Corresponding author: Mitsuhiko Noda,
Diabetes Care. 2014;37(1):217-25. doi: 10.2337/dc13-0701. Epub 2013 Aug 12.
OBJECTIVE To assess vital signs, QT intervals, and newly diagnosed cardiovascular disease during severe hypoglycemia in diabetic patients. RESEARCH DESIGN AND METHODS From January 2006 to March 2012, we conducted a retrospective cohort study to assess type 1 and type 2 diabetic patients with severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that could not be resolved by the patients themselves in prehospital settings. RESULTS A total of 59,602 cases that visited the emergency room by ambulance were screened, and 414 cases of severe hypoglycemia were analyzed. The median (interquartile range) blood glucose levels were not significantly different between the type 1 diabetes mellitus (T1DM) (n = 88) and type 2 diabetes mellitus (T2DM) (n = 326) groups (32 [24-42] vs. 31 [24-39] mg/dL, P = 0.59). During severe hypoglycemia, the incidences of severe hypertension (≥180/120 mmHg), hypokalemia (<3.5 mEq/L), and QT prolongation were 19.8 and 38.8% (P = 0.001), 42.4 and 36.3% (P = 0.30), and 50.0 and 59.9% (P = 0.29) in the T1DM and T2DM groups, respectively. Newly diagnosed cardiovascular disease during severe hypoglycemia and death were only observed in the T2DM group (1.5 and 1.8%, respectively). Blood glucose levels between the deceased and surviving patients in the T2DM group were significantly different (18 [14-33] vs. 31 [24-39] mg/dL, P = 0.02). CONCLUSIONS T1DM and T2DM patients with severe hypoglycemia experienced many critical problems that could lead to cardiovascular disease, fatal arrhythmia, and death.
评估糖尿病患者严重低血糖时的生命体征、QT 间期和新诊断的心血管疾病。
我们进行了一项回顾性队列研究，从 2006 年 1 月至 2012 年 3 月，在日本的一个国家中心评估患有严重低血糖的 1 型和 2 型糖尿病患者。严重低血糖定义为患者在院前环境中出现任何无法自行缓解的低血糖症状。
共筛选了 59602 例通过救护车就诊的病例，分析了 414 例严重低血糖病例。1 型糖尿病（T1DM）（n=88）和 2 型糖尿病（T2DM）（n=326）组的中位（四分位间距）血糖水平无显著差异（32[24-42]与 31[24-39]mg/dL，P=0.59）。在严重低血糖期间，严重高血压（≥180/120mmHg）、低钾血症（<3.5mEq/L）和 QT 延长的发生率分别为 19.8%和 38.8%（P=0.001）、42.4%和 36.3%（P=0.30）以及 50.0%和 59.9%（P=0.29）在 T1DM 和 T2DM 组中分别为。在严重低血糖期间，仅在 T2DM 组中观察到新诊断的心血管疾病和死亡（分别为 1.5%和 1.8%）。T2DM 组中死亡和存活患者的血糖水平差异显著（18[14-33]与 31[24-39]mg/dL，P=0.02）。
严重低血糖的 T1DM 和 T2DM 患者经历了许多可能导致心血管疾病、致命性心律失常和死亡的严重问题。
