Kimura Yoshinobu, Kimura Naoya, Akazawa Manabu
Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588 Japan.
Department of Pharmacy, Soka Municipal Hospital, 2-21-2 Soka, Soka, Saitama 340-8560 Japan.
Diabetol Int. 2021 Feb 17;12(4):420-429. doi: 10.1007/s13340-021-00499-1. eCollection 2021 Oct.
There are few reports on the association between malnutrition and hypoglycemia. The geriatric nutritional risk index (GNRI) allows risk classification by morbidity and mortality resulting from conditions often associated with malnutrition in older individuals. However, the association between GNRI and hypoglycemia is unclear. This study examined the associations between nutrition-related risk and hypoglycemia among older individuals with type 2 diabetes (T2D) using diabetes medication.
This single-center historical cohort study included hospitalized patients aged ≥ 65 years with T2D on medication. Nutrition-related risk was assessed using the GNRI and classified into four risk groups. Hypoglycemia and serious hypoglycemia were determined by oral or intravenous glucose intake and blood glucose < 3.9 mmol/L (70 mg/dL) as hypoglycemia, among them blood glucose < 3.0 mmol/L (54 mg/dL) as serious hypoglycemia. Data were recorded at least once during hospitalization.
Patients who met the criteria ( = 1.754) were included in the study. The participants median age was 75.0 years. During the study, 81 patients (4.6%) experienced hypoglycemia and 7 patients (0.4%) experienced serious hypoglycemia. Hypoglycemia was observed in patients in the major risk (16.0%), moderate risk (9.7%), low risk (5.2%), and no risk (1.5%) groups ( for trend < 0.001). After adjusting for other risk factors, the hazard ratios of hypoglycemic among people with major, moderate, and low risk were 5.50, 3.86, and 2.55, respectively.
Hypoglycemia increased with increasing nutrition-related risk among older individuals with T2D using diabetes medication. The GNRI is a simple and useful assessment tool in the clinical setting.
关于营养不良与低血糖之间关联的报道较少。老年营养风险指数（GNRI）可根据老年个体中常与营养不良相关的疾病所导致的发病率和死亡率进行风险分类。然而，GNRI与低血糖之间的关联尚不清楚。本研究使用糖尿病药物，探讨了2型糖尿病（T2D）老年患者营养相关风险与低血糖之间的关联。
这项单中心历史队列研究纳入了年龄≥65岁且正在使用药物治疗的T2D住院患者。使用GNRI评估营养相关风险，并将其分为四个风险组。低血糖和严重低血糖通过口服或静脉摄入葡萄糖以及血糖<3.9 mmol/L（70 mg/dL）定义为低血糖，其中血糖<3.0 mmol/L（54 mg/dL）定义为严重低血糖。在住院期间至少记录一次数据。
符合标准的患者（n = 1754）纳入研究。参与者的中位年龄为75.0岁。在研究期间，81例患者（4.6%）发生低血糖，7例患者（0.4%）发生严重低血糖。在主要风险组（16.0%）、中度风险组（9.7%）、低风险组（5.2%）和无风险组（1.5%）的患者中均观察到低血糖（趋势P<0.001）。在调整其他风险因素后，主要、中度和低风险人群发生低血糖的风险比分别为5.50、3.86和2.55。
在使用糖尿病药物的T2D老年患者中，低血糖随着营养相关风险的增加而增加。GNRI是临床环境中一种简单且有用的评估工具。
