糖尿病患者途中禁食诱发低血糖（FEEHD）：临床实践中一种被忽视的低血糖形式。
Fasting-Evoked En Route Hypoglycemia in Diabetes (FEEHD): An Overlooked Form of Hypoglycemia in Clinical Practice.
作者信息
Aldasouqi Saleh, Mora Samia, Bhalla Gaurav, Kakumanu Naveen, Corser William, Abela George, Dlewati Mohammad, Estrada Kathleen, Almounajed Abdul, Tabbaa Tarek, Hammoud Jamal, Newkirk Cathy
机构信息
Division of Endocrinology, Department of Medicine, College of Human Medicine, Michigan State University, USA.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA.
出版信息
Int J Endocrinol. 2018 Oct 24;2018:1528437. doi: 10.1155/2018/1528437. eCollection 2018.
OBJECTIVE
Many patients with diabetes opt to fast for lab tests, especially for lipid profiles, thus missing breakfast. In parallel, recent studies and international guidelines have indicated that routine fasting for lipid panels may not be necessary. Missing breakfast while fasting for lab tests may invoke hypoglycemia, if patients are not properly instructed about adjusting diabetes medications on the night before or on the day of the lab test. Our group described this form of hypoglycemia and introduced the term FEEHD to refer to it (fasting-evoked en route hypoglycemia in diabetes). In a recently published small study, we reported a rate of occurrence of FEEHD of 27.1%. The objective of this study was to evaluate the rate of occurrence of FEEHD in another clinic.
METHODS
Patients with diabetes were asked to complete a simple, 2-page survey inquiring about hypoglycemic events while fasting for labs in the preceding 12 months.
RESULTS
A total of 525 patients completed the surveys out of 572 patients invited (91.8% response rate). A total of 363 patients with complete data were analyzed, with a mean age of 60.6 (SD 12.5) years. A total of 62 (17.1%) patients reported having experienced one or more FEEHD events in the prior 12 months. Of the 269 patients who were at higher risk of FEEHD (on insulin secretagogues or on insulin), 59 (21.9%) reported having experienced FEEHD. Only 33 of FEEHD patients (53%) recalled having contacted their provider regarding the events and only 22 (35%) indicated having received some sort of FEEHD prevention instructions.
CONCLUSION
Our study shows a significant rate of occurrence of FEEHD in the real world (a clinical practice). FEEHD is especially dangerous, as patients often commute (drive) to and from the laboratory facility (potential risk of traffic accidents). Given study limitations, further studies are needed to assess prevalence of FEEHD in other settings and in the general populations.
目的
许多糖尿病患者选择为进行实验室检查而禁食，尤其是为了检测血脂水平，从而错过早餐。与此同时，近期的研究和国际指南表明，常规禁食以进行血脂检测可能并无必要。在为实验室检查禁食时错过早餐可能引发低血糖，如果患者在实验室检查前一晚或当天未得到关于调整糖尿病药物的正确指导。我们团队描述了这种形式的低血糖，并引入了“FEEHD”这一术语来指代它（糖尿病患者禁食诱发途中低血糖）。在最近发表的一项小型研究中，我们报告FEEHD的发生率为27.1%。本研究的目的是评估另一诊所中FEEHD的发生率。
方法
要求糖尿病患者完成一份简单的两页调查问卷，询问他们在过去12个月为实验室检查禁食期间的低血糖事件。
结果
在邀请的572名患者中，共有525名患者完成了调查（回复率为91.8%）。对363名有完整数据的患者进行了分析，平均年龄为60.6（标准差12.5）岁。共有62名（17.1%）患者报告在过去12个月中经历过一次或多次FEEHD事件。在269名发生FEEHD风险较高的患者（使用胰岛素促泌剂或胰岛素治疗）中，59名（21.9%）报告经历过FEEHD。在发生FEEHD的患者中，只有33名（53%）回忆起就这些事件联系过他们的医疗服务提供者，只有22名（35%）表示收到过某种FEEHD预防指导。
结论
我们的研究表明，在现实世界（临床实践）中FEEHD的发生率很高。FEEHD特别危险，因为患者经常往返于实验室（存在交通事故的潜在风险）。鉴于研究存在局限性，需要进一步研究以评估FEEHD在其他环境和普通人群中的患病率。
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