Walz Lotta, Jönsson Anna K, Zilg Brita, Östgren Carl Johan, Druid Henrik
Forensic Medicine Laboratory, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
MSD AB, Stockholm, Sweden.
PLoS One. 2016 Oct 21;11(10):e0164950. doi: 10.1371/journal.pone.0164950. eCollection 2016.
AIMS/HYPOTHESIS: The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs.
A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia.
During the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18).
CONCLUSIONS/INTERPRETATION: Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia.
目的/假设：本研究旨在确定与确诊的致命性高血糖相关的危险因素，这些因素可能使使用降糖药物的个体面临潜在可预防的死亡风险。
对2006年8月至2012年12月在瑞典进行的一项基于登记的回顾性病例对照研究进行了分析，该研究纳入了全国范围内因法医尸检确定死于高血糖的个体。死后玻璃体液葡萄糖用于诊断高血糖。存储在国家法医学数据库中的法医调查结果与全国登记册相关联。在瑞典处方药登记册中识别出因确诊高血糖且已配发降糖药物而死亡的病例，并随机选择已配发降糖药物的在世对照，按照年龄和性别进行匹配。获取了病例和对照的合并症、配发药物、临床数据和社会经济因素等信息。使用调整后的多元逻辑回归模型来识别与致命性高血糖相关的危险因素。
在研究期间，322人死于确诊的高血糖，其中大多数为男性（79%），平均年龄为53.9岁（标准差±14）。致命性高血糖的危险因素包括：胰岛素治疗（比值比=4.40；95%置信区间，1.96，9.85）、血糖控制不佳（比值比=2.00；95%置信区间，1.23，3.27）、死亡前药物 refill 依从性不足（比值比=3.87；95%置信区间，1.99，7.53）、微血管疾病（比值比=3.26；95%置信区间，1.84，5.79）、精神疾病（比值比=2.30；95%置信区间，1.32，4.01）、药物滥用（比值比=8.85；95%置信区间，2.34，35.0）和/或独居（比值比=2.25；95%置信区间，1.21，4.18）。
结论/解读：我们的结果表明，临床关注有心理社会问题的患者血糖控制不佳的情况很重要，因为这可能表明严重的不依从，进而可能导致致命性高血糖。
