实用老年医学

实用老年医学 ›› 2023, Vol. 37 ›› Issue (6): 590-594.doi: 10.3969/j.issn.1003-9198.2023.06.013

• 临床研究 • 上一篇    下一篇

健康状态分层视角下老年2型糖尿病病人血糖管理现况调查

宗前兴, 宗小燕, 王雪菲, 陶璐, 郭淳, 唐伟, 巫海娣, 刘冬梅, 樊垚, 莫永珍   

  1. 211166 江苏省南京市,南京医科大学护理学院(宗前兴,宗小燕,陶璐,郭淳);
    215006 江苏省苏州市,苏州大学医学部护理学院(王雪菲);
    210024 江苏省南京市,南京医科大学附属老年医院内分泌科(唐伟,巫海娣,刘冬梅);临床流行病学研究室(樊垚);护理部(莫永珍)
  • 收稿日期:2023-01-20 出版日期:2023-06-20 发布日期:2023-06-30
  • 通讯作者: 莫永珍,Email: moyongzh＠sina.com
  • 基金资助:
    江苏省干部保健科研项目(BJ21027);南京医科大学内涵建设专项护理学优势学科资助(苏政办发〔2018〕87号);南京医科大学老年2型糖尿病队列研究项目(NMUC2020041)

A survey of blood glucose management in elderly patients with type 2 diabetes mellitus from the perspective of health status stratification

ZONG Qian-xing,ZONG Xiao-yan,WANG Xue-fei, TAO Lu, GUO Chun, TANG Wei, WU Hai-di, LIU Dong-mei, FAN Yao, MO Yong-zhen   

  1. School of Nursing, Nanjing Medical University, Nanjing 211166, China(ZONG Qian-xing,ZONG Xiao-yan,TAO Lu,GUO Chun);
    School of Nursing, Medical College of Soochow University, Suzhou 215006, China(WANG Xue-fei);
    Department of Endocrinology(TANG Wei,WU Hai-di,LIU Dong-mei); Department of Clinical Epidemiology(FAN Yao); Nursing Department(MO Yong-zhen), Geriatric Hospital of Nanjing Medical University, Nanjing 210024, China
  • Received:2023-01-20 Online:2023-06-20 Published:2023-06-30
  • Contact: MO Yong-zhen,Email:moyongzh＠sina.com

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摘要： 目的 探讨老年T2DM群体不同健康状态分层的比例、人口学及临床特点,分析该群体的血糖控制水平及在不同指南标准下的血糖达标情况。 方法 在综合评估共病、认知及日常活动能力后,将253例老年T2DM病人健康状况分为良好健康、中等健康和较差健康3组,比较3组一般临床特征以及血糖达标情况。 结果 老年T2DM病人健康状态分层占比为:良好健康组34.39%(87/253),中等健康组52.57%(133/253),较差健康组13.04%(33/253)。性别、年龄、婚姻、居住方式、文化程度、饮酒、并发症、病程、舒张压、胰岛素的使用在不同分层之间差异均有统计学意义(P＜0.05)。总体而言,44.3%(112/253)的病人HbA1c值＜7%。其中,良好健康组血糖达标率为48.3%(42/87)、中等健康组为41.4%(55/133)、较差健康组为45.5%(15/33),3组间差异无统计学意义(χ2=1.043,P=0.594)。以2020年版指南为参考,根据不同分层设立血糖达标标准,3组HbA1c达标率分别为63.2%(55/87)、66.9%(89/133)和72.7%(24/33),对应上升了14.9%、25.5%和27.2%。2021年版指南标准增设易致低血糖药物使用的因素考量,3组HbA1c达标率较2020年版分别对应下降18.4%、29.3%和33.3%。其中较差健康组HbA1c达标率不足40%,且因血糖值过低未达标者比例高于血糖过高者。 结论 健康状态分层视角下老年T2DM病人HbA1c水平偏低,相当比例的病人尚未达到指南推荐的要求。临床需结合分层与低血糖高风险药物使用情况制定血糖控制目标,促使管理更加安全有效。

关键词: 2型糖尿病, 老年人, 健康状态, 糖尿病管理

Abstract: Objective To explore the proportion, demographic and clinical characteristics of different health status stratifications in the elderly patients with type 2 diabetes mellitus (T2DM), and to analyze the blood glucose control level and the status of blood glucose attainment under different guidelines. Methods After a comprehensive evaluation of comorbidity, cognition and daily activities, the 253 elderly patients with T2DM were divided into good health group(n=87), intermediate health group(n=133)and poor health group(n=33). Demographic data, clinical characteristics and the compliance rate of blood glucose were compared among the three groups. Results Gender, age, marriage, living style, education level, drinking, complications, course of disease, diastolic blood pressure and insulin use showed significant differences among different stratification groups (P<0.05). Of all the patients, 44.3% (112/253) presented with glycosylated hemoglobin (HbA1c) value ＜7%. The control rate of blood glucose was 48.3% (42/87),41.4% (55/133)and 45.5% (15/33) in good health group,intermediate health group and poor health group, with no statistical difference (χ2=1.043, P=0.594). With the 2020 edition of the guidelines as reference, the HbA1c control rate of the three groups was 63.2% (55/87),66.9% (89/133) and 72.7%(24/33), respectively, which increased by 14.9%, 25.5% and 27.2%. According to the 2021 edition of the guideline, the control rate of HbA1c in the three groups decreased by 18.4%, 29.3%and 33.3%, respectively, compared with the 2020 edition.The HbA1c control rate was less than 40% in the poor health group, and the proportion of those who failed to meet the standard due to low blood glucose value was higher than that of those with high blood glucose value. Conclusions On the perspective of health status stratification, the level of HbA1c in the elderly patients with T2DM is low, and a considerable proportion of the patients have not met the standard recommended by the guidelines.In clinical practice, it is necessary to set glycemic control targets in combination with stratification and the use of drugs with high risk of hypoglycemia, so as to promote safer and more effective management.

Key words: type 2 diabetes mellitus, aged, health status, diabetes management

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