Identifying older diabetic patients at risk of poor glycemic control.
Identifying older diabetic patients at risk of poor glycemic control.
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DOI：
10.1186/1471-2318-2-4
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发表时间：
2002-08-23
期刊：
影响因子：
4.1
通讯作者：
Gruppo Italiano di Farmacovigilanza nell'Anziano
中科院分区：
文献类型：
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作者：
Incalzi RA;Corsonello A;Pedone C;Corica F;Carosella L;Mazzei B;Perticone F;Carbonin P;Gruppo Italiano di Farmacovigilanza nell'Anziano
最佳的血糖控制可以防止糖尿病并发症的发生。识别有血糖控制不良风险的糖尿病患者可能有助于促进专门的干预措施。本研究的目的是确定老年糖尿病住院患者短期和长期血糖控制不良的预测因素。共有1354名老年糖尿病住院患者连续入组一项多中心研究，形成训练人群（回顾性组）；264例连续入住普通内科病房的患者构成了测试人群（前瞻性组）。在试验人群入院时和出院后一年测量糖化血红蛋白（HbA1c）。通过logistic回归分析评估训练人群中出院血糖≥140 mg/dl的独立相关因素，并制定临床预测规则。在测试人群中评估预测规则和入院HbA1c预测出院后1年血糖≥140 mg/dl和HbA1c bb0 7%的能力。选定的入院变量（舒张压< 80 mmHg，血糖值= 143-218 mg/dl，血糖值> 218 mg/dl，胰岛素或联合降糖治疗史，Charlson指数> 2）相结合，获得预测训练人群出院时空腹血糖≥140 mg/dl的评分。入院HbA1c超过7.8%时加1分为修正分。在测试人群中，修正评分是出院血糖≥140 mg/dl（敏感性= 79%，特异性= 63%）和1年HbA1c水平≥7%（敏感性= 72%，特异性= 71%）的最佳预测指标。一个简单的临床预测规则可能有助于识别有短期和长期血糖控制不良风险的老年糖尿病住院患者。
Optimal glycemic control prevents the onset of diabetes complications. Identifying diabetic patients at risk of poor glycemic control could help promoting dedicated interventions. The purpose of this study was to identify predictors of poor short-term and long-term glycemic control in older diabetic in-patients. A total of 1354 older diabetic in-patients consecutively enrolled in a multicenter study formed the training population (retrospective arm); 264 patients consecutively admitted to a ward of general medicine formed the testing population (prospective arm). Glycated hemoglobin (HbA1c) was measured on admission and one year after the discharge in the testing population. Independent correlates of a discharge glycemia ≥ 140 mg/dl in the training population were assessed by logistic regression analysis and a clinical prediction rule was developed. The ability of the prediction rule and that of admission HbA1c to predict discharge glycemia ≥ 140 mg/dl and HbA1c > 7% one year after discharge was assessed in the testing population. Selected admission variables (diastolic arterial pressure < 80 mmHg, glycemia = 143–218 mg/dl, glycemia > 218 mg/dl, history of insulinic or combined hypoglycemic therapy, Charlson's index > 2) were combined to obtain a score predicting a discharge fasting glycemia ≥ 140 mg/dl in the training population. A modified score was obtained by adding 1 if admission HbA1c exceeded 7.8%. The modified score was the best predictor of both discharge glycemia ≥ 140 mg/dl (sensitivity = 79%, specificity = 63%) and 1 year HbA1c > 7% (sensitivity = 72%, specificity = 71%) in the testing population. A simple clinical prediction rule might help identify older diabetic in-patients at risk of both short and long term poor glycemic control.