Continuous subcutaneous insulin infusion in diabetes mellitus type 1 and 2: lower HbA1c-values and a high level of patient satisfaction

OBJECTIVE: To determine the HbA1c-values and the degree of satisfaction of patients who had switched from multiple subcutaneous insulin injections to continuous subcutaneous insulin infusion (CSII). DESIGN: Retrospective. METHOD: Data were collected and evaluated from all patients with type 1 or 2 diabetes mellitus who started treatment with CSII in the period from 1 January 1999 to 31 December 2001 in the Rijnmond-Zuid Medical Centre, Zuider site, Rotterdam, the Netherlands. The data included the insulin dosage and HbA1c-percentages before and three months after the start of CSII, and the degree of satisfaction of the patients on a scale from 1 (poor) to 10 (good). RESULTS: Of the 57 patients who started CSII, two resumed multiple daily subcutaneous injections within a few months. Of the other 55 patients, 36 (including 15 men) had type-1 diabetes, with an average age of 36.1 years, and 19 (including 8 men) had type-2 diabetes, with an average age of 49.7 years. Poor regulation of the blood glucose levels was the main reason (n = 40; 73%) for switching to CSII. In the 36 patients with type-1 diabetes, there was no significant change in the total dose of insulin before and during CSII, while the mean HbA1c-level decreased from 8.2 (SD: 1.2) to 7.3% (SD: 1.0; p = 0.0005). In the 19 patients with type-2 diabetes, there was also no significant change in insulin dosage, while the HbA1c-level decreased from 8.1 (SD: 1.0) to 7.6% (SD: 1.1; p = 0.056). All 47 interviewed patients were satisfied with the treatment. The mean score was 8.3 in type-1 diabetes mellitus and 8.1 in type-2 diabetes mellitus. CONCLUSION: Following three months on CSII, the average HbA1c-percentages were lower than during the previous treatment with multiple subcutaneous insulin injections. The patients were satisfied with the convenience of the treatment.     

泵基础量转换为甘精胰岛素的剂量换算关系及血糖波动程度比较

目的 探讨胰岛素泵治疗使血糖相对平稳后转换为胰岛素多点皮下注射治疗,比较胰岛素泵治疗时的基础量和甘精胰岛索之间的剂量关系及转换前后整体血糖的波动情况.方法 将2006年3月至2008年4月收治的102例2型糖尿病患者应用胰岛素泵治疗使血糖平稳后,改为甘精胰岛素联合门冬胰岛素多点皮下注射治疗,在空腹血糖相对稳定的前提下,观察胰岛素泵基础用量及甘精胰岛素用量,同时比较转换前后全日血糖的波动情况.结果 胰岛素泵的基础量为(0.30±0.11)U/(kg·d),甘精胰岛素的用量为(0.28±0.09)U/(kg·d),两者比较差异无统计学意义;胰岛素泵治疗达标时的日平均血糖为(7.94±1.32)mmol/L,胰岛素多点皮下注射治疗达标时的日平均血糖为(7.49±1.34)mmol/L,两者的日平均血糖分别大于3倍的样本标准差.结论 甘精胰岛素可以起到类似于胰岛索泵基础量模式的作用.     

Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain

BACKGROUND: The use of continuous subcutaneous insulin infusion (CSII) for treating Type I diabetes mellitus (DM1) has been related to better metabolic control compared it to daily multiple insulin injections (DMI) and thus to a lowering of the related costs. However, this therapy is now being used to a lesser extent due, at least partially, to the higher initial cost of purchase. This study is aimed at estimating the clinical and economic consequences of using CSII as compared to DMI by means of a cost-utility analysis. METHODS: A mathematical simulation model was adapted using nationwide clinical and economic data to simulate the long-term clinical and economic consequences for a DM1 patient. The time horizon was the patient's lifetime, including only direct healthcare costs and updating both costs and benefits at an annual 3% rate. RESULTS: In the basecase, the patients treated using CSII gained 0.890 years (p < 0.05) and 0.852 QALYs (p < 0.05). CSII treatment gives rise to an incremental average cost of 25,523 Euro (p < 0.05) per patient treated, which gave us an incremental cost- utility ratio of 29,947 Euro-QALY [CI 95% (29,519; 30,375)]. CONCLUSIONS: The improvement in the glucose control among those patients treated using CSII was related to an overall lower cost in the handling of DM1 patients, which was found to have a favourable cost-utility ratio in comparison to conventional MDI treatment.     

