合并血管疾病的 2 型糖尿病患者更常发生低血糖：DiaRegis 注册研究分析。

Hypoglycaemia is more frequent in type 2 diabetic patients with co-morbid vascular disease: an analysis of the DiaRegis registry.

机构信息

Herzzentrum Ludwigshafen, Medizinische Klinik B Ludwigshafen, Germany.

出版信息

Eur J Prev Cardiol. 2012 Aug;19(4):765-72. doi: 10.1177/1741826711411104. Epub 2011 May 31.

DOI:10.1177/1741826711411104

PMID:21628353

Abstract

BACKGROUND

Patients with type-2 diabetes are at risk for treatment- and disease-related complications. Little is known about the interrelation of hypoglycaemia and co-morbid vascular disease (VD), defined as coronary heart disease, stroke and peripheral arterial disease.

HYPOTHESIS

Hypoglycaemia is associated with co-morbid VD in diabetic patients.

METHODS

DiaRegis is a prospective registry that included patients with type-2 diabetes in 2009/2010. Metric variables are displayed as median and quartiles. For the comparison of patients with or without VD Odds Ratios (OR) were determined from univariate analyses and adjusted for differences in patient characteristics (multivariable analysis).

RESULTS

Data on hypoglycaemia and VD within the last 12 months were available for 3741 patients (98.2%) with a median (IQR) age of 65.9 (57.6-72.9) years; 46.7% were female. VD patients (n = 909; 24.3%) were older (70.7 vs 63.9 years; p < 0.0001), less often female (33.6% vs 50.9%; p < 0.0001) and had had diabetes for a longer duration (6.4 vs 5.4 years; p < 0.0001). Mean cholesterol (total, HDL and LDL) was also slightly lower (p < 0.0001). Glycaemic control (HbA1c, fasting and postprandial glucose) was comparable. VD patients received less metformin (80.7 vs 85.2%; p < 0.01) and more sulfonylureas (31.8 vs 27.6%; p < 0.05). There was an increased incidence of symptomatic hypoglycaemia with or without requiring help and with a need for medical assistance. After adjusting a number of baseline variables the rates of symptomatic hypoglycaemias with help remained significantly increased (OR 3.73 (95% CI 1.31-10.65) in patients with VD.

CONCLUSIONS

As hypothesized there is a strong association between the incidence of hypoglycaemia and vascular disease at comparable glycaemic control, which confirms prior randomized controlled trial data suggesting an interrelationship between hypoglycaemia and vascular disease.

摘要

背景

2 型糖尿病患者存在治疗相关和疾病相关并发症的风险。关于低血糖症与合并的血管疾病（定义为冠心病、中风和外周动脉疾病）之间的相互关系，人们知之甚少。

假说

低血糖症与糖尿病患者的合并血管疾病有关。

方法

DiaRegis 是一项前瞻性登记研究，于 2009/2010 年纳入 2 型糖尿病患者。计量变量以中位数和四分位数表示。对于有无血管疾病的患者，采用单变量分析确定比值比（OR），并根据患者特征的差异进行调整（多变量分析）。

结果

3741 例（98.2%）患者在过去 12 个月内有低血糖症和血管疾病的数据，中位（IQR）年龄为 65.9（57.6-72.9）岁；46.7%为女性。血管疾病患者（n=909；24.3%）年龄更大（70.7 岁 vs 63.9 岁；p<0.0001），女性比例更低（33.6% vs 50.9%；p<0.0001），糖尿病病程更长（6.4 年 vs 5.4 年；p<0.0001）。胆固醇均值（总胆固醇、HDL 和 LDL）也略低（p<0.0001）。血糖控制（HbA1c、空腹和餐后血糖）相当。血管疾病患者接受的二甲双胍更少（80.7% vs 85.2%；p<0.01），磺脲类药物更多（31.8% vs 27.6%；p<0.05）。有症状低血糖症的发生率增加，无论是否需要帮助，以及需要医疗援助。在调整了一些基线变量后，有血管疾病的患者有症状低血糖症需要帮助的发生率仍显著增加（OR 3.73（95%CI 1.31-10.65））。