Li Yang, Geng Shasha, Yuan Huixiao, Ge Jianli, Li Qingqing, Chen Xin, Zhu Yingqian, Liu Yue, Guo Xiaotong, Wang Xiaoli, Jiang Hua
Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
J Glob Health. 2024 Dec 20;14:04263. doi: 10.7189/jogh.14.04263.
Shanghai's high level of ageing has given rise to a considerable number of elderly patients with type 2 diabetes mellitus (T2DM) who are confronted with the challenge of managing multimorbidity. We aimed to determine the prevalence of multimorbidity in elderly T2DM patients in a representative Pudong New Area community and critically evaluate current guidelines' inclusiveness in addressing major comorbidities.
Through the Shanghai Health Cloud platform, we extracted medical records of residents in the Huamu community (Pudong New Area, Shanghai) to screen elderly patients with at least three outpatient visits or one hospitalisation per year between 2019 and 2022. According to International Classification of Disease, 10th edition codes and personal identification number, we identified the status of T2DM and 12 other common chronic diseases, matched T2DM patients and non-T2DM patients 1:1 by age and gender, and then calculated the prevalence of multimorbidity status and annual prevalence of each comorbidity. We analysed associations between T2DM and specific chronic diseases using logistic regression models.
More than 90% of elderly T2DM patients had at least one additional chronic disease. Multimorbidity was more frequent in women and older patients. Hyperlipidemia, hypertension, and ischaemic heart disease were the most prevalent comorbidities. The diagnosis of T2DM was significantly associated with both cardiovascular-kidney-metabolic and neuropsychiatric diseases. In addition, a higher prevalence and risk of chronic obstructive pulmonary disease (COPD) were consistently detected in elderly patients with T2DM, regardless of age and gender.
Multimorbidity in elderly patients with T2DM needs broader acknowledgement. Current guidelines focus more on cardiovascular-kidney-metabolic and neuropsychiatric diseases with inadequate guidance on COPD management. Hence, the pleiotropic effects of glucose-lowering drugs on COPD should be further investigated to optimise the comprehensive management strategy for this population.
上海的高度老龄化导致大量老年2型糖尿病（T2DM）患者面临多重疾病管理的挑战。我们旨在确定浦东新区一个具有代表性社区中老年T2DM患者的多重疾病患病率，并严格评估现行指南在解决主要合并症方面的包容性。
通过上海健康云平台，我们提取了花木社区（上海浦东新区）居民的医疗记录，以筛选出在2019年至2022年期间每年至少有三次门诊就诊或一次住院治疗的老年患者。根据国际疾病分类第10版编码和个人识别码，我们确定了T2DM和其他12种常见慢性病的状况，按年龄和性别将T2DM患者与非T2DM患者1:1匹配，然后计算多重疾病状况的患病率和每种合并症的年患病率。我们使用逻辑回归模型分析T2DM与特定慢性病之间的关联。
超过90%的老年T2DM患者至少患有一种其他慢性病。多重疾病在女性和老年患者中更为常见。高脂血症、高血压和缺血性心脏病是最常见的合并症。T2DM的诊断与心血管-肾脏-代谢疾病和神经精神疾病均显著相关。此外，无论年龄和性别，在老年T2DM患者中始终检测到较高的慢性阻塞性肺疾病（COPD）患病率和风险。
老年T2DM患者的多重疾病需要得到更广泛的认识。现行指南更多地关注心血管-肾脏-代谢疾病和神经精神疾病，而对COPD管理的指导不足。因此，应进一步研究降糖药物对COPD的多效性作用，以优化该人群的综合管理策略。
