Clarke W L, Cox D J, Gonder-Frederick L, Julian D, Kovatchev B, Young-Hyman D
Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Diabetes Care. 1999 Apr;22(4):580-4. doi: 10.2337/diacare.22.4.580.
To identify self-management antecedents of low blood glucose (BG) (< 3.9 mmol/l) that might be easily recognized, treated, or avoided altogether.
Ninety-three adults with type 1 diabetes (age, 35.8 +/- 8 years [mean +/- SD]; duration of diabetes, 17.0 +/- 11 years; daily insulin dose, 0.58 +/- 0.18 U/kg; and HbAlc, 8.6 +/- 1.8%) were recruited to participate in the study. Of the 93 subjects, 42 had a history of severe hypoglycemia (SH), defined as two or more hypoglycemic episodes in the preceding 12 months, and 51 subjects had no history of SH (No-SH) in the same time period. Before each of 70 BG measurements obtained over a 3-week period, subjects used a handheld computer to record whether their most recent insulin, food, and exercise was more than, less than, or the same as usual. Associations among self-management behaviors preceding BG readings < 3.9 mmol/l versus those preceding BG readings of 5.6-7.8 mmol/l were determined using chi 2 tests, analyses of variance, and logistic regression analyses.
Analysis of 6,425 self-management/self-monitoring of BG events revealed that the usual amounts of insulin, food, and exercise preceded the events 58.3% of the time. No significant differences were observed for changes in insulin before readings of BG < 3.9 mmol/l versus 7.8 < BG > 5.6 mmol/l, but significantly less food (P < 0.01) was eaten and more exercise (P < 0.001) was performed before the low BG measurement. No interactions between SH and No-SH groups and management behaviors were observed. However, each of the three management variables entered significantly in a logistic model that predicted 61% of all readings of BG < 3.9 mmol/l.
Subjects with a history of SH did not report managing their diabetes differently from those with no such history. Specifically, when low BG occurred, the preceding management behaviors, although predictive of low BG, were not different in SH and No-SH subjects. Overall, self-management behaviors did not distinguish SH from No-SH subjects. Thus, even though it might be beneficial for all patients to review their food and exercise management decisions to reduce their frequency of low BG, an educational intervention whose content stresses insulin, food, and exercise would be unlikely by itself to be sufficient to reduce the frequency of SH.
确定低血糖（血糖<3.9 mmol/l）的自我管理前驱因素，这些因素可能易于识别、治疗或完全避免。
招募了93名1型糖尿病成年人（年龄35.8±8岁[均值±标准差]；糖尿病病程17.0±11年；每日胰岛素剂量0.58±0.18 U/kg；糖化血红蛋白8.6±1.8%）参与研究。在这93名受试者中，42人有严重低血糖（SH）病史，定义为在过去12个月内有两次或更多次低血糖发作，51名受试者在同一时期无SH病史（无SH）。在3周内获得的70次血糖测量之前，受试者使用手持计算机记录他们最近的胰岛素、食物和运动与平时相比是更多、更少还是相同。使用卡方检验、方差分析和逻辑回归分析确定血糖读数<3.9 mmol/l之前的自我管理行为与血糖读数为5.6 - 7.8 mmol/l之前的自我管理行为之间的关联。
对6425次血糖自我管理/自我监测事件的分析表明，在这些事件发生前，胰岛素、食物和运动的量通常占58.3%的时间。血糖<3.9 mmol/l读数前与7.8 mmol/l >血糖>5.6 mmol/l读数前胰岛素变化无显著差异，但在低血糖测量前摄入的食物显著减少（P<0.01），进行的运动显著增加（P<0.001）。未观察到SH组和无SH组与管理行为之间的相互作用。然而，在一个预测所有血糖<3.9 mmol/l读数的61%的逻辑模型中，三个管理变量中的每一个都显著进入模型。
有SH病史的受试者报告的糖尿病管理方式与无此类病史的受试者没有差异。具体而言，当发生低血糖时，尽管之前的管理行为可预测低血糖，但SH组和无SH组受试者的管理行为并无不同。总体而言，自我管理行为并不能区分有SH和无SH的受试者。因此，尽管所有患者回顾他们的食物和运动管理决策以减少低血糖发生频率可能有益，但仅强调胰岛素、食物和运动的教育干预本身不太可能足以降低严重低血糖的发生频率。
