Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Sci Rep. 2021 Feb 22;11(1):4305. doi: 10.1038/s41598-021-82838-5.
We investigated the association between the incidence of severe hypoglycemia and the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes. Baseline and follow-up data for 988,333 participants with type 2 diabetes were retrieved from the National Health Insurance System database. The number of severe hypoglycemia episodes experienced from 2007 to 2009 was determined. The primary outcome was the development of ESRD after the baseline evaluation. Participants were followed from the baseline until death or December 31, 2016, during this period 14,545 participants (1.5%) developed ESRD. In the crude model, compared with those who experienced no severe hypoglycemia, the hazard ratios (95% confidential intervals) for developing ESRD were 4.96 (4.57-5.39), 6.84 (5.62-8.32), and 9.51 (7.14-12.66) in participants who experienced one, two, and three or more episodes of severe hypoglycemia, respectively. Further adjustment for various confounding factors attenuated the association between severe hypoglycemia and ESRD; the significance of the association between severe hypoglycemia and ESRD was maintained. Having three or more severe hypoglycemia episodes was associated with a nearly two-fold increased risk of developing ESRD. Prior episodes of severe hypoglycemia were associated with an increased risk of ESRD among Korean adults with type 2 diabetes.
我们调查了 2 型糖尿病患者严重低血糖发作与终末期肾病（ESRD）风险之间的关系。从国民健康保险系统数据库中检索到了 988333 名 2 型糖尿病患者的基线和随访数据。确定了 2007 年至 2009 年期间经历的严重低血糖发作次数。主要结局是在基线评估后发生 ESRD。在这段时间内，参与者从基线开始随访，直到死亡或 2016 年 12 月 31 日，在此期间有 14545 名（1.5%）参与者发生了 ESRD。在粗模型中，与未经历严重低血糖的参与者相比，经历 1、2 和 3 次或更多次严重低血糖发作的参与者发生 ESRD 的风险比（95%置信区间）分别为 4.96（4.57-5.39）、6.84（5.62-8.32）和 9.51（7.14-12.66）。进一步调整各种混杂因素后，严重低血糖与 ESRD 之间的关联减弱，但严重低血糖与 ESRD 之间的关联仍然存在。经历 3 次或更多次严重低血糖发作与发生 ESRD 的风险增加近两倍相关。严重低血糖发作的既往发作与韩国成年 2 型糖尿病患者发生 ESRD 的风险增加相关。
