老年糖尿病患者低血糖诱发异常心电图分析

目的探讨老年糖尿病患者低血糖反应的心电图改变特征。方法分析75例老年糖尿病患者低血糖反应的心电图资料。结果75例老年糖尿病患者在发生低血糖反应过程中，心电图有异常改变者67例，占89％，其中以心律变化者最多，共54例，占81％；冠脉供血不足39例，占52％；急性心肌梗死6例，占8％。结论老年糖尿病低血糖反应时有心脏和心电图异常改变者，可导致严重后果，及时治疗可以恢复。     

老年糖尿病患者出现低血糖反应的急救及护理

目的探讨老年糖尿病患者出现低血糖反应的急救及护理措施。方法回顾分析在我院治疗48例老年糖尿病低血糖患者的临床资料,对急救和护理措施进行总结,观察最终效果。结果低血糖反应发生原因包括进食量过少19例,占39.6%;胰岛素注射剂量过大6例,占12.5%;运动量过大10例,占20.8%;口服降糖量不当11例,占22.9%;其他2例,占4.2%。干预后所有患者血糖均恢复至正常水平,低血糖症状消失,血糖浓度达到3.9mmol/L及以上。结论老年糖尿病患者出现低血糖反应与饮食、用药等因素密切相关,以低血糖发生原因为依据采取有针对性的防治措施,降低血糖事件的发生率。     

老年2型糖尿病患者夜间无症状低血糖时心电图变化特点的临床观察

目的观察老年T2DM患者发生夜间无症状低血糖时心电图的变化特点。方法选取老年T2DM患者236例,收集临床资料和生化指标,并予72h动态血糖监测(CGM)和72h动态心电图,比较发生低血糖者和未发生低血糖者的临床特征及心电图变化特点。结果 (1)68例(28.81%,68/236)患者发生夜间无症状低血糖(低血糖组),其中轻度低血糖44例(64.71%,44/68),严重低血糖24例(35.29%,24/68),未发生夜间无症状低血糖者168例(无低血糖组);(2)低血糖组病程和使用口服药联合胰岛素降糖方案患者所占比例均高于无低血糖组[(17.38±5.51)vs (14.62±5.00)年,35(51.47%)vs 62(36.90%),P0.05或P0.01],HbA1c低于无低血糖组[(7.00±1.04)%vs (8.75±1.56)%,P0.01];(3)低血糖组心率减速力(DC)、QT离散度(QTD)、T波峰末期值(Tp-e)及Tp-e/Q-T比值均低于无低血糖组[DC:(3.00±0.40)vs (4.86±0.46)ms;QTD:(34.59±5.28)vs (40.83±5.54)ms;Tp-e:(105.68±13.81)vs(120.87±14.72)ms;Tp-e/QT:(0.12±0.02)vs(0.23±0.05),t=29.169、7.942、7.306、24.140,P0.01]。结论老年糖尿病患者发生夜间无症状低血糖时,心电图DC、QTD、Tp-e及Tp-e/QT均降低,可能与低血糖诱发心律失常有密切关系。     

2型糖尿病患者院内低血糖状况分析

对某医院内分泌科2011年9月-2012年6月收治的260名住院2型糖尿病患者住院期间的末梢血糖监测数据进行收集和分析。结果:45.00%的2型糖尿病患者在住院期间发生低血糖共335次。有症状性低血糖占78.50%,无症状性低血糖17.91%,严重低血糖3.58%;血糖在3.9mmol/L～2.2mmol/L间93.13%,血糖低于2.2mmol/L者6.87%;空腹及餐前低血糖占49.55%,餐后低血糖33.13%,睡前及凌晨低血糖17.31%;48.72%患者发生低血糖1次,51.28%发生至少2次;男性患者更易发生无症状性低血糖及严重低血糖(P<0.05);使用胰岛素治疗者比口服药物治疗更易发生无症状性低血糖(P<0.05)。结论老年、男性、病程长、并发症多重及使用胰岛素的患者更易发生低血糖。     

重视老年人无症状性低血糖

低血糖反应在糖尿病药物治疗中时有发生,且以老年病人多见,临床上多无典型的心慌,冷汗、手抖等低血糖症状,如果未及时发现并做处理,极易造成心脑肾等脏器损害,以至引起严重后果。现就我科2007年2月-2013年8月以来住院病人中老年患者发生低血糖反应的资料进行分析,在发生低血糖反应28例老年患者中,有12例属于无症状性低血糖反应,平均年龄（71±2）岁。     

