Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
Centre for Endocrine, Diabetes and Obesity Research (CEDOR), Capital and Coast District Health Board, Wellington, New Zealand.
Diabetes Obes Metab. 2018 May;20(5):1256-1261. doi: 10.1111/dom.13231. Epub 2018 Feb 14.
To determine whether an individualized body weight-based glucose treatment in adults with type 2 diabetes (T2DM) is more likely to resolve hypoglycaemia with a single treatment without excessive rebound hyperglycaemia compared to fixed doses of 12 or 30 g of glucose.
Adults with T2DM were enrolled in a cross-over study. Each episode of hypoglycaemia (capillary glucose <4.0 mmol/L) was randomly assigned to 1 of 3 treatment protocols: 0.3 g glucose/kg body-weight or a fixed dose of either 12 or 30 g glucose, independent of weight. All participants received each treatment in random order for up to 15 hypoglycaemic episodes. Glucose was re-tested 10 minutes after treatment, with a repeat dose if still <4 mmol/L.
Mean (SD) age of the 30 participants was 68 (8.1) years, mean weight was 91.5 (16.8) kg and mean HbA1c was 58.7 (9.2) mmol/mol. Among a total of 244 episodes of hypoglycaemia, 10 participants had 15 treatment episodes and 18 participants had fewer than 10 treatment episodes. The odds ratio, adjusted for multiple comparisons, for resolution of hypoglycaemia at 10 minutes, comparing weight-based treatment and 12 g treatment was 3.2 (95% CI, 1.1-9.0), P = .009, comparing 30 g treatment and 12 g treatment was 8.9 (95% CI, 2.2-36.6), P < .001, and comparing weight-based treatment and 30 g treatment was 0.36 (95% CI, 0.08-1.67) P = .10.
In T2DM, both a weight-based 0.3 g/kg treatment and a fixed 30 g glucose treatment result in higher blood glucose than a 12 g treatment, along with increased probability of resolution of hypoglycaemia after 10 minutes. Both treatments result in an excess of mild rebound hyperglycaemia (>8 mmol/L) at 30 minutes.
确定在 2 型糖尿病（T2DM）成人中，基于个体化体重的葡萄糖治疗是否比固定剂量的 12 克或 30 克葡萄糖更有可能在单次治疗时避免低血糖，同时避免出现过度反弹性高血糖。
纳入了 T2DM 成人患者进行交叉研究。每一次低血糖发作（毛细血管血糖 <4.0 mmol/L）均随机分配至以下 3 种治疗方案之一：0.3 g 葡萄糖/公斤体重，或固定剂量的 12 克或 30 克葡萄糖，与体重无关。所有参与者均以随机顺序接受每种治疗方案，最多进行 15 次低血糖发作治疗。治疗后 10 分钟复测血糖，如果仍 <4 mmol/L，则重复给药。
30 名参与者的平均（标准差）年龄为 68（8.1）岁，平均体重为 91.5（16.8）kg，平均 HbA1c 为 58.7（9.2）mmol/mol。在总共 244 次低血糖发作中，10 名参与者进行了 15 次治疗，18 名参与者进行了少于 10 次治疗。调整多重比较后，与 12 克治疗相比，10 分钟时低血糖缓解的优势比，体重为基础的治疗为 3.2（95%CI，1.1-9.0），P =.009，30 克治疗与 12 克治疗相比为 8.9（95%CI，2.2-36.6），P <.001，体重为基础的治疗与 30 克治疗相比为 0.36（95%CI，0.08-1.67），P =.10。
在 T2DM 中，基于体重的 0.3 g/kg 治疗和固定的 30 g 葡萄糖治疗均导致血糖高于 12 g 治疗，且在 10 分钟后低血糖缓解的可能性增加。两种治疗方案在 30 分钟时均导致轻度反弹性高血糖（>8 mmol/L）过多。
