The Risks and Benefits of Implementing Glycemic Control Guidelines in Frail Older Adults with Diabetes Mellitus
The Risks and Benefits of Implementing Glycemic Control Guidelines in Frail Older Adults with Diabetes Mellitus
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DOI：
10.1111/j.1532-5415.2011.03362.x
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发表时间：
2011-04-01
影响因子：
6.3
通讯作者：
Eng, Catherine
中科院分区：
文献类型：
--
作者：
Lee, Sei J.;Boscardin, W. John;Eng, Catherine
目的：确定实施美国老年医学会（AGS）指南中糖化血红蛋白（HbA1c）水平低于8%的体弱老年糖尿病（DM）患者的低血糖和高血糖结局。DESIGNGuideline实现。设置全包养老方案。受试者：指南实施前（2002年10月- 2004年12月，n=338）、早期（2005年1月- 2006年6月，n=289）和后期（2006年7月- 2008年12月，n=385）均诊断为糖尿病，且至少有一次HbA1c检测。干预2005年临床医生教育与年度监测中每个临床医生的糖尿病患者HbA1c比例小于8%。低血糖（血糖< 50 mg/dL）、高血糖（血糖低于400 mg/dL）、严重低血糖（因低血糖就诊急诊）。结果研究前、早期和晚期的参与者在年龄、种族和民族、合并症和功能依赖方面相似。晚期使用降糖药物较多，使用二甲双胍的参与者较多(术前28%，晚期42%，P
OBJECTIVESTo determine the hypo- and hyperglycemic outcomes associated with implementing the American Geriatrics Society (AGS) guideline for a glycosylated hemoglobin (HbA1c) level of less than 8% in frail older adults with diabetes mellitus (DM).DESIGNGuideline implementation.SETTINGProgram of All-Inclusive Care for the Elderly.PARTICIPANTSAll participants in the before (October 2002-December 2004, n=338), early (January 2005-June 2006, n=289) and late (July 2006-December 2008, n=385) periods of guideline implementation with a diagnosis of DM and at least one HbA1c measurement.INTERVENTIONClinician education in 2005 with annual monitoring of the proportion of each clinician's patients with DM with HbA1c less than 8%.MEASUREMENTSHypoglycemia (blood glucose < 50 mg/dL), hyperglycemia (blood glucose > 400 mg/dL), and severe hypoglycemia (emergency department (ED) visit for hypoglycemia).RESULTSParticipants in the before, early, and late periods were similar in age, race and ethnicity, comorbidities, and functional dependence. Antihyperglycemic medication use was greater in the late period, with more participants using metformin (28% before, 42% late, P