80岁及以上男性2型糖尿病患者降糖药物使用情况调查

Study on the Characteristics of Hypoglycemic Therapy in Male Patients with Diabetics above 80 Years Old

目的:分析80岁及以上男性2型糖尿病患者降糖治疗的特点。方法:通过回顾性病历调查方式,收集自2007年1月至2012年1月于我院老年内分泌科住院且入院前半年无明确低血糖发作的60岁以上男性2型糖尿病患者病历资料,记录本次入院一般情况、生化指标、降糖治疗方案的选择等病历资料,按年龄是否≥80岁分为老年组及高龄组进行比较并进行统计学分析。结果:共纳入老年男性2型糖尿病患者531人(77.9±9.6岁)。相比于老年组,高龄组代谢紊乱更严重,肾功能进一步下降(P<0.05)。高龄组空腹血糖、餐后2 h血糖及糖化血红蛋白水平均高于老年组(P<0.01)。研究人群中使用最多的降糖药物为α-糖苷酶抑制剂,其次为二甲双胍及胰岛素。与老年组相比,高龄组磺脲类、双胍类及格列酮类降糖药使用比例较低,α-糖苷酶抑制剂、格列奈类及胰岛素使用比例增高(P<0.01)。治疗方式上以口服降糖药所占比例最高,其次为口服降糖药联合胰岛素,单独使用胰岛素及采用生活干预方式的所占比例均较小。与老年组相比,高龄组使用口服降糖药物治疗的比例较低,而胰岛素治疗比例明显升高,其差异均具有统计学意义(P<0.01)。结论:80岁及以上糖尿病患者是一个特殊群体,在选择降糖治疗方案和制定血糖控制目标应充分考虑高龄糖尿病患者的特点,做到降糖治疗安全有效。

Objective：To study the characteristics of hypoglycemic therapy in male patients with diabetics above 80 years old.Methods：531 cases of male diabetic patients aged 80 years and over were reviewed.All the patients were registered from in-patient department from 2009 to 2012 and with out hypoglycemia during the recent six months before admission.The information including general conditions,blood biochemical parameters,the choice of hypoglycemic agents were collected through past medicine history review.We compare the efficacy and safety of hypoglycemic therapy between patients groups stratified by age and carry out statistical analysis of results.Results：531 elderly male diabetes patients were involved （the mean age was 77.9±9.6 years）.All the patients were divided into two groups by age （＜80 years vs ≥ 80 years）.The levels of waist circumference,systolic blood pressure,pulse pressure,triglyceride and serum creatinine in above 80 years old group were higher than that in the below 80 years old group （P＜0.05）.Creatinine clearance rate and high density lipoprotein cholesterol in above 80 years old group were lower than that in below 80 years old group （P＜0.05）.The level of fasting blood-glucose,postprandial blood glucose and HbA1c in above 80 years old group were higher than that in below 80 years old group （P＜0.01）.Alpha-Glucosidase Inhibitor was the most frequently used medicine （57.1％）,followed by Metformin （49.1％） and Insulin （30.1％）.Compared with below 80 years old group,the less use of Sulfonylureas,Metformin and Glitazones were found in above 80 years old group,and the adverse results can been seen in use of Alpha-Glucosidase Inhibitor and Glinides （P＜0.01）.Most patients accepted hypoglycemia agent therapy to control blood glucose （55.9％）,followed by insulin injection and oral hypoglycemia agent combination therapy （31.6％）.The proportion of the patients with only lifestyle interventions or only insulin therapy were small.Compared with below 80 years old group,the proportions of oral medicine treatment were lower in above 80 years old group.Insulin therapy were more common in above 80 years old group than less than 80 years old group （P＜0.01）.Conclusion：Diabetic patients aged 80 years and over is a special group,thus the characteristics of the elderly should be considered in the choice of drugs and the glucose level of control standard.