A retrospective cross-sectional study of type 2 diabetes overtreatment

Data used in the paper submitted to BMC Geriatrics, Wojszel ZB & Kasiukiewicz A, 2019, "A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward" Abstract Background: Glycemic control targets in older patients should be individualized according to functional status and comorbidities. The aim of the study was to identify high-risk patients who had evidence of tight glycemic control and thus at risk of serious hypoglycemia. Methods: Retrospective cross-sectional study of type 2 diabetes patients admitted to the geriatric ward receiving diabetes medications. Patients’ hospital records were analyzed. The high risk of hypoglycemia group constituted patients who were aged 80+ years, diagnosed with dementia, with end- stage renal disease, or with a history of macrovascular complications. The primary outcome measure was hemoglobin A1C (HbA1C)≤7.0% [53mmol/mol]. Results: 213 patients were included (77.5% women; 49.3% 80+ year-old). 65.3% received sulfonylurea, 39,4%- metformin, 32.9% insulin, and 4.2%- acarbose (in 61.5% as monotherapy, and in 38.5% combination therapy). We identified 130 patients (60%) as the denominator for the primary outcome measure; 73.1% had a HbA1C value ≤7.0% [53.3mmol/mol], but 55.4% ≤6,5% [48.8mmol/mol], and 40.8% ≤6.0% [42mmol/mol]. Conclusions: The results show a very high rate of tight glycemic control in older patients admitted to the geriatric ward, for whom higher HbA1C targets are recommended. This indicates the high probability of diabetes overtreatment in this group, associated with a high risk of recurrent hypoglycemia. This is all the more likely because most of them received medications known to cause hypoglycemia. This points to the need of paying more attention to specific difficulties in diabetes treatment in older people, especially those suffering from various geriatric syndromes and diseases worsening their prognosis.

本数据集取自提交至《BMC老年病学》（BMC Geriatrics）的论文，作者为Wojszel ZB与Kasiukiewicz A，发表于2019年，论文标题为《老年病房收治的2型糖尿病（type 2 diabetes）患者过度治疗的回顾性横断面研究》。

摘要
背景：老年患者的血糖控制目标应根据其功能状态与合并症进行个体化设定。本研究旨在识别存在严格血糖控制证据、因此存在严重低血糖（hypoglycemia）风险的高危患者。
方法：本研究为回顾性横断面研究，研究对象为老年病房收治的、接受糖尿病药物治疗的2型糖尿病患者，研究人员对患者的住院病历进行了回顾分析。低血糖高危组纳入符合以下任一条件的患者：年龄≥80岁、确诊痴呆（dementia）、患有终末期肾病（end-stage renal disease）或存在大血管并发症（macrovascular complications）病史。本研究的主要结局指标为糖化血红蛋白（hemoglobin A1C, HbA1C）≤7.0%[53mmol/mol]。
结果：本研究共纳入213例患者，其中女性占比77.5%，80岁及以上患者占49.3%。65.3%的患者接受磺脲类药物（sulfonylurea）治疗，39.4%接受二甲双胍（metformin）治疗，32.9%接受胰岛素（insulin）治疗，4.2%接受阿卡波糖（acarbose）治疗；上述治疗中，61.5%为单药治疗，38.5%为联合治疗。本研究针对主要结局指标的分析共纳入130例患者（占总入组人数的60%），其中73.1%的患者糖化血红蛋白值≤7.0%[53.3mmol/mol]，55.4%≤6.5%[48.8mmol/mol]，40.8%≤6.0%[42mmol/mol]。
结论：研究结果显示，老年病房收治的老年患者中严格血糖控制的比例极高，而临床指南推荐该类人群采用更高的糖化血红蛋白控制目标。这表明该群体中糖尿病过度治疗的概率较高，且与复发性低血糖的高风险密切相关。由于多数患者使用了已知可诱发低血糖的药物，这一风险进一步升高。本研究提示，临床需更加关注老年人群糖尿病治疗中的特定难点，尤其是那些罹患多种老年综合征及影响预后疾病的患者。