Hepburn D A, Deary I J, Frier B M, Patrick A W, Quinn J D, Fisher B M
Department of Diabetes, University of Edinburgh, Scotland, United Kingdom.
Diabetes Care. 1991 Nov;14(11):949-57. doi: 10.2337/diacare.14.11.949.
This study allocated the symptoms identified during acute hypoglycemia objectively to the autonomic or neuroglycopenic groups of symptoms by the use of factor analysis.
Twenty-five nondiabetic subjects, 14 newly diagnosed insulin-dependent diabetic patients, and 16 insulin-dependent diabetic patients with diabetes greater than 4 yr duration were studied. Acute hypoglycemia was induced with insulin (2.5 mU.kg-1 body wt.min-1 i.v.), and symptoms of hypoglycemia were recorded with a seven-point scale at regular time points throughout the studies. Factor analysis of the symptom scores at the time of the acute autonomic reaction with principal component analysis followed by Varimax rotation was used to separate those symptoms that might belong to neuroglycopenic and autonomic groups.
Hypoglycemia was induced to a mean +/- SE plasma glucose nadir of 1.3 +/- 0.1 mM in nondiabetic subjects, to 2.0 +/- 0.3 mM in newly diagnosed diabetic patients, and 1.4 +/- 0.2 mM in patients with diabetes of greater than 4 yr duration. The most frequently reported autonomic symptoms were sweating, trembling, and warmness, and the most frequently reported neuroglycopenic symptoms were inability to concentrate, weakness, and drowsiness. Neuroglycopenic symptoms were reported more commonly at the onset of hypoglycemia, which was identified by the development of symptoms. Factor analysis grouped trembling, anxiety, sweating, warmness, and nausea together, and this grouping was labeled an autonomic factor. A second factor was identified that included dizziness, confusion, tiredness, difficulty in speaking, shivering, drowsiness, and inability to concentrate, which was labeled a neuroglycopenic factor.
This study demonstrated the high frequency with which neuroglycopenic symptoms occur at the onset of hypoglycemia and the symptoms that could be used by an individual patient as a warning of the development of acute hypoglycemia, although the rapid reduction of plasma glucose is faster than experienced by the ambulant diabetic patient. Factor analysis assisted with the allocation of symptoms to either the autonomic or neuroglycopenic groupings, but the allocation of some symptoms remained undefined, and care must be taken when assessing symptoms such as hunger, weakness, blurred vision, and drowsiness when comparing the frequency of autonomic versus neuroglycopenic symptoms. To reduce the confusion resulting from the use of different symptom questionnaires in studies of hypoglycemia, a sample questionnaire is presented, the development of which was assisted by our analysis.
本研究通过因子分析，将急性低血糖期间出现的症状客观地归类到自主神经症状组或神经低血糖症状组。
对25名非糖尿病受试者、14名新诊断的胰岛素依赖型糖尿病患者以及16名病程超过4年的胰岛素依赖型糖尿病患者进行了研究。通过静脉注射胰岛素（2.5 mU·kg-1体重·分钟-1）诱发急性低血糖，并在整个研究过程中的固定时间点用七点量表记录低血糖症状。采用主成分分析和方差最大旋转法对急性自主神经反应时的症状评分进行因子分析，以区分可能属于神经低血糖组和自主神经组的症状。
非糖尿病受试者低血糖诱发后血浆葡萄糖最低点平均为1.3±0.1 mM，新诊断的糖尿病患者为2.0±0.3 mM，病程超过4年的糖尿病患者为1.4±0.2 mM。最常报告的自主神经症状是出汗、颤抖和发热，最常报告的神经低血糖症状是注意力不集中、虚弱和嗜睡。神经低血糖症状在低血糖发作时更常被报告，低血糖发作通过症状的出现来确定。因子分析将颤抖、焦虑、出汗、发热和恶心归为一组，该组被标记为自主神经因子。确定了第二个因子，包括头晕、困惑、疲劳、言语困难、寒战、嗜睡和注意力不集中，该因子被标记为神经低血糖因子。
本研究表明，神经低血糖症状在低血糖发作时出现的频率较高，并且个体患者可以将这些症状作为急性低血糖发作的预警，尽管血浆葡萄糖的快速下降比门诊糖尿病患者经历的更快。因子分析有助于将症状归类到自主神经组或神经低血糖组，但某些症状的归类仍不明确，在比较自主神经症状与神经低血糖症状的频率时，评估饥饿、虚弱、视力模糊和嗜睡等症状时必须谨慎。为减少低血糖研究中使用不同症状问卷导致的混淆，给出了一份样本问卷，其编制得到了我们分析的协助。
