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价值对于存在多种严重合并症及功能受限的老年人来说,强化血糖控制所带来的伤害很可能超过其所带来的益处。目的通过健康状况检测老年糖尿病患者的血糖控制水平,并评估糖尿病潜在过度治疗的发生率。设计、设定及参与者对国家健康与营养调查研究中2001—2010年进行了糖化血红蛋白(HbA_(1c))测定的1 288例老年(≥65岁)糖尿病患者的资料进行横断面分析。所有分析具备复杂的调查设计以生成国家代表性评估。表现健康状况分类:非常复杂/差,至少有两项日常活动做起来困难,或者依赖透析;复杂/一般,至少有两项日常工具的使用困难,或存在至少3种慢性疾病;相对健康,不具备以上几点。主要结果及措施严格的血糖控制(HbA_(1c)<7.0%)以及糖尿病药物的使用很可能导致低血糖(胰岛素或磺酰脲类药物)。结果在1 288例老年糖尿病患者中,50.7%〔95%CI(46.6%,54.8%)〕的患者代表310万人〔95%CI(270,350)万人〕为相对健康状况,28.1%〔95%CI(24.8%,31.5%)〕的患者代表170万人〔95%CI(140,200)万人〕为复杂/一般的健康状况,21.2%〔95%CI(18.3%,24.4%)〕的患者代表130万人〔95%CI(110,150)万人〕为非常复杂/差的健康状况。总体来说,61.5%〔95%CI(57.5%,65.3%)〕的患者代表380万人〔95%CI(340,420)万人〕其HbA_(1c)<7.0%;这个比例在3种健康状况中无差别{62.8%〔95%CI(56.9%,68.3%)〕为相对健康状况,63.0%〔95%CI(57.0%,68.6%)〕为复杂/一般健康状况,56.4%〔95%CI(49.7%,62.9%)〕为非常复杂/差的健康状况(P=0.26)}。在HbA_(1c)<7.0%的老年患者中,54.9%〔95%CI(50.4%,59.3%)〕接受了胰岛素或磺酰脲类药物治疗;这个比例在各类健康状况糖尿病患者中近似。在研究涵盖的10年间,HbA_(1c)<7.0%的老年患者比例(P=0.34)、HbA_(1c)<7.0%且健康状况为复杂/一般或非常复杂/差的患者比例(P=0.27)、HbA_(1c)<7.0%健康状况为复杂/一般或非常复杂/差但接受胰岛素或磺酰脲类药物治疗的患者比例(P=0.65)均无明显变化。结论及意义尽管对于健康状况为复杂/一般或非常复杂/差的老年糖尿病患者来说,强化治疗所带来的伤害很可能超过其带来的益处,但是大多数患者2001—2010年已经达到了严格的血糖目标。大部分患者接受了胰岛素或磺酰脲类药物治疗,这可能导致严重的低血糖。本研究发现,有相当大比例的老年糖尿病患者接受了潜在过度治疗。
Value The benefits of intensive glycemic control are likely to outweigh the benefits of older adults with multiple severe complications and limited function. Objective To test the level of glycemic control in elderly diabetic patients by health status and to evaluate the incidence of potential overdiagnosis of diabetes mellitus. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of data from 1 288 elderly patients (≥65 years) with diabetes mellitus who had HbA 1c measurements from 2001 to 2010 in the National Health and Nutrition Study. All analyzes have sophisticated survey designs to generate country representative assessments. Performance Health Status Category: very complicated / poor, at least two daily activities difficult to do or rely on dialysis; complex / general, at least two daily tools of use, or at least three chronic diseases; relatively healthy, not Have the above points. Main Outcomes and Measures Strict glycemic control (HbA_ (1c) <7.0%) and the use of diabetes medications are likely to cause hypoglycemia (insulin or sulfonylureas). Results Of the 1 288 elderly patients with diabetes, 50.7% (95% CI, 46.6%, 54.8%) had 3.1 million (95% CI, 270.350 million) representing relative health status and 28.1% (95% (95% CI (140,200)) were complicated / general health status and 21.2% [95% CI (18.3%, 24.4%)] were represented on behalf of the patients with CI (24.8%, 31.5% 1.3 million [95% CI (110,150)] are very complicated / poor health conditions. Overall, 61.5% [95% CI (57.5%, 65.3%]] represented 3.8 million (95% CI (340,420) million) with HbA 1c (7.0%); 63.0% [95% CI (57.0%, 68.6%)] were in a complex / general state of health, 56.4% [95% CI (56.9%, 68.3% (49.7%, 62.9%)] were very complicated / poor health status (P = 0.26)}. Of the elderly patients with HbA_ (1c) <7.0%, 54.9% [95% CI (50.4%, 59.3%)] received insulin or sulfonylureas; this proportion was similar for all types of diabetic patients. The proportion of elderly patients with HbA_ (1c) <7.0% (P = 0.34), those with HbA_ (1c) <7.0% and whose health status was complicated / general or very complicated / poor during the 10 years of the study (P = 0.27 ), HbA_ (1c) <7.0% There was no significant change in the proportion of patients who were in complicated / general or very complex / poor health status but undergoing insulin or sulfonylurea treatment (P = 0.65). Conclusions and implications Although intensive care may well outweigh its benefits for older diabetics with complex / general or very complex / poor health status, most patients have reached 2001-2010 Strict glycemic target. Most patients receive insulin or sulfonylurea medications, which can cause severe hypoglycemia. This study found that a significant proportion of elderly diabetic patients underwent potentially over-treatment.