Kovatchev B P, Cox D J, Gonder-Frederick L A, Young-Hyman D, Schlundt D, Clarke W
University of Virginia Health Sciences Center, Charlottesville, 22908, USA.
Diabetes Care. 1998 Nov;21(11):1870-5. doi: 10.2337/diacare.21.11.1870.
To evaluate the clinical/research utility of the low blood glucose index (LBGI), a measure of the risk of severe hypoglycemia (SH), based on self-monitoring of blood glucose (SMBG).
There were 96 adults with IDDM (mean age 35+/-8 years, duration of diabetes 16+/-10 years, HbA1 8.6+/-1.8%), 43 of whom had a recent history of SH (53 did not), who used memory meters for 135+/-53 SMBG readings over a month, and then for the next 6 months recorded occurrence of SH. The SMBG data were mathematically transformed, and an LBGI was computed for each patient.
The two patient groups did not differ with respect to HbA1, insulin units per day, average blood glucose (BG) and BG variability. Patients with history of SH demonstrated a higher LBGI (P < 0.0005) and a trend to be older with longer diabetes duration. Analysis of odds for future SH classified patients into low- (LBGI <2.5), moderate- (LBGI 2.5-5), and high- (LBGI >5) risk groups. Over the following 6 months low-, moderate-, and high-risk patients reported 0.4, 2.3, and 5.2 SH episodes, respectively (P = 0.001). The frequency of future SH was predicted by the LBGI and history of SH (R2 = 40%), while HbA1, age, duration of diabetes, and BG variability were not significant predictors.
LBGI provides an accurate assessment of risk of SH. In the traditional relationship history of SH-to-future SH, LBGI may be the missing link that reflects present risk. Because it is based on SMBG records automatically stored by many reflectance meters, the LBGI is an effective and clinically useful on-line indicator for SH risk.
基于自我血糖监测（SMBG）评估低血糖指数（LBGI）作为严重低血糖（SH）风险衡量指标的临床/研究效用。
96例成年胰岛素依赖型糖尿病患者（平均年龄35±8岁，糖尿病病程16±10年，糖化血红蛋白8.6±1.8%），其中43例近期有严重低血糖史（53例无），他们使用记忆型血糖仪进行了为期一个月的135±53次自我血糖监测读数，随后在接下来的6个月记录严重低血糖的发生情况。对自我血糖监测数据进行数学转换，为每位患者计算低血糖指数。
两组患者在糖化血红蛋白、每日胰岛素用量、平均血糖（BG）及血糖变异性方面无差异。有严重低血糖史的患者低血糖指数更高（P<0.0005），且有年龄更大、糖尿病病程更长的趋势。对未来严重低血糖发生几率的分析将患者分为低风险（LBGI<2.5）、中度风险（LBGI 2.5 - 5）和高风险（LBGI>5）组。在接下来的6个月中，低风险、中度风险和高风险患者分别报告了0.4、2.3和5.2次严重低血糖事件（P = 0.001）。未来严重低血糖的发生频率可由低血糖指数和严重低血糖史预测（R2 = 40%），而糖化血红蛋白、年龄、糖尿病病程及血糖变异性并非显著预测因素。
低血糖指数能准确评估严重低血糖风险。在严重低血糖史与未来严重低血糖的传统关系中，低血糖指数可能是反映当前风险的缺失环节。由于它基于许多反射式血糖仪自动存储的自我血糖监测记录，低血糖指数是一种有效且临床实用的严重低血糖风险在线指标。
