胰岛素治疗在老年2型糖尿病患者长期血糖控制、糖化血红蛋白变异性中的作用

Effect of insulin therapy on long-term glycemic control, HbA1c variability in elderly patients with type 2 diabetes

目的:探讨胰岛素治疗在老年2型糖尿病患者长期随访期间血糖控制、血糖波动中的作用。方法:采用回顾性调查方法,选取2007年1月–2011年1月在我院住院行动态血糖监测的老年男性2型糖尿病患者,共计200例,并进行随访观察,根据是否应用胰岛素治疗分为胰岛素治疗组和非胰岛素治疗组,比较两组长期随访期间血糖控制、糖化血红蛋白(HbA1c)变异性的差异。结果:平均随访观察时间12.5年,胰岛素治疗组长期血糖控制达标率低于非胰岛素治疗组(39.1%vs 65.7%,P <0.001),HbA1c均值高于非胰岛素治疗组[(7.28±0.71)%vs(6.85±0.76)%,P <0.001],两组间HbA1c变异系数无明显差异。单因素Spearman相关分析显示胰岛素治疗与HbA1c均值相关(P <0.001),与HbA1c变异系数无关。非条件多因素Logistic回归分析提示在调整相关混淆因素后,胰岛素治疗是老年男性2型糖尿病随访期间Hb A1c均值的独立相关因素(OR=3.23,95%CI:1.33~7.85,P=0.010),与HbA1c变异系数无关。结论:胰岛素治疗与长期随访期间HbA1c均值相关,与HbA1c变异性无关。

Objective: To investigate the effect of insulin therapy on long-term glycemic control and glycemic variability in elderly patients with type 2 diabetes. Methods: 200 elderly male patients with type 2 diabetes who received continuous glucose monitoring and follow-up in our hospital from January 2007 to January 2011 were retrospectively collected and divided into insulin therapy group and non-insulin therapy group according to whether insulin was used or not. The differences of long-term glycemic control and glycosylated hemoglobin(HbA1c) variability between the two groups during long term follow-up were compared.Results: All the patients were followed up for an average of 12.5 years. The target rate of long-term glucose control in insulin therapy group was significantly lower than that of non-insulin therapy group(39.1% vs 65.7%, P < 0.001). The mean HbA1c of the insulin therapy group was significantly higher than that of the non-insulin therapy group [(7.28 ± 0.71)% vs(6.85 ± 0.76)%, P <0.001] while there was no significant difference in coefficient of variation(CV) of HbA1c between two groups. Univariate Spearman correlation analysis showed that insulin therapy was associated with the mean value of HbA1c(P < 0.001), but was not related to the CV of HbA1c. Unconditional multivariate Logistic regression analysis suggested that insulin therapy was an independent related factor of the mean value of HbA1c during follow-up(OR = 3.23, 95%CI: 1.33 – 7.85, P = 0.010), and was not related to CV of HbA1c in elderly male patients with type 2 diabetes after adjusting relative confounding factors. Conclusion: Insulin therapy was associated with the mean value of HbA1c during long term follow-up, but not related to HbA1c variability.