药物性低血糖症39例临床分析

药物性低血糖症是接受降糖药物治疗的糖尿病患者最常见的并发症,只要能及时发现和处理,预后良好,如稍有疏忽,则可有致命性危险或遗留不同程度的脑损害。1991～1999年我院共诊治39例药物性低血糖患者。现将其临床资料分析如下。1　临床资料11　一般资料　本院急诊科、内科及其他科住院病人,发生降糖药物所致的低血糖症39例,男21例,女18例;年龄50～78岁,平均65.6岁。确诊为糖尿病38例,均为2型糖尿病,未能诊断为糖尿病1例,单独使用磺脲类药物所致20例,其中优降糖18例,消渴丸2例。磺脲类加双胍类药物所致9例,胰岛素所致10例。12　低血糖诊断[1]…     

引起糖尿病药物性低血糖症相关因素分析-附42例报告

目的探讨引起糖尿病药物性低血糖症相关因素及预防对策。方法回顾性分析2007年1月～2010年12月糖尿病药物治疗过程中低血糖症42例患者的临床资料。结果 42例患者均有不同程度交感神经兴奋症状、昏迷22例、9例患者出现偏瘫症状,4例躁动、阵发性抽搐等症状;单独使用磺脲类药物19例,磺脲类加双胍类药物所致11例,胰岛素10例,磺脲类加胰岛素2例;新近诊断2型糖尿病,未经饮食及运动治疗,即投用足量降糖药物8例;胰岛素的不当10例;肾功能减退6例;同时口服降糖中药8例;其他10例。治疗后死亡3例。结论糖尿病药物性低血糖症与多种因素所致,对预后有不良影响,应采取下列措施预防:遵循的原则,用药从小剂量开始,注意个体化;应做好宣教工作;老年患者或者有肝、肾功能不全的患者慎用长效磺脲类降糖药,考虑用α-糖苷酶抑制剂、噻唑烷二酮类药物;定期检测糖血,根据血糖调整降糖药。     

降糖药物治疗中50例低血糖患者原因分析及预防

目的：探讨糖尿病患者降糖药物治疗中发生低血糖原因及预防对策。方法：回顾性分析降糖药物治疗中发生低血糖50例患者的临床资料。结果：单独使用磺脲类药物治疗31例,磺脲类加双胍类1O例,双胍类加胰岛素2例,单独胰岛素治疗7例;临床上有肾上腺素能症状中枢神经系统的表现,少数无明显症状;出现低血糖症时血糖浓度0.7～2.8mmol/L;治疗后50例在8h内血糖浓度正常,7例多次发生低血糖,1例因并发肺炎、感染性休克等死亡。结论：糖尿病患者降糖药物治疗中低血糖发生率较高,原因复杂,通过严密观察、指导科学用药、适当运动、自我监测预防低血糖反应的发生。     

糖尿病低血糖症46例诊治体会

糖尿病 (ＤＭ)低血糖症是ＤＭ治疗中常见现象 ,多为降糖药物使用不当所致 ,如救治不及时 ,易造成永久性的脑损害 ,严重者可致患者死亡。现就我院 1992至 2 0 0 0年救治的ＤＭ低血糖症 46例总结如下。1　临床资料本组 46例ＤＭ低血糖患者 ,男 3 0例 ,女 16例 ,年龄 45～ 87岁 ,平均 (60± 15 )岁 ,年龄 >60岁者 3 4例。单独使用磺脲类降糖药者 2 3例 ,磺脲类加双胍类降糖药者 13例 ,使用胰岛素者 10例。追溯病史 6例为新诊断ＤＭ患者 ,未行饮食控制及运动治疗即投以足量优降糖。 14例发病前有纳差情况 ,16例合并ＤＭ肾病肾功能不全 ,8例见于…     

老年糖尿病低血糖昏迷32例临床分析

近年来 ,随着糖尿病发病率的增加 ,并发低血糖昏迷者也明显增多 ,特别是以老年患者占多数。我院急症科自 1993～ 1999年共收治老年糖尿病低血糖昏迷患者 32例 ,现报告如下。1　临床资料1.1　一般资料　 32例中 ,男 18例 ,女 14例 ;年龄 6 0～81岁。均为 2型糖尿病患者。 (1)口服磺脲类药物所致者 16例 ,其中服用优降糖 13例 ,剂量为 10～ 30ｍｇ ｄ ;达美康 3例 ,剂量为 16 0～ 2 4 0ｍｇ ｄ。 (2 )服用磺脲类加双胍类药物所致者 12例 ,包括优降糖加二甲双胍10例 ,优降糖剂量为 5～ 10ｍｇ ｄ ,二甲双胍剂量为 0 .75～ 1.5ｇ ｄ ;优降糖加降…     

