van Meijel Lian A, de Vegt Femmie, Abbink Evertine J, Rutters Femke, Schram Miranda T, van der Klauw Melanie M, Wolffenbuttel Bruce H R, Siegelaar Sarah, DeVries J Hans, Sijbrands Eric J G, Özcan Behiye, de Valk Harold W, Silvius Bianca, Schaper Nicolaas, Stehouwer Coen D A, Elders Petra J M, Tack Cornelis J, de Galan Bastiaan E
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
BMJ Open Diabetes Res Care. 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-000935.
People with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes.
Observational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to recover, were assessed using the validated Dutch version of the Clarke questionnaire. In addition, clinical variables were collected including age, diabetes duration, hemoglobin A1c, ethnicity and education.
2350 people with type 2 diabetes on insulin were included: 59.1% men, mean age 61.1±10.4 years, mean diabetes duration 14.8±9.2 years and 79.5% on basal-bolus therapy. A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. Increased odds for IAH were found with complex insulin regimens and lower odds with having a partner and body mass index ≥30 kg/m. Severe hypoglycemia was associated with complex insulin regimens, non-Caucasian ethnicity and use of psychoactive drugs, and inversely with metformin use.
In this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and >30% had a history of severe hypoglycemia in the past year.
使用胰岛素治疗的2型糖尿病患者有发生低血糖的风险。反复发生低血糖会导致低血糖意识障碍（IAH），并增加严重低血糖的风险。本研究旨在评估荷兰全国范围内接受胰岛素治疗的2型糖尿病患者自我报告的IAH和严重低血糖的患病率及决定因素。
对荷兰糖尿病明珠队列进行观察性研究，该队列由在初级、二级和三级糖尿病护理中心接受治疗的2型糖尿病患者组成。使用经过验证的荷兰版克拉克问卷评估过去一年中IAH的存在情况以及严重低血糖的发生情况，严重低血糖定义为需要外部帮助才能恢复的事件。此外，收集了临床变量，包括年龄、糖尿病病程、糖化血红蛋白、种族和教育程度。
纳入了2350例接受胰岛素治疗的2型糖尿病患者：男性占59.1%，平均年龄61.1±10.4岁，平均糖尿病病程14.8±9.2年，79.5%接受基础-餐时胰岛素治疗。共有229例患者（9.7%）被归类为患有IAH，742例患者（31.6%）报告有严重低血糖。发现使用复杂胰岛素方案会增加IAH的几率，而有伴侣和体重指数≥30kg/m²则会降低IAH的几率。严重低血糖与复杂胰岛素方案、非白种人种族和使用精神活性药物有关，与使用二甲双胍呈负相关。
在这个全国性队列中，近十分之一接受胰岛素治疗的2型糖尿病患者患有IAH，超过30%的患者在过去一年中有严重低血糖病史。
