Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study.
Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study.
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DOI：
10.1001/jamainternmed.2013.12956
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发表时间：
2014-02-01
影响因子：
39
通讯作者：
Karter, Andrew J.
中科院分区：
文献类型：
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作者：
Huang, Elbert S.;Laiteerapong, Neda;Liu, Jennifer Y.;John, Priya M.;Moffet, Howard H.;Karter, Andrew J.
在未来的几十年里，老年糖尿病患者的人数预计将大幅增长。了解这一人群中糖尿病的临床病程对于建立循证临床实践建议、研究优先事项、分配资源和制定卫生政策至关重要。对比不同年龄和糖尿病病程类别的糖尿病并发症和死亡率。这项队列研究（2004-2010年）纳入了72，310例老年（≥60岁）2型糖尿病患者，这些患者入组了一个大型综合医疗保健服务系统。计算每个年龄类别（60岁、70岁、80岁以上）和糖尿病持续时间（较短：0-9年vs.较长：10年以上）的发病率密度（每1000人-年（pys）的事件）。急性高血糖事件、急性低血糖事件（低血糖）、微血管并发症[终末期肾病（ESRD）、外周血管疾病、下肢截肢、晚期眼病]、心血管并发症[冠状动脉疾病（CAD）、脑血管疾病（CVD）、充血性心力衰竭（CHF）]和全因死亡率。在短期糖尿病老年人中，心血管并发症其次是低血糖，是最常见的非致命性并发症。例如，在70-79岁糖尿病病程较短的奥尔兹中，CAD和低血糖发生率（分别为11.5和5.0/1000 pys）高于ESRD（2.6/1000）、截肢（1.3/1000）和急性高血糖事件（0.8/1000）。我们在同一年龄组的糖尿病病程较长的受试者中观察到相似的模式，其中CAD和低血糖的发生率最高（分别为19.0和15.9 /1000 pys），与ESRD（7.6/1000）、截肢（4.3/1000）和急性高血糖事件（1.8/1000）相比。对于给定的年龄组，每种结局的发生率，特别是低血糖和微血管并发症，随着持续时间的延长而显著增加。然而，对于给定的糖尿病持续时间，低血糖、心血管并发症和死亡率随着年龄的增长而急剧增加，而微血管并发症的发生率保持稳定或下降。糖尿病病程和年龄增长独立预测糖尿病发病率和死亡率。随着糖尿病长期生存率的增加以及人口老龄化，将需要更多的研究和公共卫生工作来减少低血糖，以补充正在进行的减少心血管和微血管并发症的努力。
In the coming decades, the population of older adults with diabetes is expected to grow substantially. Understanding the clinical course of diabetes in this population is critical for establishing evidence-based clinical practice recommendations, research priorities, allocating resources, and setting health policies. Contrast rates of diabetes complications and mortality across age and diabetes duration categories. This cohort study (2004–2010) included 72,310 older (≥60 years of age) patients with type 2 diabetes enrolled in a large, integrated healthcare delivery system. Incidence densities (events per 1000 person-years (pys)) were calculated for each age category (60s, 70s, 80+ years) and duration of diabetes (shorter: 0–9 years vs. longer: 10+ years). Incident acute hyperglycemic events, acute hypoglycemic events (hypoglycemia), microvascular complications [end-stage renal disease (ESRD), peripheral vascular disease, lower extremity amputation, advanced eye disease], cardiovascular complications [coronary artery disease (CAD), cerebrovascular disease (CVD), congestive heart failure (CHF)], and all-cause mortality. Among older adults with diabetes of short duration, cardiovascular complications followed by hypoglycemia were the most common non-fatal complications. For example, among 70–79 year olds with short duration of diabetes, CAD and hypoglycemia rates were higher (11.5 and 5.0/1000 pys respectively), compared to ESRD (2.6/1000), amputation (1.3/1000), and acute hyperglycemic events (0.8/1000). We observed a similar pattern among subjects in the same age group with long diabetes duration where CAD and hypoglycemia had some of the highest incidence rates (19.0 and 15.9 /1000 pys respectively), compared to ESRD (7.6/1000), amputation (4.3/1000), and acute hyperglycemic events (1.8/1000). For a given age group, rates of each outcome, particularly hypoglycemia and microvascular complications, increased dramatically with longer duration. However, for a given duration of diabetes, rates of hypoglycemia, cardiovascular complications, and mortality increased steeply with advancing age, while rates of microvascular complications remained stable or declined. Duration of diabetes and advancing age independently predict diabetes morbidity and mortality rates. As long-term survivorship with diabetes increases and as the population ages, more research and public health efforts to reduce hypoglycemia will be needed, to complement ongoing efforts to reduce cardiovascular and microvascular complications.
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影响因子：
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作者：
Coca SG;Ismail-Beigi F;Haq N;Krumholz HM;Parikh CR
通讯作者：
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影响因子：
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DOI：
10.1016/j.jamda.2012.04.012
发表时间：
2012-07-01
影响因子：
7.6
作者：
Sinclair, Alan;Morley, John E.;Lorig, Kate
通讯作者：
Lorig, Kate