西格列汀治疗老年2型糖尿病患者的临床观察

<正>老年2型糖尿病患者的治疗相对于年轻糖尿病患者有很多特点:①老年糖尿病患者的脏器功能减退,往往有很多的合并症及并发症,导致了口服降糖药的选择面缩小,如肾功能不全禁用二甲双胍,心功能不全禁用胰岛素增敏剂,部分患者出现了继发性磺脲类失效等;②胰岛素注射技术、饮食运动治疗的配合、血糖的监测等方面知识的掌握对老年患者而言均是难题,要求使用顺应性好、疗效确切的药物;③老年患者对低血糖反应性差,如果发生低血糖则危害更大,需要使用低血糖发生率低、安全性好的药物。近年来出现的二肽基肽酶-4(DPP-4)抑制剂为老年糖尿病患者提供了一种较为理想的选择。近来我们观察了磷酸西格列汀片治疗老年2型糖尿病疗效及安全性,报告如下。     

胰岛素加二甲双胍治疗磺脲类降糖药物失效的Ⅱ型糖尿病

目的探讨胰岛素加二甲双胍治疗磺脲类药物失效Ⅱ型糖尿病的疗效.方法将6 5例磺脲类药物失效Ⅱ型糖尿病患者随机分为观察组(35例)和对照组(30例),对照组改用胰岛素治疗,观察组在对照组治疗基础上加口服二甲双胍.结果观察组治疗后空腹血糖、餐后2小时血糖,HbAlc明显降低接近理想水平,胰岛素用量明显减少,体重增加少,能调节血脂异常,而无出现低血糖等反应.结论胰岛素二甲双胍治疗磺脲类降糖药物失效的Ⅱ型糖尿病有利于血糖控制和血脂的调节.     

老年糖尿病低血糖反应32例临床分析

现将我科2002年1月至2008年1月治疗老年糖尿病低血糖反应32例总结如下。1临床资料1．1一般资料：本组32例中，其中男性18例，女性14例，年龄60-82岁，平均70．7岁，均为2型糖尿病，病程2～18年，合并高血压病15例，合并肾病6例（其中肾功能不全3例），冠心病11例，肝硬化2例，既往脑梗死3例。单用磺脲类6例，磺脲类联合双胍类6例，使用胰岛素13例，     

老年 2 型糖尿病患者并发低血糖昏迷原因分析简

目的探讨老年2型糖尿病患者并发低血糖昏迷的发生原因,提出预防建议,减少或预防老年2型糖尿病患者并发低血糖昏迷的发生率。方法回顾性分析36例老年2型糖尿病患者并发低血糖昏迷患者的临床资料,观察本组患者低血糖昏迷发生原因及救治情况。结果36例患者中,因自行加大磺脲类降糖药物用量而至低血糖昏迷者19例,占52．78％;因进食减少而未调至降糖药物使用量而至低血糖昏迷患者6例,占16．67％;因促分泌药物与胰岛素联用而至低血糖昏迷患者3例,占8．33％;因肾功能衰退使降糖药物或胰岛素积蓄而至低血糖昏迷患者6例,占16．67％;因胰岛素使用剂量不当而至低血糖昏迷患者2例占5．56％。经积极治疗后全部患者均救治成功出院。结论老年2型糖尿病并发低血糖昏迷的原因与降糖药物使用剂量、饮食结构及肾功能损害等因素有关,临床可加大糖尿病知识宣传,做好预防措施,从而减少或降低糖尿病低血糖昏迷时间的发生率。     

老年糖尿病并发低血糖症临床分析

目的 探讨老年糖尿病并发低血糖症的临床特点、诱发因素及预防方法.方法 对72例老年糖尿病出现低血糖症患者的临床资料进行回顾性分析.结果 老年糖尿病低血糖症临床表现多样化,降糖药及胰岛素使用量不当、生理功能减退、运动及进食不规律、合并用药等是其诱发因素.72例患者经过及时治疗,64例患者低血糖症症状很快缓解,血糖正常;6例多次发生低血糖,2～3d后病情平稳、痊愈;2例患者低血糖控制后,于住院期间死亡,1例患者死于糖尿病肾病、肾功能衰竭,1例死于感染合并心力衰竭.结论 临床医师应掌握老年糖尿病及并发低血糖症的特点,警惕低血糖症的发生,加强监测血糖,防止低血糖症的发生.     

