Zhao Hui, Ying Hua-Liang, Zhang Chao, Zhang Shaohua
Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Oct 29;15:3339-3346. doi: 10.2147/DMSO.S369457. eCollection 2022.
Critically ill patients with premorbid diabetes can suffer from relative hypoglycemia (RHG), falling below the normal blood glucose (BG) target. However, these events have not been well defined or studied. In the present study, we aimed to explore the incidence and clinical significance of RHG events in critically ill patients with diabetes.
Patients with a history of diabetes who stayed in the intensive care unit (ICU) for more than three days with at least 12 BG recordings were retrospectively included in the study. A BG level > 30% below the estimated average according to patient hemoglobin A1c measured at admission was defined as a single RHG event. Outcomes were compared between patients with and those without RHG events.
In total, 113 patients were included in the final analysis. RHG was detected in 73 patients (64.6%). Those who experienced RHG events had a significantly higher incidence of ICU delirium. They also had a higher risk of 28-day mortality, but this was not statistically significant. However, patients with a higher frequency of RHG events did have a significantly higher risk of overall mortality (57.1% for more than four events vs 15.4% for three to four events, P=0.006 and 15.1% for one to two events, P=0.003).
In conclusion, RHG is a common finding in critically ill patients with diabetes and is associated with mortality and the occurrence of delirium.
患有糖尿病前期的重症患者可能会出现相对低血糖（RHG），血糖水平低于正常血糖（BG）目标值。然而，这些情况尚未得到明确界定或研究。在本研究中，我们旨在探讨糖尿病重症患者中RHG事件的发生率及临床意义。
回顾性纳入入住重症监护病房（ICU）超过3天且至少有12次血糖记录的糖尿病病史患者。根据入院时测得的患者糖化血红蛋白A1c，血糖水平低于估计平均值30%以上被定义为单次RHG事件。比较发生和未发生RHG事件的患者的结局。
最终分析共纳入113例患者。73例患者（64.6%）检测到RHG。发生RHG事件的患者ICU谵妄发生率显著更高。他们28天死亡率风险也更高，但无统计学意义。然而，RHG事件发生频率较高的患者总体死亡风险确实显著更高（超过4次事件为57.1%，3至4次事件为15.4%，P = 0.006；1至2次事件为15.1%，P = 0.003）。
总之，RHG在糖尿病重症患者中很常见，且与死亡率及谵妄的发生相关。
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