Clarke W L, Cox D J, Gonder-Frederick L A, Julian D, Schlundt D, Polonsky W
Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Diabetes Care. 1995 Apr;18(4):517-22. doi: 10.2337/diacare.18.4.517.
To prospectively evaluate the frequency and severity of hypoglycemic episodes in IDDM subjects who declare themselves to have reduced awareness of hypoglycemia, to validate their self-designations in their natural environment, and to determine objectively the presence or absence of autonomic and neuroglycopenic symptoms associated with their low blood glucose (BG) levels.
A total of 78 insulin-dependent diabetes mellitus (IDDM) subjects (mean age 38.3 +/- 9.2 years; duration of diabetes 19.3 +/- 10.4 years) completed two sets of assessments separated by 6 months. The assessments included reports of frequency and severity of low BG, symptoms associated with low BG, and a BG symptom/estimation trial using a hand-held computer (HHC). Diaries of hypoglycemic episodes were kept for the intervening 6 months. HbA1 levels were determined at each assessment.
Of the subjects, 39 declared themselves as having reduced awareness of hypoglycemia (reduced-awareness subjects). There were no differences between these reduced-awareness subjects and aware subjects with regard to age, sex, disease duration, insulin dose, or HbA1. During the HHC trials, reduced-awareness subjects were significantly less accurate in detecting BG < 3.9 mmol/l (33.2 +/- 47 vs. 47.6 +/- 50% detection, P = 0.001) and had significantly fewer autonomic (0.41 +/- 0.82 vs. 1.08 +/- 1.22, P = 0.006, reduced-awareness vs. aware) and neuroglycopenic (0.44 +/- 0.85 vs. 1.18 +/- 1.32, P = 0.004, reduced-awareness vs. aware) symptoms per subject. Prospective diary records revealed that reduced-awareness subjects experienced more moderate (351 vs. 238, P = 0.026) and severe (50 vs. 17, P = 0.0062) hypoglycemic events. The second assessment results were similar to the first and verified the reliability of the data.
IDDM subjects who believe they have reduced awareness of hypoglycemia are generally correct. They have a history of more moderate and severe hypoglycemia, are less accurate at detecting BG < 3.9 mmol/l, and prospectively experience more moderate and severe hypoglycemia than do aware subjects. Neither disease duration nor level of glucose control explains their reduced awareness of hypoglycemia. Reduced-awareness individuals may benefit from interventions designed to teach them to recognize all of their potential early warning symptoms.
前瞻性评估自称低血糖意识减退的胰岛素依赖型糖尿病（IDDM）患者低血糖发作的频率和严重程度，在自然环境中验证他们的自我认定，并客观确定与低血糖（BG）水平相关的自主神经和神经低血糖症状的有无。
共有78例胰岛素依赖型糖尿病（IDDM）患者（平均年龄38.3±9.2岁；糖尿病病程19.3±10.4年）完成了两组间隔6个月的评估。评估包括低血糖发生频率和严重程度的报告、与低血糖相关的症状，以及使用手持计算机（HHC）进行的血糖症状/估计试验。在这6个月的间隔期内记录低血糖发作日记。每次评估时测定糖化血红蛋白（HbA1）水平。
在这些患者中，39例自称有低血糖意识减退（低血糖意识减退组患者）。这些低血糖意识减退组患者与有低血糖意识的患者在年龄、性别、病程、胰岛素剂量或糖化血红蛋白方面无差异。在HHC试验期间，低血糖意识减退组患者检测血糖<3.9 mmol/l时的准确性显著较低（检测率分别为33.2±47%和47.6±50%，P = 0.001），且每位患者的自主神经症状（分别为0.41±0.82和1.08±1.22，P = 0.006，低血糖意识减退组与有低血糖意识组）和神经低血糖症状（分别为0.44±0.85和1.18±1.32，P = 0.004，低血糖意识减退组与有低血糖意识组）明显较少。前瞻性日记记录显示，低血糖意识减退组患者经历的中度（351次对238次，P = 0.026）和重度（50次对17次，P = 0.0062）低血糖事件更多。第二次评估结果与第一次相似，验证了数据的可靠性。
认为自己有低血糖意识减退的IDDM患者通常是正确的。他们有更多中度和重度低血糖的病史，检测血糖<3.9 mmol/l时准确性较低，且前瞻性地比有低血糖意识的患者经历更多中度和重度低血糖。病程和血糖控制水平均不能解释他们低血糖意识减退的情况。低血糖意识减退的个体可能会从旨在教导他们识别所有潜在早期预警症状的干预措施中获益。
