二甲双胍在老年2型糖尿病患者应用的安全性评估

Safety of metformin in the treatment of elderly type 2 diabetes mellitus

目的观察老年2型糖尿病患者使用二甲双胍的安全性。方法对1996年1月-2006年12月在解放军总医院住院并使用二甲双胍的243例老年糖尿病患者的临床资料进行回顾性分析，观察二甲双胍治疗前后空腹血糖、餐后血糖、糖化血红蛋白（HbAlc）、肝肾功能、血乳酸等指标的变化。结果本组老年糖尿病患者服用二甲双胍治疗时间3个月-21年[（6．6±3．9）年]，单用二甲双胍治疗43例（17．7％），联合其他口服降糖药者124例（51．0％），联合胰岛素治疗者76例（31．3％），均能有效降低空腹及餐后血糖和HbAIc水平。肌酐清除率正常者（〉80ml／min）仅占18．1％，≤50mL／min者占25．8％，存在明显的随年龄增长肌酐清除率下降的趋势。整组人群或按肌酐清除率分组比较治疗前后肝肾功能和血乳酸水平无显著变化，无乳酸酸中毒发生。结论老年糖尿病患者合理应用二甲双胍治疗即可达到良好的降血糖效果也较为安全，年龄并非二甲双胍治疗的禁忌证。治疗中应注意掌握适应证和治疗剂量，在一些风险人群应监测血乳酸水平。

Objective To evaluate the safety of metformin in the treatment of elderly type 2 diabetes mellitus（T2DM）. Methods Two hundred and forty-three cases of elderly T2DM hospitalized from Jan. 1996 to Dec. 2006 were reviewed; the changes of fasting blood glucose（ FBG）, postprandial blood glucose （PBG）, glycosylated hemoglobin （HbAlc）, liver and renal function and blood lactic acid were evaluate before and after treatment. Results The mean time of treatment with metformin was （6. 6 ± 3.9） years （3 months-21 years）in these 243 cases. The levels of FBG, PBG and HbAlc significantly reduced after treatment with metformin only in 43 cases （ 17. 7% ）, metformin combined with other oral hypoglycemic drugs in 124 cases （51.0%） and metformin combined with insulin in 76 cases （31.3%）. There was only 18.1% of the cases with normal range （ 〉80 mL/min） of creatinine clearance rate （Ccr）, and 25.8% of the cases with Ccr ≤ 50 mL/min. The liver and renal function as well as the blood lactic acid had no significant change after treatment no matter in total cases or in different groups separated by Ccr. Conclusions Metformin is safety in the treatment of elderly T2DM patients. Ageing is not the contraindication of metformin. To the patients with high risk, we should monitoring the level of blood lactic acid.