School of Nursing, Yangzhou University, Jiangyang Road 136, Yangzhou, China.
Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Jiangsu Key Laboratory of Zoonosis, Yangzhou University, Yangzhou, China.
Acta Diabetol. 2023 Sep;60(9):1155-1169. doi: 10.1007/s00592-023-02102-2. Epub 2023 May 18.
To conduct a systematic review to summarize the definition, measurement tools, prevalence, and contributing factors of impaired awareness of hypoglycemia (IAH) in type 2 diabetes mellitus (T2DM).
A reproducible search strategy was used to identify factors affecting IAH in T2DM in PubMed, MEDLINE, EMBASE, Cochrane, PsycINFO, and CINAHL from inception until 2022. Literature screening, quality evaluation, and information extraction were performed independently by 2 investigators. A meta-analysis of prevalence was performed using Stata 17.0.
The pooled prevalence of IAH in patients with T2DM was 22% (95%CI:14-29%). Measurement tools included the Gold score, Clarke's questionnaire, and the Pedersen-Bjergaard scale. IAH in T2DM was associated with sociodemographic factors (age, BMI, ethnicity, marital status, education level, and type of pharmacy patients visited), clinical disease factors (disease duration, HbAlc, complications, insulin therapy regimen, sulfonylureas use, and the frequency and severity of hypoglycemia), and behavior and lifestyle (smoking and medication adherence).
The study found a high prevalence of IAH in T2DM, with an increased risk of severe hypoglycemia, suggesting that medical workers should take targeted measures to address sociodemographic factors, clinical disease, and behavior and lifestyle to reduce IAH in T2DM and thus reduce hypoglycemia in patients.
系统综述总结 2 型糖尿病（T2DM）患者意识受损性低血糖（IAH）的定义、测量工具、流行率及影响因素。
我们采用可重现的检索策略，检索了从创建到 2022 年 1 月，PubMed、MEDLINE、EMBASE、Cochrane、PsycINFO 和 CINAHL 中关于 T2DM 患者 IAH 影响因素的相关文献。由 2 名研究人员独立进行文献筛选、质量评价和资料提取。使用 Stata 17.0 软件进行流行率的荟萃分析。
T2DM 患者中 IAH 的总体流行率为 22%（95%CI：14%-29%）。测量工具包括 Gold 评分、Clarke 问卷和 Pedersen-Bjergaard 量表。T2DM 患者中 IAH 与社会人口学因素（年龄、BMI、种族、婚姻状况、教育程度和就诊药店类型）、临床疾病因素（病程、HbAlc、并发症、胰岛素治疗方案、磺脲类药物使用情况以及低血糖的频率和严重程度）以及行为和生活方式（吸烟和药物依从性）相关。
本研究发现 T2DM 患者中 IAH 流行率较高，严重低血糖风险增加，提示医务人员应采取针对性措施解决社会人口学因素、临床疾病和行为及生活方式问题，以降低 T2DM 患者的 IAH 发生率，从而减少患者的低血糖事件。
