Department of Emergency, Cayenne Hospital Center, Cayenne, French Guiana.
Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana.
Diabet Med. 2022 Feb;39(2):e14736. doi: 10.1111/dme.14736. Epub 2021 Nov 23.
AIMS/INTRODUCTION: Strict management of glucose levels in elderly people with diabetes or with comorbidities exposes them to the risk of severe hypoglycaemia (capillary or venous glucose ≤3.3 mmol/L) and the associated morbidity and mortality. We aimed to describe the clinical, laboratory, and epidemiological characteristics of people with diabetes admitted to the Emergency Department in Cayenne, French Guiana for severe hypoglycaemia and identify avoidable behaviours in this population.
An observational epidemiological study of adults with diabetes who presented to the Emergency Department with severe hypoglycaemia was conducted between 2015 and 2018. Their medical history, clinical and laboratory data were collected. The primary outcome was the association between therapeutic misuse and age ≥65 years.
Overall, 178 admissions were analysed. The main cause of hypoglycaemia was insulin dosing-error or inappropriate glycaemic targets. Among those ≥65 years, 59% had a glycated haemoglobin ≤48 mmol/mol (6.5%), and the median duration of their diabetes was 20 years. Among them, 60% were treated with sulfonylurea, repaglinide, biphasic insulin, or mixed drugs, and 48% were on non-diabetes related treatments that had a hypoglycaemic effect. Furthermore, 23% of the elderly treated with oral antidiabetics had chronic kidney disease.
Many avoidable risk factors for severe hypoglycaemia have been highlighted, in particular insulin dosing errors or non-compliance with recommendations for participants ≥ 65 years. Primary care physicians and homecare nurses need to provide preventive interventions and undergo training.
目的/引言：对患有糖尿病或合并症的老年人进行严格的血糖管理会使他们面临严重低血糖（毛细血管或静脉血糖≤3.3mmol/L）的风险，以及相关的发病率和死亡率。我们旨在描述因严重低血糖而入住法属圭亚那卡宴急诊部的糖尿病患者的临床、实验室和流行病学特征，并确定该人群中可避免的行为。
对 2015 年至 2018 年间因严重低血糖而入住急诊部的成年糖尿病患者进行了一项观察性流行病学研究。收集了他们的病史、临床和实验室数据。主要结局是治疗不当与年龄≥65 岁之间的关联。
共分析了 178 例住院病例。低血糖的主要原因是胰岛素剂量错误或不合适的血糖目标。≥65 岁的患者中，59%的糖化血红蛋白≤48mmol/mol（6.5%），糖尿病病程中位数为 20 年。其中，60%接受磺脲类药物、瑞格列奈、双相胰岛素或混合药物治疗，48%接受有低血糖作用的非糖尿病相关治疗。此外，23%接受口服降糖药治疗的老年人患有慢性肾病。
强调了许多可避免的严重低血糖风险因素，特别是对于≥65 岁的参与者的胰岛素剂量错误或不遵守建议。初级保健医生和家庭护理护士需要提供预防干预措施并接受培训。
