Ratzmann K P, Schimke E
Ehemaliges Institut für Diabetes und Stoffwechselkrankheiten, Berlin.
Med Klin (Munich). 1995 Oct 15;90(10):557-61.
The question whether the incidence of severe episodes of hypoglycaemia in type I and type II diabetics correlates with the level of the patient's knowledge about hypoglycaemia and the quality of metabolic control.
A total of 234 consecutive type I diabetics (age and diabetes duration 48 and 16 years, respectively; blood glucose, self-monitored 63%) and 237 type II diabetics treated with glibenclamide (mean dose 6.7 mg/day) (age and diabetes duration 65 and 9 years, respectively; glucosuria, self-monitored 36%) who attended the Berlin outpatient diabetic centre were investigated.
Of the type I diabetics 23 (9.8%) experienced a total of 32 severe episodes of hypoglycaemia (incidence 0.14 per patient/year). Patients at risk of experiencing hypoglycaemia were about 20 years younger, injected insulin more often (3.8 vs 2.3 injections/day; p < 0.01) and had a lower HbA1 level (7.8% vs 9.0%; p < 0.01) than those having no hypoglycaemic reactions. Ten of the 23 diabetics suffering severe episodes of hypoglycaemia showed signs of kidney disease. The most common causes of hypoglycaemia were dietary errors (18.7%) or incorrect doses of insulin (12.5%), alcohol consumption (12.5%) and unusual physical exertion (23%). In terms of their knowledge about hypoglycaemia, there were no notably differences between patients with and those without hypoglycaemic reactions. Among the 237 type II diabetics treated with glibenclamide, three (1.3%) experienced one episode of severe hypoglycaemia each (incidence: 0.013 patient/year). Old age, maximum dosage of glibenclamide (15 mg/day) and multimorbidity were characteristic of these patients. Enquiries showed that only 49% (n = 160) of all type II diabetes had adequate knowledge about hypoglycaemia.
In type I diabetics, there appears to be no relationship between the hypoglycaemia risk and the patient's theoretical knowledge of hypoglycaemia. In future, apart from theoretical knowledge, more attention must be paid to practical training to improve awareness of hypoglycaemia. Educational programs for type II diabetics must attach more weight to the problem of hypoglycaemia.
I型和II型糖尿病患者严重低血糖发作的发生率是否与患者对低血糖的认知水平及代谢控制质量相关。
对柏林门诊糖尿病中心的234例连续就诊的I型糖尿病患者（年龄和糖尿病病程分别为48岁和16年；自我监测血糖的患者占63%）和237例接受格列本脲治疗（平均剂量6.7毫克/天）的II型糖尿病患者（年龄和糖尿病病程分别为65岁和9年；自我监测糖尿的患者占36%）进行了调查。
在I型糖尿病患者中，23例（9.8%）共经历了32次严重低血糖发作（发生率为0.14次/患者/年）。有低血糖发作风险的患者比无低血糖反应的患者年轻约20岁，胰岛素注射更频繁（3.8次/天对2.3次/天；p<0.01），糖化血红蛋白水平更低（7.8%对9.0%；p<0.01）。23例发生严重低血糖发作的糖尿病患者中有10例有肾病迹象。低血糖最常见的原因是饮食错误（18.7%）、胰岛素剂量不正确（12.5%）、饮酒（12.5%）和异常体力活动（23%）。在对低血糖的认知方面，有低血糖反应的患者与无低血糖反应的患者之间没有显著差异。在237例接受格列本脲治疗的II型糖尿病患者中，3例（1.3%）各经历了1次严重低血糖发作（发生率：0.013次/患者/年）。这些患者的特点是年龄较大、格列本脲最大剂量（15毫克/天）和多种疾病并存。调查显示，所有II型糖尿病患者中只有49%（n=160）对低血糖有足够的了解。
在I型糖尿病患者中，低血糖风险与患者对低血糖的理论知识之间似乎没有关系。未来，除了理论知识外，必须更加重视实践培训以提高对低血糖的认识。针对II型糖尿病患者的教育项目必须更加重视低血糖问题。
