Pramming S, Thorsteinsson B, Bendtson I, Rønn B, Binder C
Br Med J (Clin Res Ed). 1985 Aug 10;291(6492):376-9. doi: 10.1136/bmj.291.6492.376.
The prevalence of nocturnal biochemical hypoglycaemia--that is, blood glucose concentrations below 3 mmol/l (55 mg/100 ml)--was evaluated in a random sample of 58 insulin dependent diabetics receiving twice daily insulin. Seventeen patients had at least one blood glucose value below 3 mmol/l (55 mg/100 ml) and five a value below 2 mmol/l (36 mg/100 ml) during the night. Both bedtime (2300) and fasting morning (0700) blood glucose concentrations were significantly lower in the group with nocturnal hypoglycaemia compared with the group without (p less than 0.00001). If the bedtime blood glucose concentration was below 6 mmol/l (108 mg/100 ml) the risk of nocturnal hypoglycaemia was 80% (95% confidence limits 51-96%). If the bedtime blood glucose concentration was above 6 mmol/l the likelihood of hypoglycaemia not occurring during the night was 88% (74-96%). The mean glycosylated haemoglobin A1c (HbA1c) concentration in the group with nocturnal biochemical hypoglycaemia (8.2 (range 5.0-12.4)%) was significantly lower than that in the group without (9.4(7.0-14.2)%) (p less than 0.02). The prevalence of nocturnal hypoglycaemia in the patients receiving twice daily insulin (29%) was compared with that in 15 patients receiving thrice daily insulin (47%) and was not found to be significantly different. The likelihood of this risk being greater with thrice daily insulin was, however, 88%. No patient with nocturnal biochemical hypoglycaemia woke up during the night with symptomatic hypoglycaemia. Nocturnal biochemical hypoglycaemia is common during twice daily treatment with insulin, and low values of HbA1c might be associated with a higher risk of such hypoglycaemia. The blood glucose concentration at bedtime is a significant predictor of nocturnal biochemical hypoglycaemia, and HbA1c values might be of help in identifying patients at risk.
对58例接受每日两次胰岛素治疗的胰岛素依赖型糖尿病患者的随机样本进行了夜间生化低血糖（即血糖浓度低于3 mmol/L（55 mg/100 ml））患病率的评估。17例患者夜间至少有一次血糖值低于3 mmol/L（55 mg/100 ml），5例患者夜间血糖值低于2 mmol/L（36 mg/100 ml）。与无夜间低血糖的组相比，夜间低血糖组的睡前（23:00）和空腹晨起（07:00）血糖浓度均显著更低（p<0.00001）。如果睡前血糖浓度低于6 mmol/L（108 mg/100 ml），夜间低血糖风险为80%（95%置信区间51 - 96%）。如果睡前血糖浓度高于6 mmol/L，夜间不发生低血糖的可能性为88%（74 - 96%）。夜间生化低血糖组的糖化血红蛋白A1c（HbA1c）平均浓度（8.2（范围5.0 - 12.4）%）显著低于无夜间低血糖组（9.4（7.0 - 14.2）%）（p<0.02）。将每日两次接受胰岛素治疗患者的夜间低血糖患病率（29%）与15例每日三次接受胰岛素治疗患者的患病率（47%）进行比较，未发现有显著差异。然而，每日三次胰岛素治疗时这种风险更高的可能性为88%。夜间生化低血糖的患者均未在夜间因症状性低血糖醒来。每日两次胰岛素治疗期间夜间生化低血糖很常见，且HbA1c值较低可能与此类低血糖风险较高有关。睡前血糖浓度是夜间生化低血糖的重要预测指标，HbA1c值可能有助于识别有风险的患者。