老年糖尿病患者低血糖的原因及护理

目的分析老年糖尿病患者发生低血糖的原因及护理对策。方法对55例老年糖尿病患者的低血糖反应的原因进行分析。结果老年糖尿病患者发生低血糖最常见的原因是胰岛素和口服降糖药物应用不当引起,本组25例,占45.45%,其次有饮食不当、运动不当及其他因素,分别占25.45%、16.36%、12.74%。结论对患者进行有针对性的健康知识教育,提高治疗的依从性和识别低血糖的能力,学会自我监测血糖,认识到合理用药、饮食等因素的重要性,减少了低血糖的发生率。     

75例老年糖尿病低血糖患者临床治疗

目的探讨对老年糖尿病低血糖患者的临床治疗。方法选取该院2012年1月—2013年10月诊治的老年糖尿病低血糖患者75例,对所有患者进行血糖监测及采取对应的治疗措施。结果经治疗后的75例老年糖尿病低血糖患者,有70例患者的急性低血糖症状获得良好的缓解,且血糖值正常,占93.33%;有2例患者出现严重昏迷,经过及时的救治后恢复神智,占2.67%;出现轻微呆滞的患者有3例,占4.00%。结论对老年糖尿病低血糖患者进行治疗时,应根据患者的实际病情情况采取对应的治疗措施,不仅可以提高患者的血糖恢复效率,还可以减少并发症的发生,及减少死亡率的发生。     

老年糖尿病低血糖的护理干预策略

目的为了探究老年糖尿病低血糖的护理干预策略。方法从该院2013年4月—2014年4月老年糖尿病低血糖患者中选取60例,对他们的临床反应进行分析,然后再采取护理干预措施。结果通过诊断60例老年病糖尿病低血糖患者中有23例患者是因为饮食制约不佳,占选取例数的38.3%、10例患者为运动量过大,占16.7%、19例患者为用药不当,占31.7%、8例患者为其他因素,占13.3%。然后对其采取护理干预措施取得了较好的效果。结论通过临床诊断老年糖尿病患者,发生低血糖症状主要是因为饮食制约不合理、运动量过大、用药不当、老年患者自身机能下降等几个理由,如果根据这几个理由有针对性地采取护理干预措施能够大大降低老年糖尿病低血糖的发生率。     

动态血糖监测观察老年糖尿病患者低血糖的发生率及其影响因素

目的评估老年糖尿病患者低血糖的发生率及影响因素,寻求最大程度降低老年患者低血糖事件发生的方法。方法采用雷兰动态血糖监测系统对2013年11月至2015年9月,于我科住院的血糖控制平稳的337例老年糖尿病患者进行72~80 h连续血糖监测。结果 78例(23.1%)患者发生低血糖,其中,无症状低血糖者49例(14.5%),夜间低血糖者38例(11.2%),22:00~03:00是低血糖的高发时间段。使用预混胰岛素的患者低血糖发生率最高(36.2%),口服非胰岛素促泌剂的患者无低血糖发生。日平均血糖与低血糖发生率呈负相关(r=-0.393),日平均血糖控制目标为9.4~11.8 mmol/L。结论老年糖尿病患者低血糖发生率高,治疗需个体化且降糖水平需温和,尽量避免选用胰岛素治疗,尤其是预混胰岛素,同时应加强夜间血糖监测。     

糖尿病与无症状低血糖

糖尿病患者在治疗过程中出现的低血糖可表现为无症状低血糖。其原因是糖尿病患者存在升血糖调节障碍及中枢神经介导的交感神经肾上腺对低血糖反应的缺陷。无症状低血糖的发生与先前多次发生低血糖(医源性低血糖)、睡眠、运动及自主神经病变有关。先前低血糖可致交感神经肾上腺反应阈值下调,进而导致无症状低血糖,称为低血糖性自主神经功能障碍。无症状低血糖的防治主要是避免发生先前低血糖(医源性低血糖)。     

Awareness of hypoglycemia and spectral analysis of heart rate variability in type 1 diabetes

AimsTo investigate the relationship of unawareness of hypoglycemia with spectral analysis of heart rate variability (HRV) and clinical variables in type 1 diabetes (T1D) individuals.MethodsParticipants with type 1 diabetes mellitus (type 1 diabetes) were prospectively assessed for hypoglycemia awareness using the Pedersen-Bjergaard method and were classified as normal hypoglycemia awareness, impaired hypoglycemia awareness and hypoglycemia unawareness. Indices of HRV in frequency domain were evaluated and Ewing tests were used for the diagnosis of cardiovascular autonomic neuropathy (CAN).ResultsNinety-eight participants with T1D (mean age 26 years, average diabetes duration 13 years, and mean HbA1c 8.4%) were included in this study. The prevalence of hypoglycemia unawareness was 28%. No significant difference was observed on the prevalence of CAN among groups of different hypoglycemia awareness (p = 0.740). On regression analyses, abnormal results of HRV in frequency domain were not associated with unawareness of hypoglycemia. On univariable regression analysis, age, diabetes duration and estimated creatinine clearance were associated with unawareness of hypoglycemia.ConclusionCAN as assessed by Ewing tests and spectral analysis of HRV is not associated with unawareness of hypoglycemia. There is association of age, diabetes duration and renal deficit with unawareness of hypoglycemia.     

