住院老年2型糖尿病患者降糖药物应用现状及血糖控制情况分析

发布时间：2018-03-10 19:25

本文选题：2型糖尿病　切入点：老年患者　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨老年T2DM患者治疗现状与血糖控制及常见并发症发病情况。方法:1.入选病例2012年1月至2014年12月,于大连市解放军第210医院内分泌科住院的老年T2DM患者,选取资料完整并且符合要求的病例共513例,男性231人(45%),女性282人(55%)。2.由专科医师采用统一设计的表格进行数据录入,病例资料搜集、体检及检验结果。3.一般资料:年龄、性别、体重指数、糖化血红蛋白、既往史(有无高血压病、心脑血管疾病、血脂异常等)、病程及就诊时所用降糖、降脂和降压药物以及合并症情况。4.用SPSSl9.0软件包进行数据处理和统计分析。结果:1.降糖药物用药情况:单独口服降糖药26.7%,其中单药10.5%,两种以上联合用药16.2%;胰岛素应用73.1%,其中单独应用胰岛素20.1%,联合口服降糖药53.0%,未用药0.2%。其中口服降糖药物主要为α糖苷酶抑制剂——阿卡波糖占55.2%,伏格列波糖占5.8%。二甲双胍用药占26.3%。磺脲类药物中以格列美脲应用最多,占17.2%。2.患者Hb Alc均值为(8.70±2.05)%。Hb Alc控制达标即Hb Alc7%的患者有100例,占19.5%。其中单独应用口服药物治疗的患者,Hb Alc达标率为43.1%,单独应用胰岛素治疗的患者,Hb Alc达标率为15.5%,口服药物联合胰岛素治疗的患者,Hb Alc达标率为8.8%。研究结果显示Hb Alc受病程、BMI、TC、TG、LDL、HDL等多方面因素影响,但年龄、性别及用药情况与Hb Alc的控制之间无明显关联。3.横断面分析T2DM急性、慢性并发症患病情况:常见的急性并发症有低血糖占16.6%,糖尿病高渗性昏迷占1.4%,糖尿病酮症酸中毒占1.8%。微血管并发症包括神经病变、糖尿病肾病、糖尿病视网膜病变,其中神经病变占比例最高,为359人,占70%,糖尿病肾病次之,为168人,占32.7%,其中Ⅲ期患者占62.5%,Ⅳ期患者占36.3%,Ⅴ期患者占1.2%。糖尿病视网膜病变120人,占23.4%,其中背景期占51.3%,增殖期占48.7%。大血管并发症主要为心血管疾病,其中冠心病占比例最高,为158人,占30.8%。糖尿病患者合并高血压病,为359人,占70%。分析显示糖尿病合并症组糖化血红蛋白、空腹血糖水平显著增高,与单纯糖尿病组比较差异具有统计学意义。4.入组分析的513例患者中,TC、TG、LDL、HDL、BMI、收缩压(SBP)、舒张压(DBP)达标率分别为58.5%,55.4%,30.8%,60.4%,33.7%,38.7%,62.4%。老年糖尿病患者的BMI、血脂、血压控制往往不理想。血压控制以收缩压控制情况略差,符合老年糖尿病患者的特点。5.合并高血压用药中,单药应用有38.3%,其中以ARB/ACEI,占22.3%,血压达标率为33.2%。CCB次之,占12.8%,血压达标率为25.5%;联合用药有58.9%(其中以ARB/ACEI+CCB两种药物联合,为33.1%,血压达标率为45.8%。ARB/ACEI+利尿剂联合用药次之,占17.5%,血压达标率为48.1%);2.8%患者未用降压药物。6.血脂异常患病率为47.4%,血脂异常用药中单用他汀类占58.4%,血脂达标率为32.5%。单用贝特类占30.0%,血脂达标率为28.2%,两者联合用药占4.9%,血脂达标率为51.5%。有6.6%患者未用调脂药物。结论:1.老年T2DM中降糖治疗方案中,胰岛素联合口服降糖药治疗所占比率最高。其中口服降糖药物主要为阿卡波糖、二甲双胍、格列美脲。2.老年T2DM患者血糖控制不理想,Hb Alc7%仅为19.5%。Hb Alc的控制与糖尿病的病程、血脂控制情况、BMI密切相关。3.老年T2DM患者慢性并发症患病率较高,周围神经病变最高,糖尿病肾病次之。低血糖发生率为16.6%。4.老年T2DM患者体重指数、低密度脂蛋白胆固醇、收缩压控制达标率低。合并高血压降压药物的用药比率为97.2%,血压达标率为38.7%。降脂药物的用药比率为93.4%,低密度脂蛋白胆固醇达标率为30.8%。
[Abstract]:Objective: To investigate the treatment of elderly patients with T2DM and blood glucose control and complications incidence. Methods: 1. cases from January 2012 to December 2014 in Dalian City, the 210th Hospital of PLA in the Department of endocrinology in elderly patients with T2DM, select the data integrity and meet the requirements of the 513 cases, 231 males, 282 females (45%) (55%.2.) by specialists with unified design table for data entry, case data collection, examination and inspection results of.3. general information: age, gender, BMI, HbA1c, past history (with or without hypertension, cardiovascular disease, dyslipidemia), course of disease and treatment with hypoglycemic, lipid-lowering and antihypertensive drugs and complications of.4. for data processing and statistical analysis using SPSSl9.0 software package. Results: 1. hypoglycemic drugs: single oral hypoglycemic drugs in 26.7%, including more than two kinds of drugs 10.5%. The combination of 16.2%; 73.1% the application of insulin, insulin alone 20.1%, combined with oral hypoglycemic drug 53%, untreated 0.2%. which oral hypoglycemic drugs mainly for alpha glucosidase inhibitor acarbose, voglibose accounted for 55.2%, accounting for 5.8%. of metformin and sulfonylurea drug 26.3%. in patients with Hb accounted for most applications of glimepiride, Alc mean 17.2%.2. (8.70 + 2.05)%.Hb Alc Hb control Alc7% of patients with 100 cases, which accounted for 19.5%. alone application of oral medication, the Hb standard rate of Alc is 43.1%, single application of Shima Soji therapy in patients with Alc, the standard rate of Hb was 15.5%, insulin combined with oral drug treatment in patients with Hb, the success rate of Alc the results showed that Hb 8.8%. Alc by BMI, TC, course