与 1 型糖尿病患者低血糖感知缺失和严重低血糖相关的因素。
Factors associated with hypoglycemia unawareness and severe hypoglycemia in type 1 diabetes mellitus patients.
机构信息
Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan.
出版信息
J Diabetes Investig. 2022 Dec;13(12):2018-2026. doi: 10.1111/jdi.13886. Epub 2022 Aug 16.
AIMS/INTRODUCTION: Several factors are associated with hypoglycemia unawareness and severe hypoglycemia, but few large studies have analyzed Japanese patients with type 1 diabetes. The aim of this study was to analyze the risk factors for hypoglycemia unawareness and severe hypoglycemia in Japanese type 1 diabetes patients.
MATERIALS AND METHODS
A self-administered questionnaire investigated events, complications and treatments associated with hypoglycemia in patients with type 1 diabetes. Multiple logistic regression analysis of factors associated with hypoglycemia unawareness and severe hypoglycemia requiring medical treatment was carried out. The coefficient of variation (CV) of blood glucose levels was determined using blood samples collected at six outpatient visits.
RESULTS
Of the 1,619 participants, 44.2% and 10.4% experienced hypoglycemia unawareness and severe hypoglycemia, respectively. Mean HbA1c levels in patients with hypoglycemia unawareness were lower than those in patients without hypoglycemia unawareness. The type 1 diabetes subtype, glycated hemoglobin (HbA1c) level, CV of blood glucose levels and history of severe hypoglycemia requiring medical treatment were significant independent variables predicting the presence of hypoglycemia unawareness. The glucose CV and a history of hypoglycemia unawareness were significant independent variables predicting severe hypoglycemia requiring medical treatment. In stratified analyses of patients divided into four groups according to glucose CV and HbA1c levels, the high-glucose-CV/low-HbA1c group had the highest odds ratios for hypoglycemia unawareness (2.60) and severe hypoglycemia requiring medical treatment (2.55).
CONCLUSIONS
The ambulant glucose CV correlated with both hypoglycemia unawareness and severe hypoglycemia. Patients with high glucose CV and low HbA1c are at high risk of such adverse events, and their treatment strategies should be reviewed.
目的/引言：低血糖意识障碍和严重低血糖与多种因素有关，但很少有大型研究分析过日本 1 型糖尿病患者。本研究旨在分析日本 1 型糖尿病患者低血糖意识障碍和严重低血糖的危险因素。
材料和方法
通过自我管理问卷调查了与 1 型糖尿病患者低血糖相关的事件、并发症和治疗情况。对低血糖意识障碍和需要医疗治疗的严重低血糖相关因素进行了多因素逻辑回归分析。使用在 6 次门诊就诊时采集的血样测定血糖水平的变异系数（CV）。
结果
在 1619 名参与者中，分别有 44.2%和 10.4%的患者经历了低血糖意识障碍和严重低血糖。有低血糖意识障碍的患者的平均糖化血红蛋白（HbA1c）水平低于无低血糖意识障碍的患者。1 型糖尿病亚型、糖化血红蛋白（HbA1c）水平、血糖水平的 CV 和需要医疗治疗的严重低血糖史是预测低血糖意识障碍存在的显著独立变量。血糖 CV 和低血糖意识障碍史是预测需要医疗治疗的严重低血糖的显著独立变量。根据血糖 CV 和 HbA1c 水平将患者分为四组进行分层分析，高血糖 CV/低 HbA1c 组的低血糖意识障碍（2.60）和需要医疗治疗的严重低血糖（2.55）的比值比最高。
结论
动态血糖 CV 与低血糖意识障碍和严重低血糖均相关。血糖 CV 高且 HbA1c 低的患者发生此类不良事件的风险较高，应重新评估其治疗策略。
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