A Cost-Effectiveness Analysis of Continuous Subcutaneous Insulin Injection versus Multiple Daily Injections in Type 1 Diabetes Patients: A Third-Party US Payer Perspective

Objective:  To estimate the long-term cost-effectiveness of using continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) of insulin in adult and child/young adult type 1 diabetes mellitus (T1DM) patients from a third-party payer perspective in the United States.
Method:  A previously validated health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI using published clinical and cost data. The primary input variable was change in HbA_1c, and was assumed to be an improvement of −0.9% to −1.2% for CSII compared with MDI for child/young adult and adults, respectively. A series of Markov constructs simulated the progression of diabetes-related complications.
Results:  CSII was associated with an improvement in quality-adjusted life-years (QALYs) gained of 1.061 versus MDI for adults and 0.799 versus MDI for children/young adults. ICERs were $16,992 and $27,195 per QALY gained for CSII versus MDI in adults and children/young adults, respectively. Improved glycemic control from CSII led to a lower incidence of diabetes complications, with the most significant reduction in proliferative diabetic retinopathy (PDR), end stage renal disease (ESRD), and peripheral vascular disease (PVD). The number needed to treat (NNT) for PDR was nine patients, suggesting that only nine patients need to be treated with CSII to avoid one case of PDR. The NNT for ESRD and PVD was 19 and 41, respectively.
Conclusions:  Setting the willingness to pay at $50,000/QALY, the analysis demonstrated that CSII is a cost-effective option for patients with T1DM in the United States.     

Short acting insulin analogues for treating diabetic patients with CSII (continuous subcutaneous insulin infusion)

The use of insulin pump treatment (CSII: continuous subcutaneous insulin infusion) became widely accepted in the last couple of years. A growing body of experiences accumulated in paediatric practice because CSII is preferable for treating young patients with type 1 diabetes. Nevertheless, CSII can be used, if indicated, for treating type 2 diabetic patients as well. Recently, fast acting insulin analogues are exclusively used for CSII. At moment, clinical observations with insulin lispro and insulin aspart are available but experiences with glulisine are still limited. Although some inconsistencies could be observed in the literature, it is widely accepted, that higher reduction in HbA(1c) values could be achieved by CSII as compared to intensive conservative insulin treatment; this could be more pronounced in cases with high initial HbA(1c) values. CSII with short acting insulin analogues could lead to a higher reduction of HbA(1c) values than CSII with human regular insulin. Moreover, the decrease of hypoglycaemic events could be expected in some cases.     

Effects of alpha-tocopherol supplementation and continuous subcutaneous insulin infusion on oxidative stress in Korean patients with type 2 diabetes

BACKGROUND: Most Koreans with type 2 diabetes are insulin deficient and insulin resistant. Continuous subcutaneous insulin infusion (CSII) provides a suitable amount of insulin to overcome insulin deficiency and achieve near-normal blood glucose concentrations. Our previous study showed, however, that CSII does not reduce oxidative stress even though it normalizes blood glucose concentrations. OBJECTIVE: The purpose of this study was to determine whether CSII plus alpha-tocopherol supplementation for 2 mo would alter oxidative stress in Korean patients with type 2 diabetes. DESIGN: Ninety-eight subjects received CSII plus either 200 mg alpha-tocopherol/d (n = 48) or a placebo (n = 50) for 2 mo. The general characteristics (age, duration of diabetes, body mass index, and blood glucose concentrations) of the 2 groups were not significantly different. RESULTS: Fasting and postprandial blood glucose concentrations of all subjects were normalized after CSII. Fasting plasma insulin concentrations did not differ significantly between the 2 groups after CSII. Lipid peroxide concentrations in plasma and red blood cells decreased and alpha-tocopherol concentrations in plasma and red blood cells increased after alpha-tocopherol supplementation. However, these changes were not affected significantly by CSII. Plasma vitamin C concentrations increased significantly after CSII plus alpha-tocopherol supplementation. However, the activities of antioxidant enzymes in red blood cells did not change significantly after CSII plus alpha-tocopherol supplementation. CONCLUSION: alpha-Tocopherol supplementation was beneficial in decreasing blood lipid peroxide concentrations without altering antioxidant enzyme activities in Korean patients with type 2 diabetes treated with CSII.     

