胰岛素治疗的糖尿病患者妊娠早期夜间低血糖的患病率

Hellmuth E, Damm P, Mølsted-Pedersen L, Bendtson I

Department of Obstetrics and Gynecology, Copenhagen University Hospital, Rigshospitalet, Denmark.

Acta Obstet Gynecol Scand. 2000 Nov;79(11):958-62.

BACKGROUND

Excellent metabolic control before conception and during diabetic pregnancies is the aim in order to avoid malformations and perinatal morbidity. Since an inverse correlation between median blood glucose concentration (BG) and hypoglycemia as well as a high prevalence of nocturnal hypoglycemia have been described, we investigated the frequency of nocturnal hypoglycemia and the predictive value of bedtime blood glucose concentration for development of this condition in insulin treated diabetic patients.

METHODS

During hospitalization, with no other changes in the patients' normal schedules, hourly blood samples were drawn from an iv-cannula from 22.00 h to 07.00 h for one night. BG (venous whole blood) and hemoglobin A1c were determined the following day.

RESULTS

Fifty-three patients participated; subsequently ten were excluded due to discontinuation of blood sampling during the night, caused by either discomfort or cannula problems. Of the remaining 43 patients, 16 (37%) had at least one blood glucose <3.0 mmol/l. The duration of hypoglycemia was 2.4 (1-7) h with the highest prevalence at 05 h. Only one patient felt hypoglycemic during the night. Hemoglobin A1c was similar in patients with (7.1+/-1.2%, mean+/-s.d.) and without (6.8+/-0.8%) nocturnal hypoglycemia. Women with nocturnal hypoglycemia had significantly lower BG before bedtime compared to patients without hypoglycemia, 6.4+/-3.6 mmol/l vs. 7.9+/-2.4 mmol/l, p<0.05. The best predictive value for nocturnal hypoglycemia was a BG below 6.0 mmol/l at 23.00, which resulted in a risk of nocturnal hypoglycemia of 71%. Conversely, if the BG was > or =6.0 mmol/l, the chance of avoiding nocturnal hypoglycemia was 83%.

CONCLUSION

Nocturnal hypoglycemia was seen with a prevalence of 37% during a night in the first trimester of pregnancy in insulin treated patients. Only one patient registered the hypoglycemia. Nocturnal hypoglycemia could be predicted in the majority of patients by measurements of BG before bedtime.

背景

在怀孕前和糖尿病妊娠期间实现良好的代谢控制是为了避免胎儿畸形和围产期发病。由于已描述了平均血糖浓度（BG）与低血糖之间的负相关以及夜间低血糖的高患病率，我们调查了胰岛素治疗的糖尿病患者夜间低血糖的发生频率以及睡前血糖浓度对这种情况发生的预测价值。

方法

在住院期间，患者正常日程无其他变化，在一个晚上从22:00至07:00每小时通过静脉留置针采集血样一次。次日测定BG（静脉全血）和糖化血红蛋白A1c。

结果

53名患者参与；随后10名因夜间采血中断而被排除，中断原因是不适或留置针问题。在其余43名患者中，16名（37%）至少有一次血糖<3.0 mmol/L。低血糖持续时间为2.4（1 - 7）小时，在05:00患病率最高。仅1名患者在夜间感觉有低血糖症状。有夜间低血糖的患者糖化血红蛋白A1c（7.1±1.2%，均值±标准差）与无夜间低血糖的患者（6.8±0.8%）相似。与无低血糖的患者相比，有夜间低血糖的女性睡前BG显著更低，分别为6.4±3.6 mmol/L和7.9±2.4 mmol/L，p<0.05。对夜间低血糖的最佳预测值是23:00时BG低于6.0 mmol/L，此时夜间低血糖风险为71%。相反，如果BG≥6.0 mmol/L，避免夜间低血糖的几率为83%。