College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Diabetes. 2020 Jun;44(4):335-341.e3. doi: 10.1016/j.jcjd.2019.10.007. Epub 2019 Oct 30.
The aim of this work was to determine whether: 1) blood glucose test strip use in the population is associated with hypoglycemia hospitalization rates, and 2) blood glucose test strip use among individuals is associated with a reduced risk of hypoglycemia hospitalization.
Administrative databases from Saskatchewan, Canada, were used to ascertain population-level hypoglycemia hospitalizations and test strip utilization over the period from 1996 to 2014. For objective 1, a generalized linear model with generalized estimating equations was fit to provincial data stratified by age group, sex and year. For objective 2, a nested case-control study was conducted for a cohort of insulin users with diagnosed diabetes. Multivariable conditional logistic regression was used to test the association of test strip use with hospitalization, after adjusting for clinical and demographic factors and health services use. Odds ratios (ORs) and 95% confidence intervals (95% CIs) are reported.
A total of 5,166 hospitalizations for hypoglycemia were identified in the observation period. Annual glucose test strip use increased by over 350%; however, no association was found with provincial hypoglycemia hospitalization rate during the same period, even after controlling for all-cause hospitalizations and population demographics. In the case-control analysis, test strip use was not associated with hospitalization for hypoglycemia among insulin users (n=10,617; adjusted OR, 1.08; 95% CI, 0.88 to 1.31). A sensitivity analysis in an independent cohort of noninsulin users produced a similar finding (n=47,501; adjusted OR, 1.04; 95% CI, 0.55 to 1.94).
Our findings add to the body of evidence against a protective effect of blood glucose test strip use for serious hypoglycemia.
本研究旨在确定以下两点：1）人群中血糖检测试纸的使用是否与低血糖住院率相关；2）个体中血糖检测试纸的使用是否与低血糖住院风险降低相关。
利用加拿大萨斯喀彻温省的行政数据库，确定了 1996 年至 2014 年期间的人群低血糖住院率和检测试纸使用情况。为了实现目标 1，按年龄组、性别和年份对省级数据进行了广义线性模型和广义估计方程拟合。为了实现目标 2，对确诊糖尿病的胰岛素使用者队列进行了嵌套病例对照研究。多变量条件逻辑回归用于测试检测试纸使用与住院之间的关联，调整了临床和人口统计学因素以及卫生服务使用情况。报告了比值比（ORs）和 95%置信区间（95%CI）。
在观察期内，共发现 5166 例低血糖住院病例。尽管葡萄糖检测试纸的年使用量增加了 350%以上，但在同期并未发现与全省低血糖住院率相关，即使在控制了全因住院和人口统计学因素之后也是如此。在病例对照分析中，检测试纸的使用与胰岛素使用者的低血糖住院率之间没有关联（n=10617；调整后的 OR，1.08；95%CI，0.88 至 1.31）。在一个独立的非胰岛素使用者队列中的敏感性分析得出了类似的发现（n=47501；调整后的 OR，1.04；95%CI，0.55 至 1.94）。
我们的研究结果进一步证明了血糖检测试纸的使用并不能预防严重低血糖。
