Suzuki Yuka, Miya Aika, Nakamura Akinobu, Handa Takahisa, Kameda Hiraku, Atsumi Tatsuya
Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638 Japan.
Diabetol Int. 2025 Feb 7;16(2):385-393. doi: 10.1007/s13340-025-00803-3. eCollection 2025 Apr.
Underestimating hyper-/hypoglycemia or failure to perceive hyperglycemia hinders optimal glucose management in diabetes care. Our study investigated individuals who, while aware of their hyper-/hypoglycemia, may not perceive them as problematic. Also, we clarified the factors contributing to discrepancies between these individuals' perceptions and the objective measurements.
This study was a prospective observational study comprising 284 Japanese individuals with type 2 diabetes who underwent ambulatory blinded professional continuous glucose monitoring (CGM) and self-administered the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Individuals with a time above range (TAR; > 180 mg/dL) ≥ 25% and those who answered 0 ("never") or + 1 ("almost never") for the frequency of hyperglycemia in the DTSQ were defined as having no-perception of hyperglycemia. Individuals with a time below range (TBR; < 70 mg/dL) ≥ 4% with an answer of 0 or + 1 for the frequency of hypoglycemia were labeled as having no-perception of hypoglycemia. Multivariate logistic regression analysis was performed to analyze clinical characteristics associated with the discrepancies between failure to perceive hyper-/hypoglycemia and TAR ≥ 25% or TBR ≥ 4%.
Insulin-use (odds ratio [OR] = 0.29, < 0.05) and older age (OR = 1.05, < 0.05) were independent determinants of no-perception of hyperglycemia. Low eGFR was an independent determinant of no-perception of hypoglycemia (OR = 0.94, < 0.05).
No-insulin-use, being an older adult, and renal dysfunction are linked to the discrepancy between the perception of hyper-/hypoglycemia and actual blood glucose. These results will help create personalized diabetes care.
低估高血糖/低血糖或无法感知高血糖会妨碍糖尿病护理中最佳血糖管理。我们的研究调查了那些虽知晓自身高血糖/低血糖情况，但可能不认为其存在问题的个体。此外，我们阐明了导致这些个体认知与客观测量结果存在差异的因素。
本研究为前瞻性观察性研究，纳入了284名日本2型糖尿病患者，他们接受了动态盲法专业连续血糖监测（CGM）并自行填写糖尿病治疗满意度问卷（DTSQ）。血糖高于范围时间（TAR；>180mg/dL）≥25%且在DTSQ中对高血糖发生频率回答为0（“从不”）或+1（“几乎从不”）的个体被定义为无高血糖感知。血糖低于范围时间（TBR；<70mg/dL）≥4%且对低血糖发生频率回答为0或+1的个体被标记为无低血糖感知。进行多因素逻辑回归分析，以分析与未感知高血糖/低血糖和TAR≥25%或TBR≥4%之间差异相关的临床特征。
胰岛素使用情况（比值比[OR]=0.29，<0.05）和年龄较大（OR=1.05，<0.05）是无高血糖感知的独立决定因素。估算肾小球滤过率低是无低血糖感知的独立决定因素（OR=0.94，<0.05）。
未使用胰岛素、老年和肾功能不全与高血糖/低血糖感知与实际血糖之间的差异有关。这些结果将有助于制定个性化的糖尿病护理方案。
