广东省1型糖尿病严重低血糖发病率及危险因素分析  

The incidence and related risk factors of severe hypoglycemia in type 1 diabetic patients in Gaugndong Province

作　　者：李津[1] 杨黛稚[1] 林少达[2] 梁干雄[3] 陈立曙[4] 郎江明[5] 张秀薇[6] 武革[7] 李绍清[8] 吴建能[9] 李路 方懿珊[11] 袁琳[12] 林健才[13] 陈定宇[14] 罗国春[15] 孙辽[16] 翁建平[1] 

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科,广州510630 [2]汕头大学医学院第一附属医院内分泌科,广东汕头515041 [3]广东省中山市人民医院内分泌科,518403 [4]汕头大学医学院第二附属医院内分泌科,广东汕头515041 [5]广东省佛山市中医院糖尿病科,528000 [6]广东省东莞市人民医院内分泌科,523059 [7]广东医学院附属医院,广东湛江524001 [8]广东省清远市人民医院内分泌科,511500 [9]粤北人民医院内分泌内科,广东韶关512026 [10]广东省深圳市人民医院内分泌科,518020 [11]广东省揭阳市人民医院内分泌内科,522000 [12]广东省珠海市人民医院,519000 [13]广东省江门市中心医院内分泌科,529030 [14]广东省广州市第一人民医院内分泌科,广州510180 [15]深圳大学第一附属医院内分泌科,广东深圳518060 [16]中山大学附属第五医院内分泌科,广东珠海519000

出　　处：《广东医学》2012年第18期2718-2721,共4页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2010B031500008);中山大学临床医学研究5010计划资助项目(编号:2007030)

摘　　要：目的调查1型糖尿病患者严重低血糖的发病率及其危险因素。方法自2010年8月6日至2012年3月31日在广东省16家医院收集1型糖尿病患者的人口学资料、病史等信息,中心化检测糖化血红蛋白(HbA1C)和固定餐后2 h C肽等;严重低血糖发病和复发的危险因素分别采用Poisson回归模型和logistic回归模型分析。结果共纳入611例1型糖尿病患者,严重低血糖发病率为70.6次/100人年,发病危险因素有男性(RR=1.69)、医保报销比例<50%(RR=1.38)、长病程(RR=1.23)、消瘦(RR=1.43)、未控制饮食(RR=2.05)、体育锻炼<150 min/周(RR=1.61)、合并神经病变(RR=2.00)、吸烟(RR=1.46)和低HbA1C(RR=1.47)。而超重和肥胖者发生严重低血糖的风险较低(RR=0.60)。81.1%的严重低血糖集中发生在16.2%有复发史的患者,复发的危险因素有男性(RR=2.03)、消瘦(RR=2.02)、未控制饮食(RR=3.11)、体育锻炼<150 min/周(RR=2.87)和低HbA1C(RR=1.73)。而超重和肥胖者的风险较低(RR=0.28)。结论广东省1型糖尿病患者严重低血糖发病率高,且易复发;与一些可纠正的危险因素相关。Objective To investigate the incidence and the related risk factors of severe hypoglycemia in patients with type 1 diabetes. Methods The demographic data, medical history, and hemoglobin A1C （HbA^c） and stimulated C peptide levels were collected the patients with established type 1 diabetes in 16 hospitals in Guangdong Province. The risk factors of onset and recurrence of severe hypoglycemia were analyzed with Poisson regression model and Backwards step- wise logistic regression analysis, respectively. Results A total of 611 patients were enrolled. The overall incidence of se- vere hypoglycemia was 70. 6/100 patient - years. The significant predictors of severe hypoglycemia were male （ RR = 1.69）, medical insurance claiming percentage below 50% （RR = 1.38）, long diabetes duration （RR = 1.23）, under- weight （RR = 1.43）, uncontrolled diet （RR =2. 05）, exercise less than 150min/w （RR = 1.61 ）, neuropathy （RR = 2.00）, smoking （RR = 1.46） as well as lower HbAlc （RR = 1.47）. Overweight or obesity was a protective factor （RR = O. 60）. Totally, 81.1% of severe hypoglycemia episodes occurred in 16. 2% of type 1 diabetic patients with recurrent e- vents （no less than 2 episodes）. The recurrence of severe hypoglycemia was significantly associated with male （RR = 2.03 ）, underweight （RR = 2. 02）, uncontrolled diet （RR = 3.11 ）, exercise less than 150 min/w （ RR = 2. 87 ） as well as lower HbA^c （RR = 1.73 ）. Overweight or obesity was also a protective factor （RR = 0. 28 ）. Conclusion In summary, high incidence of severe hypoglycemia in type 1 diabetic patients is revealed in this study. Moreover, we confirm that se- vere hypoglycemia is recurrent in high - risk patients. Comprehensive management should be taken against some modifia- ble risk factors in these patients.

关 键 词：糖尿病 1型 广东省 严重低血糖 

分 类 号：R-033[医药卫生]