2 型糖尿病患者中低血糖恐惧与二线胰岛素促分泌剂或胰岛素使用及随后血糖控制的相关性：来自 DISCOVER 研究的数据分析。

Associations of fear of hypoglycemia with second-line use of insulin secretagogues or insulin and subsequent glycemic control in patients with type 2 diabetes: An analysis using data from the DISCOVER study.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

Int J Clin Pract. 2020 Jun;74(6):e13485. doi: 10.1111/ijcp.13485. Epub 2020 Feb 11.

DOI:10.1111/ijcp.13485

PMID:32003099

Abstract

BACKGROUND

Associations of fear of hypoglycemia with prescription of second-line insulin secretagogues (IS) or insulin and subsequent glycemic control in patients with type 2 diabetes were analysed using data from the DISCOVER study-a large, prospective, observational study.

METHODS

Patients with type 2 diabetes initiating a second-line treatment after a first-line oral therapy were enrolled. Fear of hypoglycemia was assessed using baseline Hypoglycemia Fear Survey (HFS) worry score. Glycemic control was assessed using glycated haemoglobin (HbA1c) levels at 6-month and 1-year follow-up, and HbA1c change from baseline was analysed. To examine the association of baseline HFS worry scores with second-line use of IS or insulin, a hierarchical logistic model with country as random effect was used.

RESULTS

A total of 6217 patients were analysed. The mean HFS worry score was 6.9 ± 11.4, while patients in the upper quartile had an HFS worry score ≥9. We divided patients into three groups according to their baseline HFS worry score (0, 1-8, ≥9). HFS worry score was associated with the use of first-line IS, but not the second-line treatment. Compared to treatments with no IS and insulin, a better HbA1c response to second-line IS or insulin was noted in patients with a baseline HFS worry score of 0 or 1-8, but not in patients with a baseline HFS worry score ≥9.

CONCLUSION

HFS worry score was associated with the use of first-line IS and glycemic response to second-line IS or insulin in patients with type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02322762. Registered 23 December 2014.

摘要

背景

使用来自 DISCOVER 研究的数据，对 2 型糖尿病患者的低血糖恐惧与二线胰岛素促分泌剂（IS）或胰岛素的处方以及随后的血糖控制之间的关系进行了分析。这是一项大型前瞻性观察研究。

方法

纳入了在一线口服治疗后开始二线治疗的 2 型糖尿病患者。使用基线低血糖恐惧调查（HFS）担忧评分评估对低血糖的恐惧。使用 6 个月和 1 年随访时的糖化血红蛋白（HbA1c）水平评估血糖控制，并分析 HbA1c 从基线的变化。为了研究基线 HFS 担忧评分与 IS 或胰岛素的二线使用之间的关联，使用带有国家为随机效应的分层逻辑模型进行分析。

结果

共分析了 6217 例患者。HFS 担忧评分的平均值为 6.9±11.4，而上四分位数的患者 HFS 担忧评分≥9。我们根据基线 HFS 担忧评分（0、1-8、≥9）将患者分为三组。HFS 担忧评分与一线 IS 的使用有关，但与二线治疗无关。与没有 IS 和胰岛素的治疗相比，HFS 担忧评分在 0 或 1-8 的患者中，二线 IS 或胰岛素的 HbA1c 反应更好，但在 HFS 担忧评分≥9 的患者中则不然。