老年2型糖尿病伴糖尿病视网膜病变及白内障病人的糖代谢特征  

Characteristics of glycometabolism in elderly patients with type 2 diabetes mellitus complicated with diabetic retinopathy and cataract

作　　者：张子成 朱翔宇 杨龙璇 肖蕾 俞匀 黄晓萍 唐伟 ZHANG Zi-cheng;ZHU Xiang-yu;YANG Long-xuan;XIAO Lei;YU Yun;HUANG Xiao-ping;TANG Wei(Department of Endocrinology,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China;Department of Nurs-ing,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属老年医院内分泌科,江苏省南京市210024 [2]南京医科大学第一附属医院护理部,江苏省南京市210029

出　　处：《实用老年医学》2023年第4期365-368,共4页Practical Geriatrics

基　　金：江苏省卫生健康委员会科研项目(BJ19027)。

摘　　要：目的 探究老年T2DM合并糖尿病视网膜病变(diabetic retinopathy, DR)和(或)白内障(cataract, CAT)病人的糖代谢特征。方法 选取2019年7月至2021年9月在南京医科大学第一附属医院眼科住院的386例老年T2DM病人,根据诊断分为CAT组(163例)、DR组(15例)及CAT+DR组(208例)。通过信息化血糖监测系统(IGMS)和医院信息系统收集病人的临床数据,比较3组病人社会人口学资料、代谢指标、血糖控制评价指标的差异。结果 CAT组、DR组、CAT+DR组病人的FPG达标率均较低(54.6%、53.3%、50.5%,P=0.730)。DR组和CAT+DR组较CAT组病人糖尿病病程更长,住院总费用、西药费、手术费更高,CKD高分期占比更多,差异均有统计学意义(P<0.05)。与CAT组相比,CAT+DR组血糖达标日更少,最大血糖波动幅度更大、1级低血糖和2级低血糖事件发生率更高,差异均有统计学意义(P<0.05)。3组病人住院天数加权平均血糖和高血糖事件发生率差异无统计学意义(P>0.05)。结论 老年T2DM合并DR和(或)CAT病人的血糖波动幅度大、FPG达标率低、低血糖事件发生率高,应尽量避免使用导致血糖波动幅度大、增加低血糖风险的降糖方案。Objective To investigate the glycometabolic characteristics of the elderly patients with type 2 diabetes mellitus(T2DM)complicated with diabetic retinopathy(DR)and(or)cataract(CAT).Methods A total of 386 elderly patients with T2DM who were hospitalized in the Department of Ophthalmology,the First Affiliated Hospital of Nanjing Medical University from July 2019 to September 2021 were enrolled in this study.They were divided into CAT group(163 cases),DR group(15 cases)and CAT+DR group(208 cases)according to the diagnosis.The clinical data were collected from information glucose monitoring system and the hospital information system.The differences in demographic data,metabolic indicators and glycemic control indicators among the three groups were compared.Results The control rate of fasting plasma glucose in CAT group(54.6%),DR group(53.3%)and CAT+DR group(50.5%)was low(P=0.730).In DR group and CAT+DR group,the durations of diabetes mellitus,total costs of hospitalization,drug costs,operation costs and the percentages of patients in high CKD stages were significantly higher than those in CAT group(P<0.05).CAT+DR group had fewer control days,higher largest amplitude of glycemic excursions,higher incidene rates of level 1 and level 2 hypoglycemia than CAT group(P<0.05).There were no significant differences in patient-day-weighted mean blood glucose and the rate of hyperglycemic events among the three groups(P>0.05).Conclusions The elderly patients with T2DM complicated with DR and(or)CAT have large blood glucose fluctuations,low control rate and high rate of hypoglycemic event.It is necessary to avoid the glycemic treatment which might lead to high volatility of glucose or hypoglycemic event.

关 键 词：老年人 2型糖尿病 白内障 糖尿病视网膜病变 血糖 

分 类 号：R776.1[医药卫生—眼科] R774.1[医药卫生—临床医学]