Hypoglycemia-Associated Electroencephalogram and Electrocardiogram Changes Appear Simultaneously

Background

Tight glycemic control in type 1 diabetes mellitus (T1DM) may be accomplished only if severe hypoglycemia can be prevented. Biosensor alarms based on the body’s reactions to hypoglycemia have been suggested. In the present study, we analyzed three lead electrocardiogram (ECG) and single-channel electroencephalogram (EEG) in T1DM patients during hypoglycemia.

Methods

Electrocardiogram and EEG recordings during insulin-induced hypoglycemia in nine patients were used to assess the presence of ECG changes by heart rate, and estimates of QT interval (QTc) and time from top of T wave to end of T wave corrected for heartbeat interval and EEG changes by extraction of the power of the signal in the delta, theta, and alpha bands. These six features were assessed continuously to determine the time between changes and severe hypoglycemia.

Results

QT interval changes and EEG theta power changes were detected in six and eight out of nine subjects, respectively. Rate of false positive calculations was one out of nine subjects for QTc and none for EEG theta power. Detection time medians (i.e., time from significant changes to termination of experiments) was 13 and 8 min for the EEG theta power and QTc feature, respectively, with no significant difference (p = .25).

Conclusions

Severe hypoglycemia is preceded by changes in both ECG and EEG features in most cases. Electroencephalogram theta power may be superior with respect to timing, sensitivity, and specificity of severe hypoglycemia detection. A multiparameter algorithm that combines data from different biosensors might be considered.     

Hypoglycemia unawareness in type 1 diabetes patients using intermittent continuous glucose monitoring: Identification of risk factors and glycemic patterns

BackgroundHypoglycemia unawareness designates failure to detect eminent hypoglycemia. Clarke's questionnaire is one of the most used systems to evaluate this problem.AimsTo relate Clarke's questionnaire (QQ) results with continuous glucose monitoring data.MethodsApplication of the questionnaire in a sample of type 1 diabetes mellitus (T1DM) patients using intermittent continuous glucose monitoring (iCGM).Results111 T1DM patients were evaluated, 56.8% female, mean age 35.0 ± 12.4 years and mean disease duration 18.8 ± 10.5 years.According to CQ, 13.5% had unawareness, 76.6% awareness and 9.9% indeterminate awareness to hypoglycemia. Those with unawareness had longer disease duration (25.1 ± 10.4 vs 18.2 ± 10.3 for awareness and 14.9 ± 9.9 for indeterminate awareness, p = 0.047), more time below range (10.3 ± 4.9% vs 6.3 ± 5.1 and 6.3 ± 4.8; p = 0.009) and higher mean duration of hypoglycemia (131.7 ± 38.6 vs 116.6 ± 49.6 and 131.7 ± 38.6; p = 0.008). In multivariate analysis, mean duration of hypoglycemia was an independent predictor of CQ results. In a receiver operating curve (AUC 0.746; p = 0.004) a mean duration of hypoglycemia ≥106.5 min showed 84.6% sensitivity/64.4% specificity for unawareness.ConclusionsOur sample had a significative prevalence of hypoglycemia unawareness which increased with longer diabetes duration. iCGM data can be indicative of this problem, with a mean hypoglycemia duration ≥106.5 min being suggestive, albeit unspecific.     

