HIPOGLICEMIA EM DOENTES DIABÉTICOS IDOSOS: EXPERIÊNCIA DE UMA UNIDADE DE DIABETES | HYPOGLYCEMIA IN ELDERLY DIABETIC PATIENTS: EXPERIENCE IN A DIABETES UNIT

Inês Romero, Raquel Sousa, Inês Ferraz de Oliveira, Ana Bárbara Pedro, Joana Urzal

Resumo


PT | RESUMO
Introdução: Assiste-se atualmente a uma evolução paralela do envelhecimento da população e da prevalência crescente
de Diabetes Mellitus. Os indivíduos idosos estão particularmente susceptíveis à ocorrência de episódios de hipoglicemia, res-
ponsáveis por uma morbimortalidade significativa nesta população. Os objetivos do estudo foram a avaliação da incidência
de doentes diabéticos com episódios de hipoglicemia na população de idosos seguidos na Unidade Integrada de Diabetes
(UID) do HFF e caracterizar, comparativamente, a população de idosos com e sem episódios de hipoglicemia.
Materiais e métodos: Estudo observacional, longitudinal, retrospetivo, descritivo, consistindo na análise de variáveis
demográficas, clínicas e laboratoriais constantes em processo clínico informático Soarian®, num período de um ano, proce-
dendo-se a análise estatística dos mesmos.
Resultados: Em 2013 mais de metade dos doentes seguidos na UID eram idosos, tendo-se verificado episódios de hipo-
glicemia em 22,6%. A maioria dos doentes com episódios de hipoglicemia (CH) tratava-se de doentes com mais de 75 anos e
tinha um tempo de evolução de doença superior a 5 anos, com uma média de tempo de evolução de 17,5 anos. A presença
de complicações microvasculares foi objetivada em mais de metade destes doentes (51,2%) sendo que 47,8% apresentavam
complicações macrovasculares. A HbA1C média era de 7,8%, tendo apresentado, ao longo do ano, uma descida média de
0,6%.  A maioria (71,7%) dos doentes CH estava medicado com insulina, mais de metade destes (54,3%) medicados com
insulina com pico de ação, tratando-se de proporções significativamente superiores às objetivadas nos doentes sem episódios
de hipoglicemia (SH). Relativamente ao uso de antidiabéticos orais, 26,1% estavam medicados com sulfonilureias.
Conclusão: Este estudo vem reiterar a necessidade de individualização e adequação de objetivos de cuidados na população
idosa e com mais comorbilidades, assumindo alvos glicémicos mais permissivos e esquemas terapêuticos com menor risco
associado de hipoglicemia.


Palavras-chave: Diabetes mellitus; Idoso; Hipoglicemia; Insulina


EN | ABSTRACT
Introduction: Currently there is a simultaneous population ageing and increasing prevalence of diabetes mellitus (DM). Elderly indi-
viduals are especially prone to episodes of hypoglycaemia, which are responsible for significant morbidity and mortality in this population.
The main objective of the study was to evaluate the incidence hypoglycaemia in the elderly population followed as outpatients in the Hospital
Fernando da Fonseca Diabetes Unit (UID). The secondary objective was to perform a comparative analysis between the population of elderly
patients with episodes hypoglycaemia and without episodes of hypoglycaemia.
Materials and methods: Observational, longitudinal, retrospective, descriptive study during the period of one year. The demographic,
clinical and laboratory data was collected from the electronic medical records in Soarian ® software and then statistically analysed.
Results: In 2013, more than half of the patients followed in the UID were elderly and 22,6% of them experienced hypoglycaemia. Most
patients with hypoglycaemia were “late elderly” and had the diagnosis of DM for more than 5 years, with mean disease duration of 17.5 years.
Microvascular complications were observed in more than half of these patients (51.2%), and 47.8% had macrovascular complications. The
mean HbA1C at the beginning of study period was 7.8% and, during the year, there was an average decrease of 0.6%. The majority (71.7%)
of the patients with episodes of hypoglycaemia were under insulin therapy and most of them (54.3%) were being treated with any type of
insulin with a peak of action. These data concerning insulin therapy were significantly higher than in the group of patients not experiencing
hypoglycaemia episodes. Regarding the use of oral antidiabetics, 26.1% were medicated with sulphonylureas.
Conclusion: This study reinforces the need for individualization and patient centered approach on the treatment goals of the elderly
population. Especially the ones with more comorbidities should have more permissive glycemic targets and conservative therapeutic regimens
in order to lower the risk of hypoglycaemia.


Keywords: Diabetes mellitus; Aged; Hypoglycemia; Insulin


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