Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Clínic, Barcelona, Spain.
Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Clínic, Barcelona, Spain; Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Comte Borrell Primary Health-Care Center, Consorci d'Atenció Primària de Salut de' Eixample (CAPSBE), Barcelona, Spain.
Prim Care Diabetes. 2020 Apr;14(2):168-172. doi: 10.1016/j.pcd.2019.08.001. Epub 2019 Aug 30.
To assess the frequency of hypoglycemia events, patient characteristics and the prevalence of impaired awareness of hypoglycemia (IAH) in patients with Type 2 Diabetes (T2D) using two or more insulin injections in primary care.
Cross-sectional study performed at 9 Primary Care Centers including review of electronic medical records and an on-site visit to patients using >2 insulin injections with suboptimal control. Episodes of severe hypoglycemia (SH) in the last 12months were recorded. Non-severe hypoglycemia (NSH) was considered as self-monitoring blood glucose <70mg/dl. IAH was evaluated and HbA was obtained.
157 subjects were included (age 68.4+10.7years, 82 women, T2D duration 18.3+8.7years). 57% used multiple daily injections. Total insulin was 66.9+43.4 units/day. The mean HbA was 9.2±1.4% (77±12mmol/mol) and only 13.4% had HbA <8% (64mmol/mol). The frequency of NSH was 0.74±1.37 episodes/week. Only one patient had a SH the last 12months. Around 10-12% of patients had IAH. In comparison with normal awareness, those with IAH had a longer duration of T2D (25.3±11.6 vs. 16.1±8.2 years, respectively, p<0.01). In the multiple linear regression analysis, only the IAH score and the total insulin dose independently determined the NSH number.
NSH/SH in patients with T2D treated with two or more insulin injections in primary care settings seems to be relatively common. Although hypoglycemia awareness is predominantly preserved, the presence of IAH should not be ignored as it increases the risk of hypoglycemia and constitutes an additional barrier to recognize and address this burden in T2D.
评估在初级保健中使用两种或更多胰岛素注射治疗 2 型糖尿病（T2D）患者的低血糖事件频率、患者特征和未察觉低血糖（IAH）的患病率。
在 9 个初级保健中心进行了横断面研究，包括对电子病历的审查和对使用>2 种胰岛素注射且控制不佳的患者进行现场访问。记录过去 12 个月内严重低血糖（SH）的发作情况。非严重低血糖（NSH）被认为是自我监测血糖<70mg/dl。评估 IAH 并获得 HbA。
共纳入 157 名受试者（年龄 68.4+10.7 岁，82 名女性，T2D 病程 18.3+8.7 年）。57%使用多次每日注射。总胰岛素剂量为 66.9+43.4 单位/天。平均 HbA 为 9.2±1.4%（77±12mmol/mol），仅 13.4%的患者 HbA<8%（64mmol/mol）。NSH 的频率为 0.74±1.37 次/周。过去 12 个月内仅有 1 名患者发生 SH。约 10-12%的患者存在 IAH。与正常意识相比，IAH 患者的 T2D 病程较长（分别为 25.3±11.6 年和 16.1±8.2 年，p<0.01）。在多元线性回归分析中，只有 IAH 评分和总胰岛素剂量独立决定了 NSH 次数。
在初级保健中使用两种或更多胰岛素注射治疗的 T2D 患者中，NSH/SH 似乎较为常见。尽管低血糖意识主要得到保留，但不应忽视 IAH 的存在，因为它会增加低血糖的风险，并构成识别和解决 T2D 中这一负担的额外障碍。