Efficacy and safety of sensor augmented insulin pump therapy with low-glucose suspend feature in older adults: A retrospective study in Bogota,Colombia

Background and aimsThe literature has supported the efficacy and safety of insulin pump therapy in young adults diagnosed with type 1 diabetes (DM1). However, there is limited evidence in older adults with DM1 and DM2.MethodsA retrospective cohort study was conducted in patients ≥60 years-old with DM1 and DM2, who started Sensor Augmented Insulin Pump therapy with low-glucose suspend feature (SAP + LGS) at Hospital Universitario San Ignacio diabetes center in Bogotá, Colombia. Patients were evaluated between 2009 and 2019 and were treated with Paradigm VEO or Medtronic MiniMed 640 insulin pumps and continuous glucose monitoring system. Glycated hemoglobin (A1c), severe hypoglycemia and hypoglycemia unawareness were assessed at least every 3 months, and hospitalizations and ketoacidosis episodes incidence were assessed yearly.Results36 patients were analyzed, (67.36 ± 4.88 years-old) (body mass index 25.48 ± 4.61 kg/m2). The most common indications for starting SAP + LGS were hypoglycemia (58.3%), high glycemic variability (25.0%) and poor metabolic control (16.7%). 26 patients used VEO (72.2%) whereas 27.8% started 640 insulin pump. Data from 32 participants showed A1c decreased from 8.57 ± 1.73% to 7.42 ± 0.96 after a year of therapy (Mean difference ?1.15%, p < 0.05); 28.12% reached A1c levels <7% and 42.85% < 7.5%. There was a significant decrease in the proportion of patients with at least one severe hypoglycemia (56.7 vs 3.3%), one or more hospitalizations (20 vs 3.3%), and hypoglycemia unawareness after the first year of follow-up (p < 0.05).ConclusionsThese results suggest that SAP + LGS is safe and effective in people 60 years or older after one year of therapy. Future randomized clinical trials are needed in the elderly.     

Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil

Background

Hypoglycemia affects patient safety and glycemic control during insulin treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The Hypoglycemia Assessment Tool study in Brazil aimed to determine the proportion of patients experiencing hypoglycemic events and to characterize patient awareness and fear about hypoglycemia, among insulin-treated T1DM or T2DM patients.

Methods

This was a non-interventional, multicenter study, with a 6-month retrospective and a 4-week prospective evaluation of hypoglycemic events. Patients completed a questionnaire at baseline and at the end of the study, and also a patient diary. The answers ‘occasionally’ and ‘never’ to the question ‘Do you have symptoms when you have a low sugar level?’ denoted impaired hypoglycemia awareness. Fear was reported on a 10-point scale, from ‘not afraid at all’ to ‘absolutely terrified’.

Results

From 679 included patients, 321 with T1DM and 293 T2DM, median age of 33.0 and 62.0 years, 59% and 56% were female, and median diabetes duration was 15.0 and 15.0 years, respectively. Median time of insulin use was 14.0 and 6.0 years. During the prospective period, 91.7% T1DM and 61.8% T2DM patients had at least one hypoglycemic event. In the same period, 54.0% T1DM and 27.4% T2DM patients had nocturnal hypoglycemia, 20.6% T1DM and 10.6% T2DM patients had asymptomatic hypoglycemia, and severe events occurred in 20.0% and 10.3%, respectively. At baseline, 21.4% T1DM and 34.3% T2DM had hypoglycemia unawareness. The mean score of hypoglycemia fear was 5.9?±?3.1 in T1DM and 5.4?±?3.9 in T2DM. The most common attitude after hypoglycemic events were to increase calorie intake (60.3%) and blood glucose monitoring (58.0%) and to reduce or skip insulin doses (30.8%).

Conclusions

Referred episodes of hypoglycemia were high, in both T1DM and T2DM insulin users. Patient attitudes after hypoglycemia, such as reduction in insulin and increase in calorie intake, can affect diabetes management. These findings may support clinicians in tailoring diabetes education and insulin treatment for patients with diabetes, in order to improve their glycemic control while reducing the risk of hypoglycemic events.

     

Hypoglycemia awareness and burden among hospitalized patients at high risk for hypoglycemia

BackgroundHypoglycemia, a common complication of insulin therapy in patients with diabetes, is associated with increased hospital morbidity and mortality. Hypoglycemia may be underrecognized in hospitalized patients due to impaired counter regulation or reduced recognition. Beta blocker (BB) use may also affect hypoglycemia recognition.AimTo characterize hypoglycemia unawareness and patient perceived hypoglycemia burden in hospitalized patients.Materials and methodsOver a 2-month period, we prospectively identified non-critically ill cognitively intact hospitalized insulin-requiring patients who were undergoing bedside glucose monitoring. Participants were included if they reported any episode of hypoglycemia in the 30 days prior to admission and either had no BB use or were on stable BB for 90 days. Hypoglycemia unawareness was assessed using the Clarke score and burden of hypoglycemia was assessed with the (TRIM-HYPO) score.ResultsOf the 46 participants, 20 were not taking a BB and 26 were taking a BB. Predictors of hypoglycemia during admission included glucose coefficient of variation and hospital length of stay. Nine participants (20%) had hypoglycemia unawareness (Clarke score ≥4). Participants with a history of coronary artery disease were less likely to have impaired awareness. Burden of hypoglycemia was associated with more hypoglycemia and longer hospital length of stay. There were no differences in measures of hypoglycemia unawareness or burden according to BB use.ConclusionsBB use was not related to hypoglycemia unawareness, or burden in hospitalized high risk patients. Hypoglycemia burden may identify patients at higher risk of hypoglycemia during admission.     

