Vilovic Marino, Kurir Tina Ticinovic, Novak Anela, Krnic Mladen, Borovac Josip Andelo, Lizatovic Ivan-Kresimir, Kokic Visnja, Bozic Josko
Department of Pathophysiology, University of Split School of Medicine, Split, Croatia.
Department of Endocrinology, Diabetes and Metabolic Diseases, University Hospital of Split, Split, Croatia.
Exp Clin Endocrinol Diabetes. 2020 Aug;128(8):493-498. doi: 10.1055/a-0741-6763. Epub 2018 Nov 14.
First choice of therapy for severe hypoglycemia outside hospital environment is glucagon injection, an undertaught and underused remedy. Aim of this study was to investigate knowledge about glucagon therapy, possession rate and usage rate in insulin-treated diabetic patients, with special emphasis on history of hypoglycemia and severe hypoglycemia episodes.
In this cross-sectional study, 300 insulin-treated diabetic patients (146 males and 154 females, mean age 61.1±16.4 years) were recruited from comprehensive Diabetes Center in Croatia. Specialized self-administered, 13-item questionnaire regarding glucagon therapy and history of hypoglycemia was obtained from each patient, as well as data collected from medical history documentation.
Experience of hypoglycemic episode was reported by 233 (77.7%), and severe hypoglycemia by 73 (24.3%) patients. Participants with experience of hypoglycemia have significantly longer diabetes duration (17.2±11.2 vs. 11.9±8.5 years, P<0.001) and lower BMI values (26.38±3.97 vs. 31.11±7.17 kg/m, P<0.001). Knowledge about glucagon therapy had 55.3% patients, 44.7% obtained it from the pharmacy, while glucagon was used in 35.6% cases of severe hypoglycemia. Glucagon knowledge was better in patients that attended at least one diabetes lecture (P=0.038), while educational level showed no statistical significance (P=0.286). Main significant positive predictor of glucagon knowledge was history of severe hypoglycemia (OR 4.71, 95% CI 1.38 - 16.02, P=0.013).
Glucagon therapy was underused in treating severe hypoglycemia. It is highly important to emphasize value of quality education as one of the fundamentals of good diabetes management.
在院外环境中，严重低血糖的首选治疗方法是注射胰高血糖素，这是一种未得到充分讲授和使用的治疗方法。本研究的目的是调查胰岛素治疗的糖尿病患者对胰高血糖素治疗的了解程度、持有率和使用率，特别关注低血糖病史和严重低血糖发作情况。
在这项横断面研究中，从克罗地亚的综合糖尿病中心招募了300名接受胰岛素治疗的糖尿病患者（146名男性和154名女性，平均年龄61.1±16.4岁）。从每位患者处获得了一份关于胰高血糖素治疗和低血糖病史的13项专门的自填式问卷，以及从病史记录中收集的数据。
233名（77.7%）患者报告有低血糖发作经历，73名（24.3%）患者有严重低血糖经历。有低血糖经历的参与者糖尿病病程明显更长（17.2±11.2年对11.9±8.5年，P<0.001），体重指数值更低（26.38±3.97对31.11±7.17kg/m，P<0.001）。55.3%的患者了解胰高血糖素治疗，44.7%是从药房获得相关信息的，而在35.6%的严重低血糖病例中使用了胰高血糖素。参加过至少一次糖尿病讲座的患者对胰高血糖素的了解更好（P=0.038），而教育程度无统计学意义（P=0.286）。胰高血糖素知识的主要显著正预测因素是严重低血糖病史（比值比4.71，95%置信区间1.38 - 16.02，P=0.013）。
胰高血糖素治疗在严重低血糖治疗中的应用不足。强调高质量教育作为良好糖尿病管理的基本要素之一的价值非常重要。
