Longitudinal incidence and prevalence of adverse outcomes of diabetes mellitus in elderly patients
Longitudinal incidence and prevalence of adverse outcomes of diabetes mellitus in elderly patients
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DOI：
10.1001/archinte.167.9.921
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发表时间：
2007-05-14
影响因子：
--
通讯作者：
Feinglos, Mark N.
中科院分区：
文献类型：
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作者：
Bethel, M. Angelyn;Sloan, Frank A.;Feinglos, Mark N.
背景：老年人2型糖尿病（DM）的自然病史以前没有在全国纵向样本中描述过。方法：这项全国纵向分析（1991年1月1日至2004年12月31日）检查了新诊断为糖尿病的老年患者的死亡率和发病率。1994年诊断为糖尿病的医疗保险受益人（n = 33 772）与对照组（n = 25 563）在死亡率、下肢并发症、肾病、视网膜病变、心血管并发症和脑血管并发症方面进行了比较。结果：与对照组相比，糖尿病组11年死亡率高出9.2%。到2004年，糖尿病组出现不良并发症的比例为91.8%，对照组为72.0%。与对照组相比，DM组在各时间点微血管和大血管并发症的患病率和发生率均较高。糖尿病患者发生所有下肢并发症的风险增加，特别是那些需要手术干预的患者（坏疽、清创和截肢）。心血管并发症是发病的主要原因，糖尿病组中有57.6%的人被诊断患有心力衰竭，而对照组的这一比例为34.1%。结论：在10年随访期间，新诊断为糖尿病的老年人的并发症发生率很高，远远超过未诊断为糖尿病的老年人，这对个人和医疗保健系统都意味着沉重的负担。
Background: The natural history of type 2 diabetes mellitus (DM) in the elderly has not been previously described in a national longitudinal sample.Methods: This national longitudinal analysis (January 1, 1991, to December 31, 2004) examines mortality and morbidity rates in a representative sample of elderly patients newly diagnosed as having DM. Medicare beneficiaries diagnosed as having DM in 1994 (n = 33 772) were compared with a control group (n = 25 563) regarding death, lower extremity complications, nephropathy, retinopathy, cardiovascular complications, and cerebrovascular complications.Results: The DM group had excess mortality of 9.2% by year 11 compared with the control group. By 2004, 91.8% of the DM group experienced an adverse complication compared with 72.0% of the control group. The DM group had a higher prevalence and incidence of microvascular and macrovascular complications at all time points compared with controls. Patients with DM were at increased risk for all lower extremity complications, particularly those requiring surgical intervention (gangrene, debridement, and amputation). Cardiovascular complications were a leading cause of morbidity, with 57.6% of the DM group diagnosed as having heart failure compared with 34.1% of the controls.Conclusion: Elderly persons newly diagnosed as having DM experienced high rates of complications during 10-year follow-up, far in excess of elderly persons without this diagnosis, implying a substantial burden on the individual and on the health care system.