Cardona Saumeth, Gomez Patricia C, Vellanki Priyathama, Anzola Isabel, Ramos Clementina, Urrutia Maria A, Haw Jeehea Sonya, Fayfman Maya, Wang Heqiong, Galindo Rodolfo J, Pasquel Francisco J, Umpierrez Guillermo E
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2018 Dec 18;6(1):e000607. doi: 10.1136/bmjdrc-2018-000607. eCollection 2018.
The frequency and impact of asymptomatic hypoglycemia in hospitalized patients with diabetes is not known.
We determined the clinical characteristics and hospital outcomes of general medicine and surgery patients with symptomatic and asymptomatic hypoglycemia.
Prospective observational study in adult patients with diabetes and blood glucose (BG) <70 mg/dL. Participants were interviewed about signs and symptoms of hypoglycemia using a standardized questionnaire. Precipitating causes, demographics, insulin regimen, and complications data during admission was collected.
Among 250 patients with hypoglycemia, 112 (44.8%) patients were asymptomatic and 138 (55.2%) had symptomatic hypoglycemia. Patients with asymptomatic hypoglycemia were older (59±11 years vs 54.8±13 years, p=0.003), predominantly males (63% vs 48%, p=0.014), and had lower admission glycosylated hemoglobin (8.2%±2.6 % vs 9.1±2.9%, p=0.006) compared with symptomatic patients. Compared with symptomatic patients, those with asymptomatic hypoglycemia had higher mean BG during the episode (60.0±8 mg/dL vs 53.8±11 mg/dL, p<0.001). In multivariate analysis, male gender (OR 2.08, 95% CI 1.13 to 3.83, p=0.02) and age >65 years (OR 4.01, 95% CI 1.62 to 9.92, p=0.02) were independent predictors of asymptomatic hypoglycemia. There were no differences in clinical outcome, composite of hospital complications (27% vs 22%, p=0.41) or in-hospital length of stay (8 days (IQR 4-14) vs 7 days (IQR 5-15), p=0.92)) between groups.
Asymptomatic hypoglycemia was common among insulin-treated patients with diabetes but was not associated with worse clinical outcome compared with patients with symptomatic hypoglycemia. Older age and male gender were independent risk factors for asymptomatic hypoglycemia.
糖尿病住院患者中无症状低血糖的发生率及其影响尚不清楚。
我们确定了有症状和无症状低血糖的普通内科及外科患者的临床特征及住院结局。
对血糖（BG）<70mg/dL的成年糖尿病患者进行前瞻性观察研究。使用标准化问卷就低血糖的体征和症状对参与者进行访谈。收集入院期间的诱发原因、人口统计学资料、胰岛素治疗方案及并发症数据。
在250例低血糖患者中，112例（44.8%）为无症状低血糖，138例（55.2%）为有症状低血糖。无症状低血糖患者年龄较大（59±11岁 vs 54.8±13岁，p=0.003），男性居多（63% vs 48%，p=0.014），且入院时糖化血红蛋白水平较低（8.2%±2.6% vs 9.1±2.9%，p=0.006），与有症状患者相比。与有症状患者相比，无症状低血糖患者发作期间的平均血糖水平较高（60.0±8mg/dL vs 53.8±11mg/dL，p<0.001）。多因素分析中，男性（比值比2.08，95%置信区间1.13至3.83，p=0.02）及年龄>65岁（比值比4.01，95%置信区间1.62至9.92，p=0.02）是无症状低血糖的独立预测因素。两组间临床结局、医院并发症综合发生率（27% vs 22%，p=0.41）或住院时间（8天（四分位间距4 - 14）vs 7天（四分位间距5 - 15），p=0.92）无差异。
无症状低血糖在接受胰岛素治疗的糖尿病患者中很常见，但与有症状低血糖患者相比，其临床结局并不更差。年龄较大及男性是无症状低血糖的独立危险因素。
