为了调查患病率,结果,以及与长期护理机构(LTCF)中2型糖尿病(T2DM)的潜在血糖过度治疗和治疗不足相关的因素。
系统评价。
患有T2DM且年龄≥60岁的居民生活在LTCF中。
在对MEDLINE进行系统搜索后,检索了2000年1月至2020年9月之间发表的文章,EMBASE,科克伦图书馆,CINAHLplus,灰色文学纳入标准是报告(1)基于血红蛋白A1c(HbA1c)和/或血糖定量定义(隐式或显式)的潜在过度治疗和治疗不足;(2)患病率,结果,以及潜在的血糖过度治疗和治疗不足的相关因素;(3)该研究涉及LTCF的居民。
共纳入15项研究。潜在过度治疗的患病率(5%-86%,n=15项研究)和治疗不足(1.4%-35%,n=8项研究)在设施和地理位置之间差异很大,并根据使用的定义。潜在过度治疗的患病率为16%-74%,当定义为在具有≥1个低血糖危险因素或严重合并症的居民中使用降糖药物治疗时,HbA1c<7%(n=10项研究)。潜在治疗不足通常定义为使用降糖药物的居民HbA1c>8.5%,患病率1.4%-14.8%(n=6项研究)。没有研究前瞻性地测量居民健康结果从过度治疗和治疗不足。潜在的过度治疗与口服降糖药物的使用呈正相关。痴呆诊断或痴呆严重程度,和/或需要协助日常生活活动(n=2项研究)。潜在的过度治疗与使用胰岛素/联合胰岛素和口服降糖药物之间存在负相关。没有研究报告与潜在治疗不足相关的因素。
根据每个研究中使用的定义,T2DM居民中潜在的血糖过度治疗和治疗不足的患病率差异很大。纵向研究检查血糖管理和健康结果之间的关联,需要使用过度治疗和治疗不足的共识定义,以确定LTCF中实际的血糖过度治疗和治疗不足的结果.
To investigate the prevalence, outcomes, and factors associated with potential glycemic overtreatment and
undertreatment of type 2 diabetes mellitus (T2DM) in long-term care facilities (LTCFs).
Systematic
review.
Residents with T2DM and aged ≥60 years living in LTCFs.
Articles published between January 2000 and September 2020 were retrieved following a systematic search of MEDLINE, EMBASE, Cochrane Library, CINAHL plus, and gray literature. Inclusion criteria were the reporting of (1) potential overtreatment and
undertreatment quantitatively defined (implicitly or explicitly) based on hemoglobin A1c (HbA1c) and/or blood glucose; (2) prevalence, outcomes, and associated factors of potential glycemic overtreatment and undertreatment; and (3) the study involved residents of LTCFs.
Fifteen studies were included. Prevalence of potential overtreatment (5%-86%, n = 15 studies) and undertreatment (1.4%-35%, n = 8 studies) varied widely among facilities and geographical locations, and according to definitions used. Prevalence of potential overtreatment was 16%-74% when defined as treatment with a glucose-lowering medication in a resident with ≥1 hypoglycemia risk factor or serious comorbidity, together with a HbA1c <7% (n = 10 studies). Potential undertreatment was commonly defined as residents on glucose-lowering medication having HbA1c >8.5% and the prevalence 1.4%-14.8% (n = 6 studies). No studies prospectively measured resident health outcomes from overtreatment and
undertreatment. Potential overtreatment was positively associated with use of oral glucose-lowering medications, dementia diagnosis or dementia severity, and/or need for assistance with activities of daily living (n = 2 studies). Negative association was found between potential overtreatment and use of insulin/combined insulin and oral glucose-lowering medication. No studies reported factors associated with potential
undertreatment.
The prevalence of potential glycemic overtreatment and undertreatment varied widely among residents with T2DM depending on the definition(s) used in each study. Longitudinal studies examining associations between glycemic management and health outcomes, and the use of consensus definitions of overtreatment and undertreatment are required to establish findings about actual glycemic overtreatment and undertreatment in LTCFs.