基于真实世界数据的2型糖尿病患者胰岛素所致低血糖事件调查分析  

Investigation and Analysis of Hypoglycemia Caused by Insulin in Type 2 Diabetes Patients Based on Real World Data

作　　者：张娜娜 李美霞 李菲菲 ZHANG Nana;LI Meixia;LI Feifei(Department of Pharmacy,the Affiliated Hospital of Jiaozuo Health and Medicine School(The Sixth People’s Hospital of Jiaozuo),Jiaozuo City,He’nan Province 454150;不详)

机构地区：[1]焦作卫生医药学校附属医院(焦作市第六人民医院)药剂科,河南省焦作市454150 [2]焦作市第三人民医院血液净化中心

出　　处：《医学理论与实践》2024年第13期2168-2171,2180,共5页The Journal of Medical Theory and Practice

摘　　要：目的:基于真实世界数据,调查分析2型糖尿病(T2DM)患者胰岛素所致低血糖事件。方法:通过本市某城区12家社区卫生服务机构的签约患者健康管理系统,筛选2020年1月—2023年2月接受过胰岛素治疗的4985例T2DM患者,整理其基本信息、实验室检查数据、处方信息,并统计胰岛素治疗后出现的低血糖事件。比较不同临床特征、胰岛素治疗方案患者低血糖事件发生情况。结果:4985例T2DM患者中,共有1794例患者出现因胰岛素所致的低血糖事件,总发生率为35.99%,其中出现严重低血糖事件者有135例(2.71%);共发生低血糖次数为3016次,出现低血糖事件时无症状的情况为1545次,以三餐前发生的次数构成比(51.26%)最高,其次为睡前(36.07%);年龄≥60岁、体质量指数<24.0kg/m 2、病程≥5年、胰岛素治疗知识认知低水平、空腹血糖(FPG)≤6mmol/L、糖化血红蛋白(HbA1c)<6%、空腹C肽<4ng/mL、血肌酐(Scr)≥133μmol/L、尿素氮(BUN)≥7.1mmol/L患者的低血糖事件发生率均高于年龄<60岁、体质量指数≥24.0kg/m 2、病程<5年、胰岛素治疗知识认知中高水平、FPG>6mmol/L、HbA1c≥6%、空腹C肽≥4ng/mL、Scr<133μmol/L、BUN<7.1mmol/L患者(P<0.05);在不同胰岛素治疗方案中,以30/70混合重组人胰岛素注射液早晚餐前皮下注射(每次剂量6~10U)治疗患者的低血糖事件发生率(42.27%)最高,其次为生物合成人胰岛素注射液持续皮下泵入[初始剂量0.5U/(kg·d)]治疗、门冬胰岛素30早晚餐前皮下注射[起始剂量0.1~0.2U/(kg·d)]治疗患者(发生率分别为42.15%、40.83%),以甘精胰岛素睡前皮下注射[起始剂量0.15 U/(kg·d)]治疗患者发生率(27.85%)为最低。结论:T2DM患者胰岛素所致低血糖事件在三餐前发生最多,且其发生与患者年龄、体质量指数、病程、对胰岛素治疗知识认知水平、FPG、HbA1c、空腹C肽、Scr、BUN水平以及胰岛素治疗方案的不同有关。Objective:Investigation and analysis of hypoglycemic events caused by insulin in patients with type 2 diabetes(T2DM)based on real world data.Methods:Through the contracted patient health management system of 12 community health service institutions in a certain urban area of our city,4985 cases of T2DM patients who received insulin treatment from January 2020 to February 2023 were screened,and the basic information,laboratory examination data and prescription information were organized,and the hypoglycemic events that occur after insulin treatment were counted.The incidence of hypoglycemic events in patients with different clinical characteristics and insulin treatment regimens were compared.Results:Among 4985 T2DM patients,a total of 1794 had hypoglycemic events caused by insulin,and a total incidence rate was 35.99%,and there were 135 cases(2.71%)with severe hypoglycemic events.The total number of occurrences of hypoglycemia was 3016,and the number of asymptomatic occurrence of hypoglycemia events was 1545,and the proportion of occurrences before three meals(51.26%)was the highest,followed by bedtime(36.07%).The incidence rates of hypoglycemic events in the patients with age≥60 years old,body mass index<24.0kg/m 2,disease course≥5 years,low level of insulin treatment knowledge,fasting blood glucose(FPG)≤6mmol/L,glycosylated hemoglobin(HbA1c)<6%,fasting C-peptide<4ng/mL,blood creatinine(Scr)≥133μmol/L and urea nitrogen(BUN)≥7.1mmol/L were higher than that in patients with age<60 years old,body mass index≥24.0kg/m 2,disease course<5 years,moderate to high levels of insulin treatment knowledge cognition,FPG>6mmol/L,HbA1c≥6%,fasting C-peptide≥4ng/mL,Scr<133μmol/L and BUN<7.1 mmol/L(P<0.05).Among different insulin treatment regimens,the highest incidence rate of hypoglycemic events(42.27%)was observed in patients treated with subcutaneous injection of 30/70 mixed recombinant human insulin injection(6~10U per dose)before breakfast and dinner,followed by patients treated with continuous subcutaneous

关 键 词：真实世界数据 2型糖尿病 胰岛素 低血糖 

分 类 号：R587.1[医药卫生—内分泌]