住院老年2型糖尿病患者潜在不适当用药及影响因素研究

Study on potentially inappropriate medication use and influencing factors in hospitalized elderly patients with type 2 diabetes

目的分析住院老年2型糖尿病(T2DM)患者合并潜在不适当用药(PIM)的情况及其影响因素,为临床合理用药提供参考和依据。方法该研究为单中心观察性研究。按入排标准连续入选2019年6月至2023年5月间年龄≥65岁、住院治疗的T2DM患者。依据Beers标准(2019版),评价患者存在的多重用药及PIM情况。同时运用老年综合评估,评估患者的功能状态及合并老年综合征的情况。采用多因素logistic回归模型,分析老年T2DM患者合并PIM的影响因素。结果最终入选老年T2DM患者426例,其中男性190例(44.6%),年龄65~93岁,中位年龄74岁。所有入选患者中,合并多重用药者343例(80.5%)。依据Beers标准(2019版),共232例(54.5%)患者存在PIM 452例次。发生率最高的前5类PIM药物分别为利尿剂、苯二氮类药物、阿司匹林作为心血管事件和结肠癌的一级预防、质子泵抑制剂以及长效磺酰脲类药物。与药物相关的PIM 172例次,与疾病或症状有关的PIM 44例次,老年人应慎用的PIM 206例次,老年人应该避免药物相互作用的PIM 22例次,根据肾功能应避免的PIM 8例次。与无PIM的老年T2DM患者相比,存在PIM患者的年龄更大,合并慢性病种类更多,年龄校正的Charlson共病指数更高;长期用药种类及多重用药的比例更高;手握力较低,不能完成全足距测试的比例明显高于无PIM的患者;日常生活活动与工具性日常生活活动评分较低,需要辅助行走的比例明显高于无PIM的患者;血红蛋白、总胆固醇、低密度脂蛋白胆固醇水平较低,肌酐、尿酸、超敏C反应蛋白水平较高;以上差异均有统计学意义(P值均<0.05)。多因素logistic回归分析显示,合并慢性病种类(OR=1.177,95%CI:1.043~1.328,P=0.008)、长期服用药物种类(OR=1.124,95%CI:1.033~1.223,P=0.007),以及合并多重用药(OR=2.747,95%CI:1.340~5.629,P=0.006)是老年T2DM患者合并PIM的影响因素。结论住院老年T2DM患者合并多重用药及PIM的患病率均高。对于多病共存、合并多重用药的老年T2DM患者,应尤为重视核查用药,通过识别存在的潜在PIM,进行药物重整。

Objective To analyze the situation and factors influencing potentially inappropriate medication(PIM)in hospitalized elderly patients with type 2 diabetes(T2DM).Methods This study conducted a single-center observational study.Patients aged≥65 years old with T2DM who were hospitalized between June 2019 and May 2023 were consecutively selected based on the inclusion criteria.The evaluation of polypharmacy and PIM was done using the Beers criteria(2019 version).Additionally,comprehensive geriatric assessment was used to evaluate the patient′s functional status and geriatric syndromes.Multivariate logistic regression analysis was employed to analyze the factors influencing PIM in elderly patients with T2DM.Results In this study,426 hospitalized elderly patients with T2DM were included.Out of these patients,190 cases(44.6%)were males,with ages ranging from 65 to 93 years and a median age of 74 years.Among all the patients,343 cases(80.5%)were using multiple medications(polypharmacy).Based on the Beers criteria(2019 version),it was found that 232 patients(54.5%)had PIMs,with a total of 452 occurrences.The top five categories of PIM drugs with the highest incidence were diuretics,benzodiazepines,aspirin for primary prevention of cardiovascular events and colon cancer,proton pump inhibitors,and long-acting sulfonylureas.The PIMs were further categorized into 172 occurrences of drug-related PIM,44 occurrences related to diseases or symptoms,206 occurrences that should be used with caution in the elderly,22 occurrences of potentially clinically important drug-drug interactions to be avoided in older adults,and 8 occurrences of PIMs to be reduced/avoided according to renal function.Compared to elderly patients with T2DM without PIM,patients with PIM exhibit certain characteristics.They tend to be older,had a greater number of chronic diseases,and had a higher age-adjusted Charlson comorbidity index.Additionally,they had a higher proportion of long-term medication types and polypharmacy,and lower handgrip strength.The proportion of patients unable to complete the tandem stance was significantly higher among those with PIM.Furthermore,ADL and IADL scores were lower,and the proportion of patients requiring assisted walking was significantly higher in comparison to patients without PIM.Hemoglobin,total cholesterol,and low-density lipoprotein cholesterol levels were lower,while creatinine,uric acid,and high-sensitivity C-reactive protein levels were higher among patients with PIM.These differences were statistically significant(P<0.05)in all cases.The results of the multivariate logistic regression analysis indicated that the numbers of chronic diseases(OR=1.177,95%CI:1.043-1.328,P=0.008),the types of long-term medication(OR=1.124,95%CI:1.033-1.223,P=0.007),and combined polypharmacy(OR=2.747,95%CI:1.340-5.629,P=0.006)were significant influencing factors of PIM in elderly patients with T2DM.Conclusions The prevalence of polypharmacy and PIM is high among hospitalized elderly patients with T2DM.Elderly patients with T2DM who have multiple chronic conditions and polypharmacy require special attention to ensure appropriate medication use.It is important to carefully review the medication regimen and consider medication reconciliation by identifying any potential inappropriate medications.