Application Status Of Hypoglycemic Drugs And The Analysis Of Blood Glucose Control Of Elderly Inpatients With Type 2 Diabetes

Objective: To discuss the present status of treatment,glucose control and the incidence of common complications of the elderly T2 DM in patients.Method: 1.Selected cases,the elderly T2 DM in patients who were treated at endocrinology department of 210 Hospital in Dalian between January 2012 to December 2014.All in patients 513,including 231 cases for male(45%)and 282 cases for female(55%).2.The data were inputted with unified designed tables by diplomats.Collect the patients' data,have physical examination for them and check the results.3.General information: age,sex,body mass index,glycated hemoglobin,past history(with or without hypertension,cardiovascular diseases,dyslipidemia,etc.),illness duration and the kind of hypoglycemic agents,lipid-lowering agents and antihypertensive agents in their treatments,and complications.4.The SPSSl9.0 software was used in the data processing software and statistical analysis.Results: 1.The application of hypoglycemic drugs: 26.7% of oral antidiabetic drugs alone(including 10.5% of singal and 16.2% of associated medication over two kinds);73.1% of insulin treatment(including 20.1% of insulin alone and 53.0% of combined with Oral Hypoglycemic Agents);and 0.2% of non-administration.The mostly used oralantidiabetic drug is the ?-Glucosidase Inhibitor,including 55.2% of acarbose and 5.8% of the voglibose.And 26.3% of the pioglitazone.In the use of Sulfonylurea drugs,17.2% of glimepiride.2.The average of in patients' Hb Alc is(8.70±2.05)%.100 patients achieve Hb Alc Control(Hb Alc<7%),accounting for 19.5%.Of those,patients who are only oral drug have a Hb Alc attainment rate of 43.1%;who are only treated with insulin in have a Hb Alc attainment rate of 15.5%;who are treated with oral drug therapy as well as insulin in have a Hb Alc attainment rate of 8.8%.The study shows that the Hb Alc is influenced by the illness duration,BMI,TC,TG,LDL,HDL,and many other factors,but the control of the Hb Alc shows no correlation with the age,sex and drug utilization of the patient.3.The Cross-sectional Analysis of the acute and chronic complications' prevalence of T2DM: There are some common acute complications among the patients,as 16.6% of them have hypoglycemia,1.4% of hyperosmolar diabetic coma as well as 1.8% of diabetic ketoacidosis.Microvascular complications including the diabetic neuropathy,the diabetic nephropathy and the diabetic retinopathy.Of those,the proportion of diabetic neuropathy is the first(359 cases,70%);the diabetic nephropathy is the second highest(168 cases,32.7%),which including 62.5% of stage III,36.3% of stage IV,1.2% of stage V.Besides,there are 120 cases of the diabetic retinopathy(23.4%),which including 51.3% of background stage and 48.7% of proliferative stage.Also there are macrovascular complications,including cardiovascular disease(coronary disease),cerebrovascular disease,peripheral vascular disease(diabetic foot).Among those,the proportion of coronary disease is the highest(158 cases,30.8%).The number of diabetic patients with hypertension is the biggest(359 cases,70%).Our study shows a significantly increasing of the level of glycated Hb Alc and fasting blood-glucose in the diabetic complication group,which has statistical significance to compare with the simple diabetes group.4.In the 513 selected cases,the attainment rates of TC,TG,LDL,HDL,BMI,SBP and DBP are 58.5%,55.4%,30.8%,60.4%,33.7%,38.7% and 62.4%,respectively.The elderly T2 DM patients' blood pressure,blood lipid profile and BMI control are poor.The bad control of blood pressure and systolic blood pressure suits the characteristics of the elderly T2 DM patients.5.Drug utilization of diabetic patients with hypertension: Among 38.3% of singleagent application,the mostly used drug is ARB/ACEI(22.3%)with a compliance rate of blood pressure of 33.2%;and CCB comes next(12.8%),with a compliance rate of blood pressure of 25.5%.58.9% of patients had combined agent treatment(including 33.1% of ARB/ACEI+CCB and 17.5% of ARB/ACEI+Diuretic,and with a compliance rate of blood pressure of 45.8% and 48.1%,respectively.)2.8% of patients no antihypertensive drug.6.47.4% of cases have dyslipidosis.58.4% of them had the statins therapy with a blood lipids compliance rate of 32.5%;30% of them had fibrates with a blood lipids compliance rate of 28.2%;Combination accounted for 4.9%,with a blood lipids compliance rate of 51.5%.6.6% patients didn't have any lipid-regulating drugs.Conclusion: 1.In the hypoglycemic therapy of elderly T2 DM patients,the insulin combined with oral hypoglycemic agent treatment is mostly used.Acarbose tablets,Metformin and Glimepiride are three common oral hypoglycemic agents.2.The blood glycemic control of elderly T2 DM patients is unsatisfactory.The rate of Hb Alc<7% is only 19.5%.The control of Hb Alc is closely related with the illness duration,the control of blood lipid level and BMI of the diabetic patients.3.Elderly T2 DM patients have a high prevalence of chronic complications.Diabetic peripheral neuropathy has the highest prevalence,diabetic nephropathy second highest.The occurrence rate of glucopenia is 16.6%.4.Elderly T2 DM patients have a low eligible rate of the body mass index(BMI),LDL cholesterol and the systolic blood pressure control.The using rate of antihypertensive drug is 97.2% and the compliance rates of blood pressure is 38.7%.The using rate of lipid-lowering drugs is 93.4% and the compliance rates of LDL is 30.8%.