New clinical data with metformin therapy in patients with diabetes mellitus

Metformin is widely used for treating patients with type 2 diabetes mellitus. Recently, new options of metformin therapy were highlighted by several clinical observations. Accordingly, the benefit of metformin for treating patients with type 1 diabetes was documented (as an add-on therapy to insulin, primarily in adult patients with the phenotype of type 2 diabetes). In addition, epidemiological studies unequivocally documented that metformin is associated with lower cancer morbidity and mortality rates in type 2 diabetic patients. Metformin was used in diabetic patients with systolic heart failure and the results proved to be promising in a clinical trial. The use of metformin in type 2 diabetic patients with insulin treatment can result in a decrease in insulin dose, an improvement in glycaemic control, a beneficial effect in weight changes and a decrease in risk of macrovascular complications. A late and prolonged beneficial effect of a former favourable metabolic milieu could be expected even in the subsequent years after terminating a randomized controlled trial with metformin. Although the new clinical observations should be considered encouraging, our clinical practice should strictly follow the current guidelines based on the label of metformin.     

Basal insulin therapy in type 2 diabetes

Patients with type 2 diabetes mellitus are usually treated initially with oral antidiabetic agents, but as the disease progresses, most patients eventually require insulin to maintain glucose control. Optimal insulin therapy should mimic the normal physiologic secretion of insulin and minimize the risk of hypoglycemia. This article discusses the role of insulin therapy in patients with type 2 diabetes, emphasizing long-acting insulin agents designed to approximate physiologic basal insulin secretion and provide control over fasting plasma glucose. Clinical trials of recently developed long-acting insulins are reviewed herein, with emphasis on studies that combined basal insulin with oral agents or with short-acting insulins in a basal-bolus approach. The normal physiologic pattern of insulin secretion by pancreatic beta cells consists of a sustained basal insulin level throughout the day, superimposed after meals by relatively large bursts of insulin that slowly decay over 2 to 3 hours (bolus insulin). Basal support with long-acting insulin is a key component of basal-bolus therapy for patients with diabetes who require insulin with or without the addition of oral agents. Newer long-acting agents such as insulin glargine provide a steadier and more reliable level of basal insulin coverage and may have significant advantages over traditional long-acting insulins as part of a basal-bolus treatment strategy.     

胰岛素泵持续皮下注射治疗妊娠期糖尿病对新生儿的影响

目的:探讨胰岛素泵持续皮下注射胰岛素(CSII)治疗妊娠期糖尿病对新生儿的影响及其临床意义。方法:选择妊娠期糖尿病患者60例,其中30例应用胰岛素泵持续皮下注射治疗(CSII组),30例应用胰岛素多次皮下注射治疗(MSII组),比较两组患者的一般情况,治疗前、治疗后孕妇血糖值,新生儿出生后血糖及体重,计算并比较两组患者体重指数、治疗前后血糖、新生儿低血糖、巨大儿及大于胎龄儿的发生率。结果:两组在年龄、入组孕周、血糖及体重指数等方面差异均无统计学意义(P>0.05),而经治疗后CSII组平均血糖值低,新生儿低血糖及大于胎龄儿(LGA)发生率低,且分娩孕周晚,两组比较差异有统计学意义(P<0.05)。结论:胰岛素泵持续皮下注射比每日多次皮下注射胰岛素治疗妊娠期糖尿病降糖效果好,可延长孕周,新生儿低血糖及大于胎龄儿的发生率低,对于安全、有效地治疗妊娠期糖尿病,改善新生儿预后具有深远的临床意义。     

