Wilson Darrell M, Calhoun Peter M, Maahs David M, Chase H Peter, Messer Laurel, Buckingham Bruce A, Aye Tandy, Clinton Paula K, Hramiak Irene, Kollman Craig, Beck Roy W
1 Stanford University , Stanford, California.
Diabetes Technol Ther. 2015 Jun;17(6):385-91. doi: 10.1089/dia.2014.0342. Epub 2015 Mar 11.
Hypoglycemia remains an impediment to good glycemic control, with nocturnal hypoglycemia being particularly dangerous. Information on major contributors to nocturnal hypoglycemia remains critical for understanding and mitigating risk.
Continuous glucose monitoring (CGM) data for 855 nights were studied, generated by 45 subjects 15-45 years of age with hemoglobin A1c (HbA1c) levels of ≤8.0% who participated in a larger randomized study. Factors assessed for potential association with nocturnal hypoglycemia (CGM measurement of <60 mg/dL for ≥30 min) included bedtime blood glucose (BG), exercise intensity, bedtime snack, insulin on board, day of the week, previous daytime hypoglycemia, age, gender, HbA1c level, diabetes duration, daily basal insulin, and daily insulin dose.
Hypoglycemia occurred during 221 of 885 (25%) nights and was more frequent with younger age (P<0.001), lower HbA1c levels (P=0.006), medium/high-intensity exercise during the preceding day (P=0.003), and the occurrence of antecedent daytime hypoglycemia (P=0.001). There was a trend for lower bedtime BG levels to be associated with more frequent nocturnal hypoglycemia (P=0.10). Bedtime snack, before bedtime insulin bolus, weekend versus weekday, gender, and daily basal and bolus insulin were not associated with nocturnal hypoglycemia.
Awareness that HbA1c level, exercise, bedtime BG level, and daytime hypoglycemia are all modifiable factors associated with nocturnal hypoglycemia may help patients and providers decrease the risk of hypoglycemia at night. Risk for nocturnal hypoglycemia increased in a linear fashion across the range of variables, with no clear-cut thresholds to guide clinicians or patients for any particular night.
低血糖仍然是良好血糖控制的一个障碍，夜间低血糖尤其危险。了解夜间低血糖的主要促成因素对于理解和降低风险至关重要。
研究了855个夜间的连续血糖监测（CGM）数据，这些数据由45名年龄在15 - 45岁、糖化血红蛋白（HbA1c）水平≤8.0%且参与了一项更大规模随机研究的受试者生成。评估与夜间低血糖（CGM测量值<60mg/dL持续≥30分钟）潜在关联的因素包括睡前血糖（BG）、运动强度、睡前小吃、体内胰岛素量、星期几、前一天白天低血糖、年龄、性别、HbA1c水平、糖尿病病程、每日基础胰岛素和每日胰岛素剂量。
在885个夜间中的221个（25%）出现了低血糖，且在年龄较小者（P<0.001）、HbA1c水平较低者（P = 0.006）、前一天进行中等/高强度运动者（P = 0.003）以及之前出现过白天低血糖者（P = 0.001）中更频繁发生。睡前BG水平较低有与更频繁的夜间低血糖相关的趋势（P = 0.10）。睡前小吃、睡前胰岛素推注量、周末与工作日、性别以及每日基础胰岛素和推注胰岛素与夜间低血糖均无关联。
认识到HbA1c水平、运动、睡前BG水平和白天低血糖都是与夜间低血糖相关的可改变因素，可能有助于患者和医护人员降低夜间低血糖风险。夜间低血糖风险在一系列变量范围内呈线性增加，没有明确的阈值来指导临床医生或患者应对任何特定夜晚的情况。