Seasonal Variations of Severe Hypoglycemia in Patients With Type 1 Diabetes Mellitus,Type 2 Diabetes Mellitus,and Non-diabetes Mellitus: Clinical Analysis of 578 Hypoglycemia Cases

Blood glucose control in patients with diabetes mellitus (DM) is reportedly influenced by the seasons, with hemoglobin A1c (HbA1c) levels decreasing in the summer or warm season and increasing in the winter or cold season. In addition, several studies have shown that sepsis is also associated with the seasons. Although both blood glucose control and sepsis can strongly affect the occurrence of severe hypoglycemia, few studies have examined the seasonal variation of severe hypoglycemia. The aim of the present study is to examine the association between severe hypoglycemia and the seasons in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and non-diabetes mellitus (non-DM). We retrospectively reviewed all the patients with severe hypoglycemia at a national center in Japan between April 1, 2006 and March 31, 2012. A total of 57,132 consecutive cases that had visited the emergency room by ambulance were screened, and 578 eligible cases of severe hypoglycemia were enrolled in this study. The primary outcome was to assess the seasonality of severe hypoglycemia. In the T1DM group (n = 88), severe hypoglycemia occurred significantly more often in the summer than in the winter (35.2% in summer vs 18.2% in winter, P = 0.01), and the HbA1c levels were highest in the winter and lowest in the summer (9.1% [7.6%–10.1%] in winter vs 7.7% [7.1%–8.3%] in summer, P = 0.13). In the non-DM group (n = 173), severe hypoglycemia occurred significantly more often in the winter than in the summer (30.6% in winter vs 19.6% in summer, P = 0.01), and sepsis as a complication occurred significantly more often in winter than in summer (24.5% in winter vs 5.9% in summer, P = 0.02). In the T2DM group (n = 317), the occurrence of severe hypoglycemia and the HbA1c levels did not differ significantly among the seasons. The occurrence of severe hypoglycemia might be seasonal and might fluctuate with temperature changes. Patients should be treated more carefully during the season in which severe hypoglycemia is more common.     

Preserved sensitivity to beta2-adrenergic receptor agonists in patients with type 1 diabetes mellitus and hypoglycemia unawareness

BACKGROUND AND OBJECTIVE: Use of beta(2)-adrenergic receptor agonists has been advocated for the treatment of hypoglycemia unawareness in type 1 diabetes. In vitro, however, hypoglycemia unawareness has been associated with reduced beta(2)-adrenergic sensitivity. Therefore, in vivo sensitivity to beta(2)-adrenergic receptor agonist stimulation was compared between type 1 diabetic patients with and without hypoglycemia unawareness and nondiabetic controls. METHODS: Ten type 1 diabetic patients with hypoglycemia unawareness, 12 type 1 diabetic patients with intact hypoglycemic awareness, and 11 healthy controls were enrolled. beta(2)-Adrenergic sensitivity was determined by measuring the forearm vasodilator response to intraarterial infusion of salbutamol. Salbutamol was infused in six increasing doses ranging from 0.003 to 1.0 mug(1).min(-1).dl(-1). Forearm blood flow (FBF) was bilaterally measured by venous occlusion plethysmography. Diabetic patients received low-dose insulin before FBF measurements to ensure that experiments were carried out under normoglycemic conditions. RESULTS: At baseline, FBF was 1.9 +/- 0.3 ml(1).min(-1).dl(-1) in controls, 2.3 +/- 0.4 ml(1).min(-1).dl(-1) in patients with intact awareness, and 1.4 +/- 0.1 ml(1).min(-1).dl(-1) in patients with hypoglycemia unawareness (P = 0.048 vs. aware patients). In response to salbutamol, FBF increased 9.1-fold in controls, 8.0-fold in patients with intact awareness, and 10.7-fold in patients with hypoglycemia unawareness (P = NS). Heart rate increased in all groups due to systemic spillover of salbutamol but appeared blunted, considering a greater fall in mean arterial pressure in patients with hypoglycemia unawareness. CONCLUSIONS: Sensitivity to beta(2)-adrenergic receptor agonist stimulation is preserved in type 1 diabetic patients with hypoglycemia unawareness.