社区卫生服务中心高龄老年糖尿病患者口服降糖药用药现状调查

Use of Oral Anti-diabetic Drugs in Advanced Aged Patient with Diabetic Mellitus:A Community Health Centre-Based Survey

目的 探讨就治于社区卫生服务中心的高龄老年糖尿病患者口服降糖药的用药情况以及血糖控制现状，为其合理用药提供依据。方法 采用横断面调查方法，问卷调查2012年2月～2013年2月自愿在社区卫生服务中心就诊并建立完整健康档案的高龄老年糖尿病患者口服降糖用药情况。结果 共纳入176例高龄老年2型糖尿病患者，其中女性107例，男性69例，年龄80～94岁。80岁及以上2型糖尿病患者中同时合并高血压、冠心病和脑卒中3种疾病者有107例，占60.80%。仅使用口服降糖药者155例（占88.06%）。仅单用一种口服降糖药中使用最多的是α-葡萄糖苷酶抑制剂，占67.19%，其次为磺脲类。联合治疗以α-葡萄糖苷酶抑制剂为基础联合磺脲类使用频率最高，占53.73%。口服降糖药治疗后，73.68%的患者空腹血糖均达标（空腹血糖≤8.0 mmol/L），含α-糖苷酶抑制剂的治疗方案达标率达73.56%，含磺脲类达标率也达72.58%，有半数以上的患者因未检测糖化血红蛋白无法评估达标情况。结论 社区医生应根据高龄老年糖尿病患者自身情况选择降糖药，避免发生低血糖等不良反应。α-糖苷酶抑制剂因对老年人副作用小，血糖控制范围理想，降糖安全有效，基层社区卫生服务中心使用最多。

Objective To investigate the use of oral anti-diabetic drugs and sugar blood control situation in advanced aged patient with diabetic mellitus in a community health centre in order to provide references for rational drug use. Methods A cross-sectional survey about oral anti-diabetic drugs was carried out in senile diabetic patients who visited the community health centre and established complete health documents voluntarily from February 2012 to February 2013. Results There were 176 cases of advanced aged patients with type 2 diabetic mellitus, of which, 107 cases were female and 69 cases were male, whose age ranged from 80 to 94. Among 176 cases, there were 107 （60.80%） patients with type 2 diabetic mellitus combined with hypertension, chronic heart diseases, and stoke; 155 had oral anti-diabetic drugs （88.06%）. 67.19% of patients who took one oral anti-diabetic drug chose α-glycosidase inhibitors, followed by sulfonylurea. 53.73% of patients who received combination therapy chose glycosidase inhibitors and sulfonylurea. For the treatment of anti-diabetic drugs, 73.68% of patients met the criteria （fasting blood sugar： no more than 8.0 mmol/L）, with control rates of 73.56% for α-glycosidase inhibitors and 72.58% for sulfonylurea. More than half of the patients could not be evaluated for their glycosylated hemoglobin levels were not tested. Conclusion Doctors working in community health centres should choose oral anti-diabetic drugs according to patients’ own conditions when treating advanced aged patients with diabetic mellitus in order to avoid adverse reaction such as hypoglycemia. Glycosidase inhibitors are the mostly used drug in the community health centre because it is safe with less adverse reaction when used in senile people and it could ideally control their blood sugara.