Sanchai Tippaya, Patumanond Jayanton
Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand.
J Med Assoc Thai. 2011 Dec;94(12):1435-40.
To study clinical risk factors of severe hypoglycemia in type II diabetes.
Fifty-one type II diabetes with severe hypoglycemia admitted between October 2006 and September 2008 and 359 nonhypoglycemic type II diabetes were evaluated in this case-control study. Medical records were retrospective reviewed for age, sex, duration of diabetes, previous diabetes registration, concomitant diseases, HbA1c level and current diabetes therapy in both groups. Acute illness, blood glucose, hypoglycemic episodes, symptoms and length of stay (LOS) were assessed in hypoglycemic group. Univariate and multivariate logistic regression were used to determine risk factors of severe hypoglycemia.
Fifty-one hypoglycemic and 359 nonhypoglycemic patients were analyzed. The authors found that 40% of severe hypoglycemic cases were recurrent. The average LOS was six days. Intercurrent illness was the major leading cause of hypoglycemia (54.9%). Mean blood glucose level was 37.2 mg/dl (SD = 13.5). Twenty-three of fifty-one (45%) patients presented with unconsciousness. Predisposing risk factors associated with severe hypoglycemia were old age (p = 0.026), insulin therapy (p = 0.001), cirrhosis (p = 0.020), cerebrovascular disease (p = 0.040), and no diabetes registry (p = 0.015). Sex, HbA1c level, hypertension and chronic kidney disease were not risk factors associated with severe hypoglycemia.
Risk factors associated with severe hypoglycemia in type II diabetes were elderly, insulin therapy, cirrhosis, previous cerebrovascular disease, lack of standard diabetic care and team approach. Self-monitoring of blood glucose and individual case management should be considered in those with previous hypoglycemic events.
研究2型糖尿病严重低血糖的临床危险因素。
在这项病例对照研究中，对2006年10月至2008年9月期间收治的51例发生严重低血糖的2型糖尿病患者和359例非低血糖2型糖尿病患者进行了评估。对两组患者的年龄、性别、糖尿病病程、既往糖尿病登记情况、合并疾病、糖化血红蛋白水平及当前糖尿病治疗情况进行回顾性病历审查。对低血糖组患者评估急性疾病、血糖、低血糖发作、症状及住院时间。采用单因素和多因素逻辑回归分析确定严重低血糖的危险因素。
分析了51例低血糖患者和359例非低血糖患者。作者发现40%的严重低血糖病例为复发性。平均住院时间为6天。并发疾病是低血糖的主要原因（54.9%）。平均血糖水平为37.2mg/dl（标准差=13.5）。51例患者中有23例（45%）出现意识丧失。与严重低血糖相关的易感危险因素为老年（p=0.026）、胰岛素治疗（p=0.001）、肝硬化（p=0.020）、脑血管疾病（p=0.040）及未进行糖尿病登记（p=0.015）。性别、糖化血红蛋白水平、高血压和慢性肾脏病不是与严重低血糖相关的危险因素。
2型糖尿病严重低血糖的相关危险因素为老年、胰岛素治疗、肝硬化、既往脑血管疾病、缺乏标准化糖尿病护理及团队治疗方法。对于既往有低血糖事件的患者，应考虑进行血糖自我监测和个体化病例管理。
