Jeon Ja Young, Kim Se Ran, Kim Hae Jin, Kim Dae Jung, Lee Kwan-Woo, Lee Jung-Dong, Han Seung Jin
Department of Endocrinology and Metabolism Department of Nephrology Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea.
Medicine (Baltimore). 2016 Nov;95(47):e5365. doi: 10.1097/MD.0000000000005365.
Hypoglycemia commonly occurs in patients who are being treated for diabetes. In some cases, these patients suffer from severe hypoglycemia that requires medical assistance and which can unfortunately result in long-term disabilities. Therefore, we investigated risk factors associated with severe hypoglycemia requiring medical assistance (HMA) and the resulting neurological sequelae in patients with diabetes. This investigation was a case-control study that assessed 129 patients with diabetes and documented hypoglycemia from a single tertiary hospital between February 2013 and May 2015. They were treated with oral hypoglycemic agents alone (54%) or with insulin with/without oral hypoglycemic agents (46%). If a patient with diabetes visited the emergency department due to hypoglycemia, this was defined as HMA. The control group was composed of patients with documented, nonsevere hypoglycemia who visited the outpatient clinic during the same period. The degree of neurological disability in the HMA patients was measured using the modified Rankin Scale. A multivariate analysis revealed that independent risk factors of HMA were associated with a lack of the self-monitoring of blood glucose (SMBG) and previous episodes of severe hypoglycemia. In the HMA group, 15 patients (22%) had neurological sequelae at the time of discharge. Patients with neurological sequelae were older than those without sequelae (74.3 years vs 65.8 years, P = 0.006) and had increased psychological evidence of disorders such as insomnia, dementia, and depression (40% vs 11%, P = 0.017). Patients with sequelae were also more likely to live in rural areas (47% vs 19%, P = 0.04) and to have a longer time from last seen normal till glucose administration (5.2 hours vs 1.6 hours, P = 0.027). In the present study, absence of SMBG and previous severe hypoglycemic episodes were independent risk factors of HMA and patients with an older age, a psychological disorder, a rural residence, and a prolonged duration of hypoglycemia had higher risks of neurological sequelae. Therefore, the present findings suggest that physicians should aim to prevent hypoglycemia in patients with a history of hypoglycemia and provide education for these patients regarding regular SMBG.
低血糖常见于接受糖尿病治疗的患者。在某些情况下，这些患者会发生严重低血糖，需要医疗救助，不幸的是，这可能导致长期残疾。因此，我们调查了糖尿病患者中与需要医疗救助的严重低血糖（HMA）相关的危险因素以及由此产生的神经后遗症。这项调查是一项病例对照研究，评估了2013年2月至2015年5月期间来自一家三级医院的129例患有记录在案的低血糖的糖尿病患者。他们单独接受口服降糖药治疗（54%）或联合使用胰岛素和/或口服降糖药治疗（46%）。如果糖尿病患者因低血糖就诊于急诊科，则定义为HMA。对照组由同期就诊于门诊的记录有非严重低血糖的患者组成。使用改良Rankin量表测量HMA患者的神经残疾程度。多变量分析显示，HMA的独立危险因素与缺乏血糖自我监测（SMBG）和既往严重低血糖发作有关。在HMA组中，15例患者（22%）出院时存在神经后遗症。有神经后遗症的患者比没有后遗症的患者年龄更大（74.3岁对65.8岁，P = 0.006），并且失眠、痴呆和抑郁等心理障碍的证据增多（40%对11%，P = 0.017）。有后遗症的患者也更有可能居住在农村地区（47%对19%，P = 0.04），并且从最后一次正常状态到给予葡萄糖的时间更长（5.2小时对1.6小时，P = 0.027）。在本研究中，缺乏SMBG和既往严重低血糖发作是HMA的独立危险因素，年龄较大、患有心理障碍、居住在农村地区以及低血糖持续时间较长的患者发生神经后遗症的风险更高。因此，本研究结果表明，医生应致力于预防有低血糖病史患者的低血糖，并为这些患者提供有关定期进行SMBG 的教育。
