glycemic control prior to admission and during hospital stay compared to younger adults. Frailty is associated with longer presence of hypoglycemia in non-acute hospital settings.
医院中患有糖尿病的老年人通常与年轻人的管理方式相似，然而，尚不清楚虚弱程度是否会影响住院患者的血糖控制。
我们研究了在非急性环境中住院的2型糖尿病合并虚弱的老年人通过持续葡萄糖监测（CGM）得出的血糖参数。数据来自3项使用CGM的前瞻性研究，包括97名佩戴Libre CGM传感器的患者和166名佩戴Dexcom G6 CGM的患者。比较了103名60岁及以上老年人和168名60岁以下年轻人通过CGM得出的血糖参数（血糖范围在70 - 180的时间（TIR）；血糖低于范围（TBR）<70和54mg/dl）。使用经过验证的实验室和生命体征虚弱指数FI-LAB（n = 85）评估虚弱情况，并研究其对低血糖风险的影响。
与年轻人相比，老年人入院时的糖化血红蛋白（HbA1c）显著更低（8.76% ± 1.82 vs. 10.25% ± 2.29，p < 0.001），血糖水平更低（203.89 ± 88.65 vs. 247.86 ± 124.17mg/dl，p = 0.003），平均每日血糖（173.9 ± 41.3 vs. 183.6 ± 45.0mg/dl，p = 0.07），且住院期间血糖范围在70 - 180mg/dl的百分比更高（59.0 ± 25.6% vs. 51.0 ± 26.1%，p = 0.02）。老年人和年轻人之间低血糖发生率没有差异。更高的FI-LAB评分与CGM显示血糖<70mg/dl的百分比更高（0.204）以及CGM显示血糖<54mg/dl的百分比更高（0.217）相关。
与年轻人相比，2型糖尿病老年人在入院前和住院期间血糖控制更好。在非急性医院环境中，虚弱与低血糖持续时间更长有关。