of disease, TG, LDL, HDL and other factors influence, but the age, no obvious correlation between.3. cross gender and medication control with Hb Alc T2DM analysis of acute and chronic complications: prevalence of common acute complications with hypoglycemia in diabetic hyperosmolar coma accounted for 16.6%, accounting for 1.4%, accounting for 1.8%. of diabetic ketoacidosis microvascular complications including neuropathy, diabetic nephropathy, diabetic retinopathy, neuropathy which accounted for the highest proportion, 359, accounting for 70%, followed by diabetic nephropathy, for 168 people, accounting for 32.7%, which accounted for 62.5% of patients with stage III, IV patients accounted for 36.3%, stage 1.2%. diabetic retinopathy patients accounted for 120, accounting for 23.4%, of which the background period accounted for 51.3%, accounted for 48.7%. period of proliferation of macrovascular complications mainly for cardiovascular diseases, including coronary heart disease accounted for the highest proportion, 158 people, accounting for 30.8%. patients diabetic patients with hypertension, 359 people, accounting for 70%. analysis showed that diabetes complication group HbA1c, fasting blood glucose level increased significantly, and simple diabetes group were statistically The significance of.4. into 513 cases of group analysis in patients with TC, TG, LDL, HDL, BMI (SBP), systolic blood pressure, diastolic blood pressure (DBP) compliance rates were 58.5%, 55.4%, 30.8%, 60.4%, 33.7%, 38.7%, 62.4%. BMI in elderly patients with diabetes mellitus, blood lipid, blood pressure control, blood pressure is not ideal. In order to control the systolic blood pressure control is slightly worse, with the characteristics of elderly patients with diabetes mellitus.5. with hypertension medication, the single dose of 38.3%, of which ARB/ACEI, accounting for 22.3%, the standard rate of blood pressure was 33.2%.CCB, accounting for 12.8%, the control rate of blood pressure was 25.5%; the combination of 58.9% ARB/ACEI+CCB (of which two drugs combined. 33.1%, the standard rate of blood pressure was 45.8%.ARB/ACEI+ times the combined use of diuretics, accounted for 17.5%, the standard rate of blood pressure was 48.1%); 2.8% patients did not use.6. lipid antihypertensive drugs abnormal prevalence rate was 47.4%, dyslipidemia medication with statin monotherapy accounted for 58.4%. The success rate of blood lipids was 32.5%. with fibrates accounted for 30 %, blood lipid was 28.2%. The combination of the two drugs accounted for 4.9%, the blood rate of 51.5%. of 6.6% patients with lipid-lowering drugs. Conclusion: hypoglycemic treatment for 1. elderly patients with T2DM, insulin combined with oral antidiabetic drugs. The highest proportion of oral hypoglycemic drugs for a acarbose, metformin, glimepiride glucose.2. patients with T2DM control is not ideal, only Hb Alc7% 19.5%.Hb Alc control and diabetes duration, blood lipid control, the high prevalence of BMI.3. is closely related to the elderly patients with T2DM chronic complications, peripheral neuropathy, diabetic nephropathy. The occurrence of hypoglycemia in elderly patients with T2DM body mass index 16.6%.4. rate, low density lipoprotein cholesterol the systolic blood pressure, hypertension control rate is low. The antihypertensive drug medication ratio is 97.2%, the control rate of blood pressure lowering drugs for 38.7%. treatment ratio of 93.4%, low density lipoprotein The standard rate of white cholesterol is 30.8%.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.1

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