中华保健医学杂志

目的通过一组老年2型糖尿病的长期随诊观察,比较老年前患糖尿病和老年后新发糖尿病两组人群的临床特征、血糖控制、合并症及预后情况,探讨老年糖尿病的管理策略。方法选取1996年~2013年在解放军总医院长期医疗保健、每年进行糖尿病筛查并确诊糖尿病的老年人群,对其随访17年,并进行回顾性队列分析研究。根据糖尿病患病年龄将该人群分为老年前患病组(60岁之前患糖尿病即B-DM)和老年后新发糖尿病组(60岁之后患糖尿病即A-DM),对两组人群血糖控制相关影响因素及对生存的影响情况进行统计学分析,分析两组临床特点。结果共纳入研究对象967例,其中B-DM组159例(16.4%),A-DM组808例(83.6%),老年后是糖尿病高发年龄段。随访17年,B-DM组死亡62例(40.0%),A-DM组死亡376例(36.5%,P=0.63),A-DM组(50.4%)的Hb A1c控制达标率(6.5%)高于B-DM组(34.5%)。B-DM组胰岛素的使用率(52.2%)高于A-DM组(22.9%,P=0.0000),且B-DM组在合并糖尿病视网膜病变、糖尿病大血管病变及心血管疾病导致死亡方面均显著高于A-DM组(P<0.01)。结论老年糖尿病患者中以老年后患糖尿病者为多,血糖控制优于老年前患病组。两组均伴随不同程度的心血管风险因素,老年前糖尿病患者的合并症高于老年后糖尿病患者。定期做糖尿病筛查、综合分析、个性化治疗有利于老年2型糖尿病的总体控制。

Objective To compare the clinical characteristics,blood glucose control,complications and prognosis of elderly type 2 diabetes patients who were diagnosed with diabetes before and after the age of 60 through a 17 years retrospect alignment study.Methods Elderly patients(> 60 years of age) who were diagnosed with type 2 diabetes mellitus in our hospital from 1996 to2013 were screened.All patients were divided into two groups :B-DM(diabetes diagnosed before the age of 60) and A-DM(diabetes diagnosed after the age of 60) according to their diabetes onset ages.Factors related to blood glucose control and prognoses were statistically analyzed,and the clinical characteristics and complications were compared. Results A tota1 of 967 elderly patients with diabetes were selected. They were divided into B-MD group(n = 159,16.4%) and A-MD group(n = 808,83.6%) according to their diabetes onset ages.After 17 years,the mortality rate of all causes was found to be 40.0% in B-MD group and 36.5% in A-MD group(P = 0.63).The Hb A1 c control target rate(≤The) in A-MD group(50.4%) was higher than that in B-MD group(34.5%).Insulin usage of B-MD group(52.2%) was significantly higher than that of A-DM group(22.9%,P = 0.000).Furthermore,diabetic retinopathy,diabetic vascular complication and number of deaths caused by cardiovascular disease was significantly greater in B-MD group than those in A-MD group(P < 0.01). Conclusion Elder patients diagnosed with diabetes after the age of 60 accounted for83.6 % of all patients and showed better glycemic control than the patients diagnosed before 60. Diabetic retinopathy,diabetic vascular complication and number of deaths caused by cardiovascular disease are greater in B-MD group than that in A-MD group.Regular diabetes screening,comprehensive analyses and individual treatments are helpful for the general control of type 2 diabetes in elderly patients.