【摘要】　目的　 老年綜合評估法篩查75歲以上2型糖尿?。╰ype 2 diabetes mellitus，T2DM）合并老年綜合征的情況，并觀察以甘精胰島素為基礎(chǔ)的治療方法對老年綜合征、血糖、低血糖事件、治療滿意度等的影響。　方法　 應(yīng)用老年綜合評估中的日常生活能力、工具性日程生活能力、簡易智能量表、老年抑郁量表、微型營養(yǎng)評定法，分別評估2005年12月—2009年12月老年門診及病房住院的日常生活能力、認知功能狀態(tài)、情緒障礙和營養(yǎng)狀態(tài)，對其合并功能障礙、癡呆、抑郁、營養(yǎng)障礙、傷害性跌倒等老年綜合征的患病情況進行橫斷面調(diào)查；篩選至少合并一種老年綜合征和一個其他合并疾病，血糖控制差、預(yù)期壽命有限的患者進行以甘精胰島素為基礎(chǔ)的降糖治療，采用自身前后對照的方法了解對糖化血紅蛋白（hemoglobin A1c， HbA1c）、低血糖事件、治療滿意度的影響，并觀察甘精胰島素治療方案對上述老年綜合征的影響。　結(jié)果　 132例老年門診及病房住院的75歲以上T2DM患者功能障礙者高達50.0%（66例），罹患包括輕度認知功能障礙在內(nèi)的癡呆比例為39.4%（52例）；合并抑郁癥28.0%（37例）；營養(yǎng)失衡30.0%（39例）。33例患者符合甘精胰島素治療納入標準，經(jīng)過2年的隨訪發(fā)現(xiàn)，以甘精胰島素為基礎(chǔ)的治療方案在適當(dāng)降低HbA1c水平時，不增加老年綜合征的患病率，但可以減少胰島素多次皮下注射的次數(shù)，降低低血糖事件發(fā)生次數(shù)（由1.58次/例降為0.81次/例），提高患者治療滿意度。　結(jié)論　 75歲以上T2DM患者合并老年綜合征的比例高，老年綜合評估能及時發(fā)現(xiàn)老年綜合征；以甘精胰島素為基礎(chǔ)的治療方案不增加老年綜合征的發(fā)生，并能顯著降低低血糖事件數(shù)、改善營養(yǎng)狀態(tài)、提高患者對治療的滿意度。
【Abstract】　Objective　 To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes.　Methods　 From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed.　Results　 Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved.　Conclusions　 Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .

引用本文： 蒙張敏,王雙,曹立,李峻. 75歲以上2型糖尿病患者接受老年綜合評估及以甘精胰島素為基礎(chǔ)治療的2年隨訪研究. 華西醫(yī)學(xué), 2011, 26(6): 819-822. doi: 復(fù)制