二甲双胍在老年糖尿病患者中应用的现状调查

Investigation on the Application of Metformin in Elderly Diabetic Patients

摘要: 目的：调查某综合医院老年2型糖尿病(Type 2 Diabetes Mellitus, T2DM)患者，在不同肾功能水平下二甲双胍实际应用情况，指导合理用药。方法：利用医院医疗信息管理系统(HIS系统)，调取该院2012年4月至2019年6月住院的老年T2DM患者病例，提取该患者年龄、性别、住院科室、血清肌酐(Serum creatinine, Scr)、糖化血红蛋白(Hemoglobin A1c, HbA1c)及二甲双胍的应用情况，计算患者平均肾小球滤过率(Epidermal growth factor receptor, eGFR)，结合相关指南判断患者的二甲双胍应用情况。结果：1) 共收集资料齐全的老年T2DM患者16550例，1117例存在二甲双胍使用不合理，不合理用药率9.59%，其中347例(2.10%)未及时停药，770例(4.65%)未及时调整剂量；2) 1117例不合理用药患者中，男性384例(34.38%)，女性733例(65.62%)，人均年龄(75.92 ± 6.62)岁。其中Scr位于正常值范围内，但eGFR小于45 ml/(min∙1.73 m²)共198例，占17.73%。其中Scr位于正常值范围内，但eGFR 45~60 ml/(min∙1.73 m²)共762例，占68.22%。3) 用药科室不合理分布中，心血管内科居首位，占26.95%，其次为内分泌内科、综合内科、神经内科、保健科、急诊与重症、肾病科，累计构成比在91.79%。结论：综合医院老年糖尿病患者中存在二甲双胍用药不合理现象，用药时应避免单纯根据Scr来判断肾功能状况，应采取多种措施共同促进合理用药发展。

Abstract: Objective: To provide rational references to the treatment for diabetes, survey the usage of metformin of application under different levels of kidney function among elderly Type 2 Diabetes (T2DM) patients in a general hospital. Methods: Determine the usage of metformin among patients in combination with related guides by retrieving the information of hospitalized elderly patients with T2DM from April, 2012 to June, 2019, extracting one patients’ age, sex, the inpatient department and application of Serum creatinine (Scr), Hemoglobin A1c (HbA1c) and metformin and calculating the average of glomerular filtration rate (EGFR) with the help of the hospital information system (HIS). Results: 1) Among the 16,550 elderly T2DM patients with complete data collection, 1,117 has unreasonable usage of metformin, accounting for the rate of 9.59%. Among them, 347 (2.10%) do not stop taking the metformin in time, and 770 (4.65%) do not adjust the dose in time. 2) Among the 1,117 patients with unreasonable usage of metformin, 384 are males (34.38%) and 733 are females (65.62%), and the average age was (75.92 ± 6.62) years old. Among the samples, 198 cases have Scr within the normal range but eGFR is less than 45 ml/(min∙1.73 m²), accounting for 17.73%. And 762 cases (68.22%) have Scr within the normal range but eGFR is 45 - 60 ml/(min∙1.73 m²). 3) Among the departments on unreasonable usage of medicine, the top one is cardiovascular department, the rate accounting for 26.95%, followed by endocrinology, general medicine, neurology, health care, emergency and severe diseases, and nephrectomy, with a cumulative composition ratio of 91.79%. Conclusion: There is unreasonable usage of metformin in elderly diabetics in general hospitals. The renal function should not be just judged by blood creatinine. Various measures should be taken to promote the development of reasonable drug use.