Spotlight on Insulin Lispro in Diabetes Mellitus

Insulin lispro is a recombinant insulin analog with transposed amino acids (proline and lysine) at positions 28 and 29 near the C-terminus of the B-chain. The most prominent practical advantage of insulin lispro over human soluble insulin lies in its very rapid onset of action. This property allows it to be injected immediately before meals and minimizes the demands made on patients with type 1 diabetes mellitus, and those with type 2 disease who require insulin, by the ongoing need for careful meal planning and timing. Numerous clinical studies have shown significant improvements in postprandial glycemic control, with some evidence of reduced rates of severe or nocturnal hypoglycemia, relative to conventional human insulin in patients receiving lispro-based insulins.Quality-of-life studies show consistent preferences by patients for and increased treatment satisfaction with insulin lispro over human soluble insulin, particularly with variations of the Diabetes Treatment Satisfaction Questionnaire. Willingness of patients and taxpayers to pay additional costs for insulin lispro or a premixed lispro-based formulation over conventional human insulins, and cost benefits favoring formulary inclusion, have been shown in well designed studies carried out in Australia and Canada. Spanish data suggest cost effectiveness in terms of episodes of severe hypoglycemia avoided, and preliminary German resource utilization data indicate cost savings related to reduced hospitalization and general practice costs, with insulin lispro relative to human soluble insulin.

Conclusions

Insulin lispro and premixed formulations of lispro-based insulins offer quality-of-life improvements relative to conventional human insulins in patients with diabetes mellitus. Participants in well designed studies have expressed a preference for lispro-based insulins and have been shown to be willing to pay for the advantages they offer, and current cost-benefit data favor the inclusion of these insulins in formularies and their reimbursement by third party payers. Further research into the pharmacoeconomic implications of insulin lispro use in the long term is needed, particularly with respect to effects on indirect costs and those associated with complications of diabetes mellitus.

     

甘精胰岛素用于Ⅱ型糖尿病患者术后血糖控制的探讨

目的:探讨甘精胰岛素用于II型糖尿病患者手术后血糖控制的可行性。方法:选择51例接受外科手术后的II型糖尿病患者,分为甘精胰岛素治疗组(LAN组)16例,常规生物合成人胰岛素治疗组(MSII组)19例,胰岛素泵治疗组(CSII组)16例。LAN组患者术后使用甘精胰岛素,视空腹血糖变化情况调整其剂量,患者如进食则于餐前给予短效胰岛素。MSII组术后用静脉胰岛素输注,患者进食后可逐渐采用传统胰岛素强化治疗方案(R+R+R+NPH)。CSII组每天24 h持续泵入短效胰岛素,禁食期只给予基础量,进食后给予基础和餐时量。观察各组患者治疗前后血糖变化、胰岛素用量、低血糖发生率及术后并发症发生率,酮症发生率。结果:各组治疗后血糖均明显低于治疗前,LAN组治疗后血糖低于MSII组,与CSII组无明显差异;LAN组低血糖发生率低于MSII组,而与CSII比较无显著性差异。结论:II型糖尿病患者术后禁食或进食不规律阶段,使用常规胰岛素治疗,血糖波动较大且患者依从性差;甘精胰岛素在糖尿病患者手术后降糖效果显著,能迅速、平稳控制血糖且患者依从性好,是一种安全、有效且患者易接受的用于II型糖尿病患者术后治疗的药物。     

Management of Diabetes Mellitus

Abstract

Diabetes mellitus is a common metabolic disorder characterized by high blood glucose levels resulting from an insulin deficiency (type 1 diabetes mellitus) or a combination of insulin deficiency and insulin resistance (type 2 diabetes mellitus). The chronic hyperglycemia associated with diabetes mellitus can cause damage to the eyes, kidneys, heart and peripheral circulation, resulting in substantial morbidity, premature mortality and considerable healthcare costs.In both type 1 and type 2 diabetes mellitus, quality of glycemic control has been shown to be a major factor in the prevention of microvascular complications, and tight blood glucose control is the primary goal for all patients with diabetes mellitus.In patients with type 1 diabetes mellitus, multiple daily injections of exogenous insulin and frequent monitoring of blood glucose levels are required to achieve tight glycemic control. Patients with type 2 diabetes mellitus may achieve initial glycemic control with diet and lifestyle interventions alone; however, a large percentage of patients will require pharmacological therapy, first with an oral antidiabetic agent and, ultimately, with insulin.Premixed insulin formulations, consisting of fixed ratios of short- and intermediate-acting insulins, are a convenient and effective treatment option which account for ≈40% of insulin use worldwide. Until recently, the only premixed formulations available contained varying proportions of human regular insulin and human isophane insulin suspension (NPH). However, new premixed formulations containing insulin lispro (a rapid-acting insulin analog) and insulin lispro neutral protamine suspension (NPL) [an intermediate-acting insulin analog] are now available.Insulin lispro mix75/25 (Humalog® Mix75/25?) is a premixed formulation containing 25% insulin lispro and 75% NPL which has been investigated for use in patients with type 1 and with type 2 diabetes mellitus. Administered twice daily immediately before breakfast and dinner, insulin lispro mix75/25 provides better control of postprandial blood glucose, provides similar overall glycemic control, appears to be preferred by patients and may reduce nocturnal hypoglycemia compared with a similar premixed formulation containing 30% human regular insulin and 70% NPH (human insulin 70/30; Humulin® 70/30, Novolin® 70/30). Insulin lispro mix75/25 has a rapid onset of action, allowing for administration immediately before a meal, whereas patients need to administer human insulin 70/30 30 to 60 minutes prior to meals. Insulin lispro mix75/25 also improves glycemic control in patients whose type 2 diabetes mellitus is not well controlled by oral agents.

