Widom B, Simonson D C
Joslin Diabetes Center, New England Deaconess Hospital, Brigham and Women's Hospital, Boston, Massachusetts.
Ann Intern Med. 1990 Jun 15;112(12):904-12. doi: 10.7326/0003-4819-112-12-904.
To evaluate counterregulatory hormone secretion and neuropsychologic function during hypoglycemia in two groups of patients with insulin-dependent diabetes mellitus: those with good and those with poor glycemic control.
Cross-sectional physiologic and neuropsychologic evaluation.
Clinical research unit of a referral-based diabetes clinic.
Eight patients with well controlled diabetes (glycosylated hemoglobin [HgbA1], 8.0% +/- 0.2%), nine patients with poorly controlled diabetes (HgbA1, 11.8% +/- 0.4%), and ten healthy persons.
The insulin clamp technique was used to produce a stepwise decline in plasma glucose from 5.0 to 2.2 mmol/L over 3 hours. Tests of attention, memory, visual-spatial skills, visual-motor skills, and global cognition; a symptom survey; and counterregulatory hormone measurements were done at glucose decrements of 0.6 mmol/L.
Patients with well controlled diabetes did not differ statistically from those with poorly controlled diabetes regarding the median glucose threshold for dysfunction in visual-spatial skills, visual-motor skills, or global cognition. In contrast, glycemic thresholds for an increase in adrenergic symptoms and release of epinephrine, norepinephrine, cortisol, and growth hormone were lower in patients with well controlled diabetes than in those with poorly controlled diabetes (P less than 0.05 to 0.005).
Despite alterations in the glucose levels at which adrenergic symptoms of hypoglycemia occur and counterregulation begins, there is no statistically detectable change in the glucose threshold at which cognitive deterioration occurs in diabetic persons with strict glycemic control. This dissociation of neuropsychologic function and counterregulatory hormone secretion suggests that diabetic patients with good glycemic control are at increased risk for developing cognitive impairment before the onset of adrenergic symptoms during hypoglycemia.
评估两组胰岛素依赖型糖尿病患者在低血糖期间的对抗调节激素分泌及神经心理功能，一组血糖控制良好，另一组血糖控制不佳。
横断面生理和神经心理评估。
一家以转诊为基础的糖尿病诊所的临床研究单位。
8例血糖控制良好的糖尿病患者（糖化血红蛋白[HgbA1]，8.0%±0.2%），9例血糖控制不佳的糖尿病患者（HgbA1，11.8%±0.4%），以及10名健康人。
采用胰岛素钳夹技术，使血浆葡萄糖在3小时内从5.0毫摩尔/升逐步降至2.2毫摩尔/升。在血糖每下降0.6毫摩尔/升时，进行注意力、记忆力、视觉空间技能、视觉运动技能和整体认知测试；症状调查；以及对抗调节激素测量。
在视觉空间技能、视觉运动技能或整体认知功能障碍的中位血糖阈值方面，血糖控制良好的患者与血糖控制不佳的患者在统计学上无差异。相比之下，血糖控制良好的患者出现肾上腺素能症状以及肾上腺素、去甲肾上腺素、皮质醇和生长激素释放增加的血糖阈值低于血糖控制不佳的患者（P<0.05至0.005）。
尽管低血糖时肾上腺素能症状出现及对抗调节开始时的血糖水平有所改变，但严格血糖控制的糖尿病患者出现认知功能恶化的血糖阈值在统计学上无明显变化。神经心理功能与对抗调节激素分泌的这种分离表明，血糖控制良好的糖尿病患者在低血糖期间肾上腺素能症状出现之前发生认知障碍的风险增加。
