Salutini Elisabetta, Bianchi Cristina, Santini Massimo, Dardano Angela, Daniele Giuseppe, Penno Giuseppe, Miccoli Roberto, Del Prato Stefano
Department of Clinical and Experimental Medicine - Section of Diabetes and Metabolic Diseases, University of Pisa, Pisa, Italy.
Department of Emergency - Emergency Medicine Section, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Diabetes Metab Res Rev. 2015 Oct;31(7):745-51. doi: 10.1002/dmrr.2667. Epub 2015 Jul 14.
Hypoglycaemia is a major burden of the pharmacological therapy of diabetes and is associated with increased morbidity, mortality and treatment costs.
We screened all admissions to the emergency room of the Pisa University Hospital from 1 January 2009 to 31 December 2013, selecting individuals with a discharge diagnosis of hypoglycaemia. We retrieved 500 admissions involving adult diabetic patients: age 71 ± 16 years; M/F 50.2/49.8%; 70.2% type 2 diabetes (T2DM).
Among T2DM, 42.2% were on insulin, 10.8% on insulin plus oral anti-diabetes drugs and 38.2% on oral anti-diabetes drugs alone (92% sulphonylureas/glinides ± insulin-sensitizers). Glibenclamide was the most frequently used sulphonylurea (69%). Individuals treated with oral anti-diabetes drugs were older than those on insulin (79 ± 11 versus 74 ± 12 years; p < 0.0001). Among patients taking sulphonylurea, 47% had estimated glomerular filtration rate <60 mL/min/1.73 m(2) and 13.5% had <30 mL/min/1.73 m(2) . In-hospital admission occurred in 20% of cases. Hospitalized patients with T2DM were older than those discharged (80 ± 10 versus 76 ± 12 years, p < 0.01) and were on oral antidiabetic drugs in 54.8% of the cases, whereas 35.7% were on insulin (χ(2) , p < 0.0001) and 8.3% on combined therapy. Notably, 93.5% of those on oral anti-diabetic drugs were taking a secretagogue. Insulin-treated subjects were younger than those treated with oral anti-diabetic drugs alone (77 ± 12 versus 82 ± 7 years; p < 0.02). The mean in-hospital annual mortality rate was 85 deaths per 1000 patients-year.
Our results support the recommendation that the risk associated with insulin and insulin-secretagogues should be carefully assessed, particularly when prescribed in vulnerable patients with T2DM.
低血糖是糖尿病药物治疗的一个主要负担，与发病率、死亡率和治疗成本增加相关。
我们筛选了2009年1月1日至2013年12月31日期间比萨大学医院急诊室的所有入院病例，选择出院诊断为低血糖的患者。我们检索到500例涉及成年糖尿病患者的入院病例：年龄71±16岁；男/女比例为50.2/49.8%；70.2%为2型糖尿病（T2DM）。
在T2DM患者中，42.2%使用胰岛素，10.8%使用胰岛素加口服抗糖尿病药物，38.2%仅使用口服抗糖尿病药物（92%为磺脲类/格列奈类±胰岛素增敏剂）。格列本脲是最常用的磺脲类药物（69%）。使用口服抗糖尿病药物治疗的患者比使用胰岛素治疗的患者年龄更大（79±11岁对74±12岁；p<0.0001）。在服用磺脲类药物的患者中，47%的估算肾小球滤过率<60 mL/min/1.73 m²，13.5%的<30 mL/min/1.73 m²。20%的病例发生了住院。住院的T2DM患者比出院患者年龄更大（80±10岁对76±12岁，p<0.01），54.8%的病例使用口服抗糖尿病药物，35.7%使用胰岛素（χ²，p<0.0001），8.3%使用联合治疗。值得注意的是，93.5%服用口服抗糖尿病药物的患者正在服用促分泌剂。接受胰岛素治疗的患者比仅接受口服抗糖尿病药物治疗的患者年龄更小（77±12岁对82±7岁；p<0.02）。住院患者的年平均死亡率为每1000患者年85例死亡。
我们的结果支持以下建议，即应仔细评估与胰岛素和胰岛素促分泌剂相关的风险，特别是在为脆弱的T2DM患者开处方时。
