Daniels A, White M, Stander I, Crone D
Diabetes Services, South Auckland Health.
N Z Med J. 1999 Jun 25;112(1090):225-8.
To determine, in insulin-treated diabetes the incidence and risk factors for severe hypoglycaemia requiring ambulance visits.
A cross-sectional, questionnaire survey was made of patients with type 1 diabetes, who received help for severe hypoglycaemia from Ambulance Association personnel, during the period 1/6/95 to 31/5/96.
The ambulance service made 386 emergency visits to 247 persons with type 1 diabetes. Of these, 128 respondents (52%) completed a questionnaire detailing personal and diabetes history, usual diabetes care practices and hypoglycaemia management. Two or more visits for severe hypoglycaemia were made to 26.3% of patients, who reported a longer duration of diabetes than those who required only one visit (28 vs 20 years, p<0.03). Self-blood-glucose monitoring was performed by 98.4% of respondents and 66.4% self-adjusted insulin doses. Intensively treated patients (> or = 3 insulin injections daily) reported less awareness of hypoglycaemia than standard therapy patients (< or = 2 insulin injections daily) (p<0.05). Fifty-four per cent of respondents had glucagon available for emergency use, but those who lived alone and in general practitioner care only (27%) were less likely to have glucagon (p<0.05) compared to those with companions and in shared-care arrangements (62%). Hypoglycaemia management was influenced by the availability of glucagon. Oral glucose was used by 82% before injecting glucagon, whereas 40% of patients without glucagon called for the ambulance when severe symptoms were present even before initiating treatment with oral glucose.
This survey determined the minimum frequency of severe hypoglycaemia requiring the ambulance at 1.6 episodes patient(-1) year(-1). Precipitating factors and a lack of coping skills and behaviours that might prevent severe hypoglycaemia and ambulance calls were identified.
确定胰岛素治疗的糖尿病患者中需要呼叫救护车的严重低血糖的发生率及危险因素。
对1995年6月1日至1996年5月31日期间从救护协会人员处获得严重低血糖救助的1型糖尿病患者进行了一项横断面问卷调查。
救护服务对247名1型糖尿病患者进行了386次紧急出诊。其中，128名受访者（52%）完成了一份问卷，详细说明了个人及糖尿病病史、常规糖尿病护理措施和低血糖管理情况。26.3%的患者因严重低血糖接受了两次或更多次出诊，这些患者报告的糖尿病病程比仅需一次出诊的患者更长（28年对20年，p<0.03）。98.4%的受访者进行自我血糖监测，66.4%自行调整胰岛素剂量。强化治疗患者（每日注射胰岛素≥3次）报告的低血糖意识低于标准治疗患者（每日注射胰岛素≤2次）（p<0.05）。54%的受访者备有胰高血糖素用于紧急情况，但独居且仅接受全科医生护理的患者（27%）比有同伴且接受共同护理安排的患者（62%）更不太可能备有胰高血糖素（p<0.05）。低血糖管理受胰高血糖素可用性的影响。82%的患者在注射胰高血糖素前使用了口服葡萄糖，而40%没有胰高血糖素的患者在出现严重症状时甚至在开始口服葡萄糖治疗前就呼叫了救护车。
本次调查确定需要呼叫救护车的严重低血糖的最低发生率为1.6次/患者·年。确定了可能导致严重低血糖及呼叫救护车的诱发因素以及应对技能和行为的缺乏。
