老年2型糖尿病合并代谢综合征患者的治疗方式和控制达标状况调查

Investigation on the treatment and control of type 2 diabetes mellitus combined with metabolic syndrome in elderly patients

目的了解老年2型糖尿病（T2DM）合并代谢综合征（MS）患者的临床特点、用药情况及代谢异常组分的控制达标状况。方法回顾性分析2001-2005年住院的老年T2DM患者共349例，其中合并MS者194例，观察194例患者的临床特点、用药情况以及各代谢异常组分控制达标水平。结果老年T2DM合并MS者的比例为55.6%，体重指数（BMI）、餐后血糖、血压和甘油三酯（TG）均高于T2DM不合并MS组，HDL-C低于不合并MS组（P〈0.05）。老年T2DM合并MS的患者中，91.2%应用药物控制血糖，以双胍类、磺脲类、胰岛素为主，所占比例分别为59.3%、48.4%和36.1%；77.3%服用降压药物，以钙拮抗剂和血管紧张素转换酶抑制剂（ACEI）为主，分别为47.3%和46.2%；56.3%服用降脂药物，所占比例他汀类为34.8%，贝特类为71.4%。194例患者中，血糖各项均达标者占18.6%，血压整体达标者占40.9%，血脂四项全部达标者占29.3%。结论老年T2DM合并MS的比例很高，虽然积极用药控制，但是各代谢异常组分的控制达标率并不理想。对于血糖而言，在联合口服药物治疗效果不佳时，应使用胰岛素治疗。

objective To understand the clinical features of type 2 diabetes mellitus （T2DM） combined with metabolic syndrome （MS） in elderly patients, as well as the medicine used for treatment and the distribution of abnormal metabolic components. Methods Totally 349 T2DM patients admitted from 2001 to 2005 were retrospectively studied, among them 194 patients were combined with MS. The clinical data of those 194 patients were analyzed to evaluate their clinical feature, medicine used and the distribution of several abnormal metabolic components, of T2DM combined with MS. Results The proportion of MS in the elderly T2DM patients was 55. 6%. Body mass index （BMI）, postprandial blood glucose （PBG）, blood pressure and triglyceride （TG） were higher than that in those patients of T2DM without MS, while the high density lipoprotein cholesterol （HDL-C） was lower （P〈0. 05）. 91.2% diabetes patients was suffered from MS, for whom the medicine was used to control the blood glucose, including biguanides （59. 3%）, sulfonylureas （48. 4%） and insulin （36. 1%）. Among the 194 patients, 150 （77. 3%） with hypertension were to use medicine for controlling blood pressure, including calcium-antagon （47. 3%） and angiotensin-converting enzyme inhibitor（ACEI, 46.2%）. There were 56. 3% of 194 patients who took medicine for controlling blood lipid, including statin and fenofibrate （34. 8% and 71. 4%, respectively）. Among the 194 patients, 18. 6%, 40. 9% and 29. 3% were up to the normal level on blood glucose, blood pressure and blood lipid, respectively. Conclusion The incidence of MS is higher in the elderly T2DM patients. It＇s hard to get an ideal result on controlling the abnormal metabolic components even though several drugs have been used. For the patients with high blood glucose, it＇s better to use insulin when the other medicine can not led to a satisfactory effect.