老年综合评估用于老年2型糖尿病患者综合病情评估并接受基础胰岛素治疗的临床观察  

Clinical observation on comprehensive geriatric assessment of elderly patients with type 2 diabetes mellitus and receiving basic insulin treatment

作　　者：王石林[1] 房贤聪 陈树丹[1] 叶继章[1] 陈桂青[1] 罗经宏[1] WANG Shilin;FANG Xiancong;CHEN Shudan;YE Jizhang;CHEN Guiqing;LUO Jinghong(Geriatric Ward,Huizhou Municipal Central Hospital,Guangdong,Huizhou 516001,China)

机构地区：[1]广东省惠州市中心人民医院老年病区,广东惠州516001

出　　处：《中国医药科学》2021年第1期218-220,228,共4页China Medicine And Pharmacy

基　　金：广东省惠州市科技计划项目(2019Y055)。

摘　　要：目的观察老年综合评估(CGA)在老年2型糖尿病(T2DM)患者综合病情评估并接受基础胰岛素治疗中的应用效果。方法以CGA内含各项量表,经横断面调查,评估惠州市中心人民医院2018年2月至2019年7月住院病房120例老年T2DM患者,根据调查结果筛查符合者,接受甘精胰岛素基础降糖治疗,并于随访12个月后再次进行CGA评估,分析CGA在老年T2DM患者甘精胰岛素治疗中的应用价值。结果老年综合征患者83例(69.17%),合并一种合并症者41例(34.17%),合并两种及以上合并症者24例(20.00%),符合基础胰岛素治疗标准者30例(25.00%);30例患者治疗后的日常生活能力量表(ADL)、工具性日常生活能力量表(IADL)、简易智能量表(MMSE)、老年抑郁量表(GDS)、微型营养评定(MNA)评分与1周内跌倒、Hb A1c水平、低血糖次数及基础胰岛素剂量均优于治疗前,差异有统计学意义(P<0.05);CGA评估工作开展后患者满意度(96.67%)高于开展前(69.17%),30例接受甘精胰岛素治疗的患者治疗后的空腹血糖、餐后2 h血糖值均低于治疗前,差异有统计学意义(P<0.05)。结论CGA能够有效评估老年T2DM患者是否合并老年综合征,为临床胰岛素治疗及后续疗效评价提供指导依据;随着药物发挥疗效,患者老年综合征获得一定改善,有效控制血糖前提下,降低患者治疗期间低血糖发生次数与基础胰岛素剂量,患者满意度更高。Objective To observe the application efficacy of comprehensive geriatric assessment(CGA)of elderly patients with type 2 diabetes mellitus(T2 DM)and receiving basic insulin treatment.Methods A total of 120 elderly patients with T2 DM admitted to the inpatient department of Huizhou Municipal Central Hospital from February 2018 to July 2019 were evaluated by cross-sectional survey through inside scales of CGA.According to the survey results,those who met the criteria were screened and given insulin glargine basic hypoglycemic treatment.After 12 months of follow-up,CGA was evaluated again to analyze the application value of CGA in the treatment of elderly T2 DM patients with insulin glargine.Results There were 83 patients(69.17%)with senile syndrome,41 patients(34.17%)with one complication,24 patients(20.00%)with two or more complications,and 30 patients(25.00%)met the basic insulin treatment standard.The scores of ADL,IADL,MMSE,GDS,MNA,falling within 1 week,HbA1 c level,hypoglycemia times and basal insulin dose of 30 patients after treatment were better than those before treatment,and the differences were statistically significant(P<0.05).Patients’satisfaction(96.67%)after CGA was higher than that before CGA(69.17%),and fasting blood glucose and postprandial 2-hour blood glucose of 30 patients given insulin glargine treatment were lower than those before treatment,with statistically significant differences(P<0.05).Conclusion CGA can effectively evaluate whether elderly T2 DM patients are complicated with senile syndrome and provide guidance for clinical insulin treatment and follow-up efficacy evaluation.With the efficacy of drugs,the elderly syndrome of patients has been improved to a certain extent.Under the premise of effective glucose control,the incidence of hypoglycemia and the dose of basic insulin during treatment are reduced,and the satisfaction of patients is higher.

关 键 词：老年综合评估 2型糖尿病 基础胰岛素 甘精胰岛素 老年综合征 

分 类 号：R587.1[医药卫生—内分泌]