HYPOGLYCEMIC SIDE EFFECTS OF SULFONYLUREAS AND REPAGLINIDE IN AGEING PATIENTS - KNOWLEDGE AND SELF-MANAGEMENT
HYPOGLYCEMIC SIDE EFFECTS OF SULFONYLUREAS AND REPAGLINIDE IN AGEING PATIENTS - KNOWLEDGE AND SELF-MANAGEMENT
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DOI：
10.26402/jpp.2018.4.15
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发表时间：
2018-08-01
影响因子：
2.2
通讯作者：
Konturek, P. Ch
中科院分区：
文献类型：
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作者：
Harsch, I. A.;Kaestner, R. H.;Konturek, P. Ch
促胰岛素口服抗糖尿病药 (OAD)，如磺酰脲类和 (SU) 格列奈类药物是常用的 OAD 药物。副作用是可能引起低血糖和体重增加。目的是评估老年 2 型糖尿病患者群体发生低血糖事件时的自我管理技能。在 2 年期间，使用标准化问卷对 160 名接受胰岛素营养型 OAD 住院患者（平均年龄 77.4 岁）进行了访谈。此外，还通过简易精神状态检查（MMSE）和画钟测试（CDT）评估了可能的痴呆症。平均 HbA1c 为 7.6%。 MMSE 和 CDT 个体间相关性良好，调查时 23.8% 的患者患有中度痴呆（MMSE 10 - 20 分），13.1% 患有重度痴呆（MMSE 0 - 10 分）。当接受磺酰脲类药物治疗时，只有 16.0% 的患者意识到潜在的低血糖副作用。此外，在接受磺酰脲类药物和胰岛素联合治疗的患者中，只有 11.8% 的患者知道 OAD 的这种副作用。对瑞格列奈副作用的认知度为 21.6%（未接受胰岛素治疗），而胰岛素治疗组为 21.4%。在接受磺脲类或瑞格列奈治疗的患者中，只有 42.6% 的患者知道发生低血糖时如何应对。即使在使用胰岛素药物治疗的情况下，药物治疗组中也只有 41.2% 的受访者知道在发生低血糖时如何采取行动。我们的研究结果引起了人们的关注，并表明老年患者群体的自我管理技能不佳，这可能成为人口老龄化中日益严重的问题。促胰岛素OAD的处方或重新处方需要适应当前的认知状况并定期重新评估。
Insulinotropic oral antidiabetics (OAD) such as sulfonylureas and (SU) glinides are among the frequently prescribed OAD. Side effects are the potential to induce hypoglycemias and weight gain. The aim was to assess the self-managing skills in case of a hypoglycemic event in an elderly type 2 diabetic patient population. In a 2-year period, 160 hospitalized patients (mean age 77.4 years) under insulinotrophic OAD were interviewed using a standardized questionnaire. Additionally, possible dementia was evaluated by using the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). The mean HbA1c was 7.6%. MMSE and CDT did intraindividually correlate well and 23.8% of the patients had moderate dementia (10 - 20 points MMSE), 13.1% had severe dementia (0 - 10 points MMSE) at the time of the survey. When under treatment with a sulfonylurea, only 16.0% of patients were aware of the potential hypoglycemia-inducing side effect. Moreover, only 11.8% of patients treated with a combination of a sulfonylurea and insulin knew this side effect of the OAD. The awareness of the side effects of repaglinide was 21.6% (without insulin therapy) versus 21.4% in the insulin-comedicated group. Only 42.6% of patients treated with sulfonylureas or repaglinide knew how to act in the case of hypoglycemia. Even under comedication with insulin, only in 41.2% of the respondents in the comedicated group knew how to take action if they were to experience hypoglycemia. Our findings raise concerns and demonstrate, that the self-managing skills in an elderly patient group are not good, which may become an increasing problem in an ageing population. The prescription or the re-prescription of insulinotropic OAD needs to be adapted to the current cognitive situation and re-evaluated regularly.