HbA 变异与 1 型和 2 型糖尿病成人患者的低血糖住院治疗：一项嵌套病例对照研究。
HbA variability and hypoglycemia hospitalization in adults with type 1 and type 2 diabetes: A nested case-control study.
机构信息
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Global Pharmacovigilance and Epidemiology, Sanofi, Bridgewater, NJ, USA.
出版信息
J Diabetes Complications. 2018 Feb;32(2):203-209. doi: 10.1016/j.jdiacomp.2017.10.008. Epub 2017 Oct 23.
AIMS
To determine association between HbA variability and hypoglycemia requiring hospitalization (HH) in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D).
METHODS
Using nested case-control design in electronic health record data in England, one case with first or recurrent HH was matched to one control who had not experienced HH in incident T1D and T2D adults. HbA variability was determined by standard deviation of ≥3 HbA results. Conditional logistic models were applied to determine association of HbA variability with first and recurrent HH.
RESULTS
In T1D, every 1.0% increase in HbA variability was associated with 90% higher first HH risk (95% CI, 1.25-2.89) and 392% higher recurrent HH risk (95% CI, 1.17-20.61). In T2D, a 1.0% increase in HbA variability was associated with 556% higher first HH risk (95% CI, 3.88-11.08) and 573% higher recurrent HH risk (95% CI,1.59-28.51). In T2D for first HH, the association was the strongest in non-insulin non-sulfonylurea users (P<0.0001); for recurrent HH, the association was stronger in insulin users than sulfonylurea users (P=0.07). The HbA variability-HH association was stronger in more recent years in T2D (P≤0.004).
CONCLUSIONS
HbA variability is a strong predictor for HH in T1D and T2D.
目的
确定 1 型糖尿病（T1D）和 2 型糖尿病（T2D）成人的 HbA 变异性与需要住院治疗的低血糖（HH）之间的关联。
方法
在英国电子健康记录数据中使用嵌套病例对照设计，每例首次或复发性 HH 病例与未经历 HH 的 T1D 和 T2D 成人的对照相匹配。HbA 变异性通过≥3 次 HbA 结果的标准差来确定。应用条件逻辑模型来确定 HbA 变异性与首次和复发性 HH 的关联。
结果
在 T1D 中，HbA 变异性每增加 1.0%，首次 HH 风险增加 90%（95%CI，1.25-2.89），复发性 HH 风险增加 392%（95%CI，1.17-20.61）。在 T2D 中，HbA 变异性每增加 1.0%，首次 HH 风险增加 556%（95%CI，3.88-11.08），复发性 HH 风险增加 573%（95%CI，1.59-28.51）。在 T2D 中，首次 HH 的关联在非胰岛素非磺酰脲类药物使用者中最强（P<0.0001）；对于复发性 HH，胰岛素使用者的关联强于磺酰脲类药物使用者（P=0.07）。在 T2D 中，HbA 变异性与 HH 的关联在最近几年更强（P≤0.004）。
结论
HbA 变异性是 T1D 和 T2D 中 HH 的一个强有力的预测指标。
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