Conclusion

Insulin lispro mix75/25 is suitable for patients wishing to use premixed insulin formulations and may offer several benefits over human insulin 70/30.

     

短期胰岛素泵强化治疗难治性2型糖尿病的疗效分析

目的观察短期胰岛素泵强化治疗难治性2型糖尿病的治疗效果。方法选取难治性2型糖尿病患者50例,给予胰岛素泵强化治疗5d,其中20例联合持续动态血糖监测系统（CGMS）。观察患者治疗前后胰岛素总量,空腹及3餐后2h血糖,比较患者用泵起始、结束时平均血糖（MBG）,血糖的曲线下面积（AUC）。结果胰岛素泵强化治疗可在相对短的时间内控制好空腹血糖、餐后血糖（P〈0.01）,且胰岛素的使用总量与治疗前比较无明显差异（P〉0.05）,联合CGMS治疗的患者用泵起始、结束时MBG,血糖的AUC均存在显著性差异（P〈0.01）。结论短期胰岛素泵强化治疗难治性糖尿病效果好,胰岛素总量未增加。联合CGMS能监测血糖连续的变化曲线,可及时发现高血糖和低血糖,血糖波动小。     

Treatment of patients with diabetes mellitus by means of inhaled insulin

Good glycaemic control of diabetes mellitus is still hampered by the fear of insulin injections. Particularly in patients with type 2 diabetes, inhaled insulin as a novel therapeutic option for glycaemic control could be an alternative to subcutaneous insulin. Phase III clinical studies have shown glycaemic equivalence between inhaled insulin and conventional subcutaneous insulin. However, no study comparing inhaled insulin with short-acting insulin analogues has yet been published. Thus, methodological problems preclude conclusive remarks concerning quality-of-life issues. Inhaled insulin should be reserved for selected patient groups only. Lengthier studies to evaluate the long-term (pulmonary) safety of inhaled insulin and a cost-effectiveness study are needed.     

The first case of single pancreas transplantation in Hungary

Simultaneous pancreas kidney (SPK) transplantation is the only routinely used therapeutic option which can provide insulin independence, euglycemia and good renal replacement for type I diabetes mellitus patients with end stage renal disease. Several patients have some complications of diabetes without renal failure. For these patients pancreas transplantation alone is a therapeutic option. The first pancreas transplantation alone was performed 6 years after the launch of our pancreas transplant program. The patient was a 40-years-old man. Enteric drainage was used with portal venous drainage. Anti IL-2. R antibody, daclizumab was given as prolonged induction therapy. In spite of the technical and immunological difficulties there were neither technical failures nor acute rejection. 3 years after the transplantation the patient has a good quality of life without insulin therapy with excellent renal function. Conclusion: PTA transplant is a routinely used therapeutic option with good survival rate and good quality of life for type I diabetes mellitus patients without end stage renal disease.     

