1 型糖尿病患者使用间歇性连续血糖监测时的无症状性低血糖：危险因素和血糖模式的识别。
Hypoglycemia unawareness in type 1 diabetes patients using intermittent continuous glucose monitoring: Identification of risk factors and glycemic patterns.
机构信息
Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
Coimbra Hospital and University Centre, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
出版信息
Diabetes Metab Syndr. 2022 Jun;16(6):102525. doi: 10.1016/j.dsx.2022.102525. Epub 2022 May 27.
BACKGROUND
Hypoglycemia unawareness designates failure to detect eminent hypoglycemia. Clarke's questionnaire is one of the most used systems to evaluate this problem.
AIMS
To relate Clarke's questionnaire (QQ) results with continuous glucose monitoring data.
METHODS
Application of the questionnaire in a sample of type 1 diabetes mellitus (T1DM) patients using intermittent continuous glucose monitoring (iCGM).
RESULTS
111 T1DM patients were evaluated, 56.8% female, mean age 35.0 ± 12.4 years and mean disease duration 18.8 ± 10.5 years. According to CQ, 13.5% had unawareness, 76.6% awareness and 9.9% indeterminate awareness to hypoglycemia. Those with unawareness had longer disease duration (25.1 ± 10.4 vs 18.2 ± 10.3 for awareness and 14.9 ± 9.9 for indeterminate awareness, p = 0.047), more time below range (10.3 ± 4.9% vs 6.3 ± 5.1 and 6.3 ± 4.8; p = 0.009) and higher mean duration of hypoglycemia (131.7 ± 38.6 vs 116.6 ± 49.6 and 131.7 ± 38.6; p = 0.008). In multivariate analysis, mean duration of hypoglycemia was an independent predictor of CQ results. In a receiver operating curve (AUC 0.746; p = 0.004) a mean duration of hypoglycemia ≥106.5 min showed 84.6% sensitivity/64.4% specificity for unawareness.
CONCLUSIONS
Our sample had a significative prevalence of hypoglycemia unawareness which increased with longer diabetes duration. iCGM data can be indicative of this problem, with a mean hypoglycemia duration ≥106.5 min being suggestive, albeit unspecific.
背景
低血糖意识受损指未能察觉即将发生的严重低血糖。Clarke 问卷是评估这一问题最常用的系统之一。
目的
将 Clarke 问卷（QQ）的结果与连续血糖监测数据相关联。
方法
在使用间歇性连续血糖监测（iCGM）的 1 型糖尿病（T1DM）患者样本中应用问卷。
结果
共评估了 111 例 T1DM 患者，女性占 56.8%，平均年龄 35.0±12.4 岁，平均病程 18.8±10.5 年。根据 CQ，13.5%的患者存在低血糖意识受损，76.6%的患者有低血糖意识，9.9%的患者低血糖意识状态不确定。低血糖意识受损的患者病程更长（25.1±10.4 年 vs 18.2±10.3 年，低血糖意识和不确定意识，p=0.047），血糖低于目标范围的时间更多（10.3±4.9% vs 6.3±5.1%和 6.3±4.8%；p=0.009），低血糖的平均持续时间更长（131.7±38.6 分钟 vs 116.6±49.6 分钟和 131.7±38.6 分钟；p=0.008）。多变量分析显示，低血糖的平均持续时间是 CQ 结果的独立预测因子。在受试者工作特征曲线（AUC 0.746；p=0.004）中，低血糖的平均持续时间≥106.5 分钟对低血糖意识受损的敏感性为 84.6%/特异性为 64.4%。
结论
我们的样本存在显著的低血糖意识受损患病率，随着糖尿病病程的延长而增加。iCGM 数据可提示这一问题，低血糖的平均持续时间≥106.5 分钟提示存在低血糖意识受损，尽管特异性不高。
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