老年2型糖尿病病人的临床特点

Clinical characteristics of elderly patients with type 2 diabetes mellitus

目的比较老年起病与中年起病的老年T2DM病人的临床特点,探讨老年T2DM病人的管理策略。方法选择T2DM病人5670例,按照病人年龄及T2DM起病年龄分为3组老年起病T2DM病人2867例,中年起病的老年T2DM病人1518例,以及中年起病的中年T2DM病人1285例,测定并比较3组FPG、餐后2 h葡萄糖(PPG)、HbA1c、TC、LDL-C、HDL-C、TG、SCr、尿白蛋白/肌酐(ACR)及踝肱指数(ABI)。结果老年起病T2DM病人的血糖控制水平(FPG、PPG、HbA1c)显著优于中年起病的老年T2DM及中年起病的中年T2DM病人,3组HbA1c达标率分别为50.37%、41.96%和38.44%,差异有统计学意义(P<0.05)。老年起病T2DM病人仅饮食运动或单用一种口服降糖药的比例均高于中年起病的老年T2DM,而使用胰岛素比例显著低于中年起病的老年T2DM(17.89%比35.83%,P<0.05)。老年起病T2DM病人的糖尿病大血管并发症(冠心病、周围血管病变)比例与中年起病的老年T2DM病人比较差异无统计学意义,而糖尿病微血管并发症(糖尿病肾病)比例显著低于中年起病的老年T2DM(P<0.05)。结论老年T2DM病人以老年后起病者占大多数,与中年起病的老年T2DM病人相比,前者血糖较易控制、降糖方案相对简单,糖尿病微血管并发症(糖尿病肾病)比例显著降低。

Objective To assess the differences of clinical characteristics in the elderly patients with type 2 diabetes mellitus(T2DM)with middle-aged onset and aged onset.Methods A total of 5670 patients with T2DM were enrolled,and were divided into three groups according to the age and diabetic onset age,including 2867 aged onset elderly patients,1518 middle-aged onset elderly patients,and 1285 middle-aged onset non-elderly patients.The levels of fasting plasma glucose(FPG),postprandial glucose(PPG),glycosylated hemoglobin(HbA1c),total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,glycerin trilaurate,serum creatinine,microalbumin/creatinin ratio(ACR)and ankle brachial index(ABI)were detected and compared.Results The glucose control levels(FPG,PPG,HbA1c)of aged onset elderly patients were significantly better than those of middle-aged onset elderly patients and middle-aged onset non-elderly patients.The control rate of HbA1c in the three groups was 50.37%,41.96%and 38.44%,respectively(all P<0.05).The proportions of the patients receiving diet and exercise intervention or taking only one oral hypoglycemic drug were higher while the proportion of insulin use was significantly lower in aged onset elderly patients than those of middle-aged onset elderly patients.The proportions of diabetic macrovascular complications(coronary heart disease and peripheral vascular disease)showed no significant differences between the groups,while the proportion of diabetic microvascular complication(diabetic nephropathy)in aged onset elderly patients was significantly lower than that in middle-aged onset elderly patients(P<0.05).Conclusions The majority of elderly patients with T2DM are aged onset patients.Compared with middle-aged onset elderly patients,aged onset patients are more easier to control glucose levels and need simpler hypoglycemic medications,and the proportion of diabetic microvascular complication(diabetic nephropathy)in aged onset elderly patients is significantly lower than that of middle-aged onset elderly patients.