前期高齢糖尿病患者における血糖コントロールに関連する要因

Factors associated with glycemic control in early elderly with type 2 diabetes mellitus: An observational study

　本研究は，前期高齢2型糖尿病患者における血糖コントロールに関連する要因を明らかにすることを目的とし，外来通院中患者117名を対象に，自記式質問紙調査及び診療録調査を実施した．血糖コントロールに関連すると考えられる要因を説明変数，血糖コントロールの不良の有無を目的変数として，多変量ロジスティック回帰分析を行った．調査実施施設の倫理委員会の承認を得て行った．

　その結果，対象者の平均年齢は69.7±3.1歳，インスリン治療者は46.2％であった．HbA1c（NGSP）値8.0％以上の血糖不良群は26.5％であった．多変量ロジスティック回帰分析の結果，血糖コントロール不良に関連する要因は，「インスリン治療をしている」OR 7.06，「適切な睡眠時間でないこと」OR 5.46，「肥満」OR 4.57，「負担感が大きい」OR 3.64 であった．前期高齢者の良好な血糖コントロールには，インスリン管理状況や基本的生活習慣，及び治療負担感への支援が重要である．

　BACKGROUND: In Japan, the incidence of type 2 diabetes mellitus (T2DM) is growing steadily among the early elderly. Positive efforts are crucial to attaining good glycemic control among patients with T2DM. Hence, factors associated with glycemic control in early elderly with T2DM warrant elucidation for T2DM management.

　AIMS: This study aimed to define factors influencing glycemic control among early elderly outpatients with T2DM.

　METHODS: This study was conducted in a general hospital and clinic in Japan. Data were collected through a questionnaire survey and electronic medical records database. The multivariate logistic regression analysis was used to identify factors associated with glycemic control. This study protocol was approved by the Research Ethics Committee.

　RESULTS: We enrolled 117 patients (mean age: 69.7±3.1 years; mean disease duration: 14.1±9.7 years; mean HbA1c value: 7.4%±1.2%) in this study. Of all, 54 patients (46.2%) were treated with insulin, and the rate of poor glycemic control (HbA1c value ≧8.0%) group was 26.5%. The factors independently correlating with poor glycemic control were “insulin treatment” (odds ratio [OR], 7.06; 95% confidence interval [CI]: 2.06-24.22), “improper sleep time” (OR, 5.46; 95% CI: 1.60-18.67), “obesity” (OR, 4.57; 95% CI: 1.29-16.20), and “large sense of burden” (OR, 3.64; 95% CI: 1.13-11.78).

　CONCLUSIONS: It is imperative to support insulin management, basic lifestyle, and treatment burden for good glycemic control among early elderly with T2DM.