1型糖尿病成人低血糖意识受损与自主神经功能障碍或周围神经病变无关。

Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes Is Not Associated With Autonomic Dysfunction or Peripheral Neuropathy.

作者信息

Olsen Sandra E, Bjørgaas Marit R, Åsvold Bjørn O, Sand Trond, Stjern Marit, Frier Brian M, Nilsen Kristian B

机构信息

Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

出版信息

Diabetes Care. 2016 Mar;39(3):426-33. doi: 10.2337/dc15-1469. Epub 2015 Dec 30.

DOI:10.2337/dc15-1469

PMID:26721812

Abstract

OBJECTIVE

Impaired awareness of hypoglycemia (IAH) is a risk factor for severe hypoglycemia in people with insulin-treated diabetes; autonomic neuropathy has been suggested to underlie its development. The aim was to evaluate a putative association between IAH and autonomic dysfunction using novel and sensitive measures of autonomic neural function.

RESEARCH DESIGN AND METHODS

Sixty-six adults with type 1 diabetes were studied, 33 with IAH and 33 with normal awareness of hypoglycemia (NAH), confirmed by formal testing. Participants were matched for age, sex, and diabetes duration. Clinical and laboratory evaluations included extensive autonomic function testing, peripheral nerve conduction studies, and quantitative sensory testing. Composite abnormality Z scores were used for group comparisons.

RESULTS

The IAH and NAH group had similar median (interquartile range) age of 48 (14.5) vs. 47 (14.5) years, diabetes duration of 30 (13.5) vs. 31 (13.5) years, and mean ± SD HbA1c 7.8 ± 2.2% vs. 8.1 ± 1.9%, respectively. The autonomic composite Z score did not differ between the two groups (mean difference -0.15, 95% CI -0.46, 0.16; P = 0.33), nor did the thermal detection (mean difference 0.15, 95% CI -0.31, 0.61; P = 0.51) or nerve conduction scores (mean difference 0.03, 95% CI -0.43, 0.49; P = 0.89).

CONCLUSIONS

In adults with type 1 diabetes, IAH was not associated with autonomic dysfunction or peripheral neuropathy.

摘要

目的

低血糖意识受损（IAH）是胰岛素治疗的糖尿病患者发生严重低血糖的危险因素；自主神经病变被认为是其发生的基础。本研究旨在使用新型且敏感的自主神经功能测量方法评估IAH与自主神经功能障碍之间的假定关联。

研究设计与方法

对66例1型糖尿病成人患者进行研究，其中33例存在IAH，33例低血糖意识正常（NAH），均经正式测试确诊。根据年龄、性别和糖尿病病程对参与者进行匹配。临床和实验室评估包括广泛的自主神经功能测试、周围神经传导研究和定量感觉测试。使用综合异常Z评分进行组间比较。

结果

IAH组和NAH组的年龄中位数（四分位间距）相似，分别为48（14.5）岁和47（14.5）岁；糖尿病病程分别为30（13.5）年和31（13.5）年；平均糖化血红蛋白水平分别为7.8±2.2%和8.1±1.9%。两组的自主神经综合Z评分无差异（平均差值-0.15，95%置信区间-0.46，0.16；P=0.33），热觉检测结果（平均差值0.15，95%置信区间-0.31，0.61；P=0.51）或神经传导评分（平均差值0.03，95%置信区间-0.43，0.49；P=0.89）也无差异。