Stephenson J M, Kempler P, Perin P C, Fuller J H
Department of Epidemiology and Public Health, UCL Medical School, London, UK.
Diabetologia. 1996 Nov;39(11):1372-6. doi: 10.1007/s001250050585.
The hypothesis that diabetic patients with autonomic neuropathy are at increased risk of severe hypoglycaemia was examined in an epidemiological study of over 3000 IDDM patients in Europe (EURODIAB IDDM Complications Study). Autonomic function was assessed by two standard cardiovascular tests: change in heart rate and systolic blood pressure on standing. Severe hypoglycaemia was defined as an attack serious enough to require the help of another person. Compared to patients (68%) reporting no attacks in the last year, those reporting one or more attacks were older (34.0 +/- 10.7 vs 32.1 +/- 9.9 years, mean +/- SD, p < 0.0001), had had diabetes for a longer period (16.6 +/- 9.5 vs 13.8 +/- 9.1 years, p < 0.0001), had better glycaemic control (HbA1c 6.4 +/- 1.8 vs 6.9 +/- 1.9%, p < 0.0001) and were more likely (p = 0.002) to have abnormal responses to both autonomic tests (13.0 vs 7.7%). A single abnormal autonomic response was not associated with an increased risk of severe hypoglycaemia. The odds ratio for severe hypoglycaemia in people with abnormal responses to both autonomic tests, compared to those with normal responses, was 1.7 (95% confidence interval 1.3, 2.2) after controlling for age, duration of diabetes, glycaemic control and study centre. In conclusion, a combined autonomic deficit in heart rate and blood pressure responses to standing is associated with only a modest increase in the risk of severe spontaneous hypoglycaemia. Although the increase in risk is not large, severe hypoglycaemia was a frequently reported event in this study. IDDM patients with deficient autonomic responses who strive for tight glycaemic control may therefore be at particular risk of severe hypoglycaemia.
在一项针对欧洲3000多名胰岛素依赖型糖尿病（IDDM）患者的流行病学研究（欧洲糖尿病IDDM并发症研究）中，对自主神经病变的糖尿病患者发生严重低血糖风险增加这一假说进行了检验。通过两项标准心血管测试评估自主神经功能：站立时心率和收缩压的变化。严重低血糖被定义为严重到需要他人帮助的发作。与报告去年无发作的患者（68%）相比，报告有一次或多次发作的患者年龄更大（平均±标准差：34.0±10.7岁对32.1±9.9岁，p<0.0001），患糖尿病时间更长（16.6±9.5年对13.8±9.1年，p<0.0001），血糖控制更好（糖化血红蛋白6.4±1.8%对6.9±1.9%，p<0.0001），并且对两项自主神经测试均出现异常反应的可能性更大（p = 0.002）（13.0%对7.7%）。单一的自主神经异常反应与严重低血糖风险增加无关。在控制了年龄、糖尿病病程、血糖控制和研究中心因素后，对两项自主神经测试均有异常反应的人发生严重低血糖的比值比为1.7（95%置信区间1.3, 2.2）。总之，站立时心率和血压反应的联合自主神经功能缺陷仅与严重自发性低血糖风险适度增加相关。虽然风险增加幅度不大，但严重低血糖在本研究中是一个经常报告的事件。因此，努力实现严格血糖控制的自主神经反应不足的IDDM患者可能特别有发生严重低血糖的风险。
