Nicolucci Antonio, Prosperini Giuseppe, Buzzetti Raffaella, De Cosmo Salvatore, Fanelli Carmine G, Napoli Raffaele, Giorgino Francesco
Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy -
Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
Minerva Endocrinol. 2018 Dec;43(4):501-510. doi: 10.23736/S0391-1977.18.02850-X.
Hypoglycemia is the major limiting factor in the glycemic management of diabetes. Aim of this study was to produce a risk stratification tool to support the medical decision making, by facilitating the identification of patients at higher risk of hypoglycemia.
A multistep approach was adopted, including a systematic review of observational studies investigating risk factors for severe hypoglycemia in type 2 diabetes (T2DM), followed by an expert input forum to identify factors perceived as relevant and at the same time reliably detectable, to be used for the development of a risk score.
The systematic review led to the identification of 41 studies. Many factors have been seldom investigated, and their association with the risk of hypoglycemia is still unclear. Factors more frequently associated with a high risk of hypoglycemia were: low level of education, ethnicity, irregular meals/malnutrition, insulin and sulfonylurea therapy, polypharmacy, previous hypoglycemia, impaired renal function, cognitive impairment, depression and frailty. The expert input forum involved 35 diabetologists. Following the ranking of the relevance of the factors identified, a parsimonious yet comprehensive set of risk factors was identified.
The process led to the identification of relevant factors, to be used for the development of a hypoglycemia risk score. An ad-hoc study will be performed to assess the contribution of these risk factors and their relative weight. If the risk score will confirm its ability to correctly stratify patients according to their risk of hypoglycemia, it will represent a useful support to optimize the care of people with T2DM.
低血糖是糖尿病血糖管理中的主要限制因素。本研究的目的是通过促进识别低血糖风险较高的患者，制定一种风险分层工具以支持医疗决策。
采用了多步骤方法，包括对调查2型糖尿病（T2DM）严重低血糖危险因素的观察性研究进行系统评价，随后举办专家意见论坛，以确定被认为相关且同时可可靠检测的因素，用于制定风险评分。
系统评价共纳入41项研究。许多因素很少被研究，它们与低血糖风险的关联仍不明确。与低血糖高风险更常相关的因素有：低教育水平、种族、饮食不规律/营养不良、胰岛素和磺脲类药物治疗、多种药物联用、既往低血糖、肾功能损害、认知障碍、抑郁和虚弱。专家意见论坛有35名糖尿病专家参与。在对所确定因素的相关性进行排序后，确定了一组简洁而全面的风险因素。
该过程确定了相关因素，用于制定低血糖风险评分。将开展一项专项研究，以评估这些风险因素的作用及其相对权重。如果风险评分能够证实其根据患者低血糖风险正确分层的能力，它将为优化T2DM患者的护理提供有用支持。