肝源性糖尿病患者胰岛素强化治疗后低血糖发生率的临床分析

[目的]观测肝源性糖尿病患者胰岛素强化治疗后低血糖的发生频率,并分析其临床意义。[方法]选取本院近1年来收治的肝源性糖尿病患者94例为实验组,单纯2型糖尿病患者100例为对照组。每组均采用胰岛素泵(CSII)持续皮下输注短效胰岛素,动态血糖监测系统(CGMS)连续监测血糖72h,检测低血糖的发生率。[结果]治疗前两组间空腹血糖值比较及治疗后两组间空腹血糖值比较,差异均无统计学意义(P﹥0.05)。胰岛素强化治疗后,两组血糖均达到目标血糖值,但实验组的低血糖发生率为10.24,对照组的低血糖发生率为1.56,两组低血糖发生率比较,差异有统计学意义(P﹤0.01)。与对照组相比,实验组的血糖波动值差异也有明显统计学意义(P﹤0.01)。[结论]肝源性糖尿病患者胰岛素强化治疗后低血糖发生率明显增高,血糖波动幅度更大。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的 了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33．3％、服药依从性差者占66．67％。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33.3%、服药依从性差者占66.67%。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

Initiating insulin therapy in patients with diabetes mellitus type 2: in a transmural setting is at least as effective as in an outpatient setting; a retrospective study with a 4-year follow-up

OBJECTIVE: Assessing whether the initiation of insulin therapy in patients with diabetes mellitus type 2 can be delivered as effectively in a structured transmural care model as in the more usual outpatients structure. DESIGN: Retrospective comparative cohort study. METHOD: In 1997 data were collected from 52 patients with diabetes mellitus type 2 all of whom were above 40 years of age and transferred to insulin therapy in 1993: 25 in a transmural care setting and 27 in an outpatients setting, both in Amsterdam, the Netherlands. Both groups were treated according to one protocol concerning the initiation and monitoring of insulin therapy, treatment goals and follow-up. Outcome measures were: percentage of glycated haemoglobin (HbA1c), health status, self-care behaviour and patient satisfaction. In 1993 the mean age was (transmural/outpatients setting): 67.5/65.3 years; percentage of men: 32%/48%; mean duration of diabetes: 7.3/10.6 years; HbA1c: 9.1%/9.3%; mean body mass index: 27.4/29.1 kg/m2. RESULTS: In the period 1993-1997 the mean HbA1c decreased from 9.1% to 7.2% in the transmural care group and from 9.3% to 7.6% in the outpatients care group (both: p = 0.000). The percentage of patients with poor glycaemic control (HbA1c > 8%) decreased from 60 to 8 in the transmural care group and from 59 to 15 in the outpatients care group. The percentage of patients with good glycaemic control (HbA1c < 7%) increased from 4 to 52 in the transmural care group and from 11 to 30 in the outpatients care group. No statistically significant differences were found between the patient groups with respect to health status, self-care behaviour and patient satisfaction. CONCLUSION: The transfer of patients with diabetes mellitus type 2 insulin therapy in a shared care setting was at least as effective as in an outpatients setting.     

关于2型糖尿病并发末梢神经病变危险因素的病例对照研究

糖尿病末梢神经病变(Diabetic Peripheral Neuropathy,DPN)是糖尿病常见并发症之一,不仅本身严重危害健康,有很高的病死率,而且与其他慢性并发症的发生发展关系密切。目的探讨2型糖尿病病人并发DPN的危险因素。方法采用以医院为基础的1:1配对病例对照研究方法。运用条件Logistic回归分析,建立主效应方程分析讨论DPN的危险因素。结果单因素Logistic回归分析表明,DPN发生的保护性因素包括:文化程度高、治疗方法力度大、现患冠心病、饮茶;危险因素包括:糖尿病病程长、血糖控制(HbAlc%)不良、使用胰岛素、合并糖尿病肾病、合并糖尿病视网膜病变、主诉眩晕症状、皮肤干燥、现患高血压、既往酮症、患糖尿病前肉类食物的摄入较多、既往吸烟(调查时已戒烟)、创伤经历、腰臀比WHR超标、血胆固醇(Chol)水平高。多因素Logistic回归分析示DPN发生的危险因素有6个:糖尿病病程、使用胰岛素、主诉眩晕症状、糖尿病前肉类食物摄入较多、饮酒以及既往创伤经历(手术、冻伤等)。结论DPN与多种因素相关,在2型糖尿病患者中,糖尿病病程长、使用胰岛素、主诉眩晕症状、糖尿病前肉类食物摄入较多、饮酒、既往创伤史会增加糖尿病神经病变的发生危险,我们应在DPN的防治过程中特别予以注意。