Department of Internal Medicine and Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
Diabetes Care. 2018 Jun;41(6):1164-1171. doi: 10.2337/dc17-1834. Epub 2018 Mar 16.
To identify severe hypoglycemia events, defined as emergency department visits or hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events.
This was a retrospective cohort study from January 2006 to December 2015 using the electronic medical record in the Cleveland Clinic Health System (CCHS). Participants included 50,439 patients with type 2 diabetes receiving care in the CCHS. Number of severe hypoglycemia events and associated patient characteristics were identified.
The incidence proportion of severe hypoglycemia increased from 0.12% in 2006 to 0.31% in 2015 ( = 0.01). Compared with patients who did not experience severe hypoglycemia, those with severe hypoglycemia had similar median glycosylated hemoglobin (HbA) levels. More patients with severe hypoglycemia versus those without had a prior diagnosis of nonsevere hypoglycemia (9% vs. 2%, < 0.001). Logistic regression confirmed an increased odds for severe hypoglycemia with insulin, sulfonylureas, increased number of diabetes medications, history of nonsevere hypoglycemia (odds ratio [OR] 3.01, < 0.001), HbA <6% (42 mmol/mol) (OR 1.95, < 0.001), black race, and increased Charlson comorbidity index. Lower odds of severe hypoglycemia were noted with higher BMI and use of metformin, dipeptidyl peptidase 4 inhibitors, and glucagon-like peptide 1 agonists.
In this retrospective study of patients with type 2 diabetes with severe hypoglycemia, patient characteristics were identified. Patients with severe hypoglycemia had previous nonsevere hypoglycemia diagnoses more frequently than those without. Identifying patients at high risk at the point of care can allow for change in modifiable risk factors and prevention of severe hypoglycemia events.
在克利夫兰诊所医疗系统（CCHS）中识别患有 2 型糖尿病并接受治疗的患者中因严重低血糖而导致急诊就诊或住院的事件，并确定与严重低血糖事件相关的患者特征。
这是一项回顾性队列研究，时间跨度为 2006 年 1 月至 2015 年 12 月，研究对象来自克利夫兰诊所健康系统（CCHS）的电子病历。参与者包括 50439 名在 CCHS 接受治疗的 2 型糖尿病患者。确定了严重低血糖事件的数量和相关患者特征。
严重低血糖的发生率比例从 2006 年的 0.12%增加到 2015 年的 0.31%（=0.01）。与未发生严重低血糖的患者相比，发生严重低血糖的患者糖化血红蛋白（HbA）水平中位数相似。与未发生严重低血糖的患者相比，发生严重低血糖的患者更有可能有非严重低血糖的既往诊断（9%比 2%，<0.001）。Logistic 回归证实，胰岛素、磺脲类药物、糖尿病药物数量增加、非严重低血糖史（比值比 [OR] 3.01，<0.001）、HbA<6%（42 mmol/mol）（OR 1.95，<0.001）、黑人种族和 Charlson 合并症指数增加，严重低血糖的发生几率更高。严重低血糖的发生几率较低与较高的 BMI 以及使用二甲双胍、二肽基肽酶 4 抑制剂和胰高血糖素样肽 1 激动剂有关。
在这项针对患有 2 型糖尿病且发生严重低血糖的患者的回顾性研究中，确定了患者特征。与未发生严重低血糖的患者相比，发生严重低血糖的患者更频繁地有非严重低血糖的既往诊断。在护理点识别出高风险患者，可以改变可改变的危险因素，预防严重低血糖事件的发生。
