目的:这篇综述旨在确定2型糖尿病在虚弱人群中治疗过度和不足的后果的证据基础。
方法:在这篇系统综述中,我们搜索了MEDLINE,Embase,PubMed,CINAHL和Cochrane图书馆于2001年1月至2022年8月15日进行研究。我们纳入了各种评估和报告虚弱的研究类型,包括≥18岁的患者。研究包括那些报告了虚弱人群中糖尿病治疗过度或不足的患病率,以及那些检查与虚弱的老年人糖尿病患者血糖控制相关的结果的研究。使用叙事综合方法使用定制提取表提取数据。
结果:共确定了4114篇文章,其中112篇符合纳入标准。其中包括11项研究中的15,130名参与者,样本量从101到11,140不等。在纳入的研究中确定了一些领域,其中糖尿病治疗不足或过度会影响患者的预后。这些包括住院,再入院,逗留时间,falls,死亡率,认知障碍和心血管疾病结局。
结论:结果表明,研究之间的结果存在高度异质性,并且许多研究人员检查了少量参与者。在这次审查中,研究表明,在虚弱的老年人中,过度治疗和治疗不足都会增加不良结局.需要围绕虚弱的老年人糖尿病患者的最佳血糖控制进行进一步研究,以确定理想的目标范围并制定实用的临床指南以促进实现这些目标。
OBJECTIVE: This review aims to identify the evidence base for the consequences of over and
undertreatment of type 2 diabetes mellitus in a frail population.
METHODS: In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or
undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach.
RESULTS: A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes.
CONCLUSIONS: The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and
undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.