Lipids behavior and adverse effects for oral antidiabetic agents in patients with Type 2 diabetes treated with sulfonylureas alone based on systematic review

The secondary and adverse effects when biguanides, alpha-glycosidase inhibitor or thiazolidine derivative was used with sulphonylurea agent (SU) as compared with those with SU alone in Type 2 diabetes patients by using Systematic Review. Two-agent concurrent treatment groups, taken from studies in which subjects were assigned to a group given only a sulfonylurea agent and a group given a sulfonylurea agent with the other glycemic control agent (combination of a sulfonylurea agent and a biguanide agent (I), combination of a sulfonylurea agent and an alpha-glucosidase inhibitor (II), and combination of a sulfonylurea agent and thiazolidinedione (III)), were studied in a randomized controlled trial. The secondary efficacy outcome measures were total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, and change in body weight. The incidence of hypoglycemia, feeling of fullness, diarrhea, liver dysfunction, and edema was investigated as a safety outcome measure, and the clinical significance of concurrent treatment with a sulfonylurea agent in addition to the other glycemic control agent was investigated. With respect to (II), an antidiabetic effect was showed. As for (III), it had the disadvantage of increased body weight. Furthermore, increase of HDL-C levels, in particular, was observed. The improving effect of (III) on serum lipids may be clinically effective for considering the pathologic condition of diabetes, which is often complicated by hyperlipidemia.     

儿童糖尿病酮症酸中毒及双胍类药物治疗中乳酸酸中毒问题的研究

目的：探讨１型糖尿病儿童酮症酸中毒时乳酸酸中毒发生情况,乳酸酸中毒与双胍类药物副作用的关系,双胍类药物在治疗１型糖尿病病人时的乳酸水平。方法：测定１９９６年２月－１９９７年１０月期间我院住院的１型糖尿病病人入院时乳酸水平,及纠正酸中毒后,双胍药治疗前后乳酸水平。结果：３３例病人入院时发生酮症酸中毒的有２３例,乳酸酸中毒１例。     

西格列汀联合治疗单一口服药治疗效果不佳的2型糖尿病观察

目的：评价联合西格列汀治疗血糖控制不佳的2型糖尿病患者的有效性及安全性。方法：54例单一口服药治疗（二甲双胍16例,磺脲类38例）的2型糖尿病患者,糖化血红蛋白未达标（HbA1c〉6.5%）,联合西格列汀100 mg,po qd治疗24周,比较治疗前后血糖控制情况,不良反应及体质量增加情况。结果：治疗后HbA1c较治疗前降低了0.91%,FPG降低了1.3mmol·L-1,PPG降低了3.8 mmol·L-1,差异均有统计学意义（P〈0.01）。24周发生低血糖1人次,其他不良反应3例。体质指数与治疗前比差异无统计学意义（P〉0.05）。结论：西格列汀联合治疗可明显改善血糖控制,低血糖发生少,不良反应少。     

Severe hypoglycemia in an elderly patient treated with metformin

The following case of severe hypoglycemia was reported during a systematic evaluation of hospital admissions caused by adverse drug reactions (supported by BfArM). HISTORY AND FINDINGS ON ADMISSION: A 79-year-old diabetic woman was admitted to hospital in a stuporous and unresponsive state. The initial physical examination revealed no other abnormal findings. Serum blood glucose was found to be 2.0 mmol/l and HbA1c was 4.6%. The patient had been started on antidiabetic therapy with metformin 2 months earlier. Treatment with other drugs being taken at that time, an ACE inhibitor, an NSAID and nitrofurantoin, remained unchanged. DIAGNOSIS, TREATMENT AND FOLLOW-UP: Laboratory tests excluded lactic acidosis and renal insufficiency. Cerebral computed tomography findings were normal. The patient improved dramatically following administration of glucose. Other laboratory findings confirmed the diagnosis of hypoglycemia. Blood glucose concentrations ranged between 4.0 and 10.0 mmol/l in the subsequent days and the patient could be discharged in full health. CONCLUSIONS: Drug-induced hypoglycemia is possible even in diabetics not receiving insulin or oral antidiabetic agents increasing insulin secretion. The risk of drug-induced hypoglycemia should be particularly considered when drugs containing blood glucose-lowering components are combined. Metformin does not usually cause hypoglycemia when administered as monotherapy. We suspected that hypoglycemia in this patient was caused by additional blood glucose-lowering effects of the ACE inhibitor and the NSAID possibly combined with a suboptimal nutrition. The indications for metformin administration undergo critical scrutiny.     

Hypoglycemia in patients with type 2 diabetes from India and Malaysia treated with sitagliptin or a sulfonylurea during Ramadan: a randomized, pragmatic study

Abstract Objective: To compare the incidence of symptomatic hypoglycemia between sitagliptin and sulfonylurea in Muslim patients with type 2 diabetes who fasted during Ramadan. Methods: In a multicenter, pragmatic, randomized study, patients with type 2 diabetes were recruited from clinical centers in India (n?=?765) and Malaysia (n?=?105). Eligible patients (age?≥?18 yrs) expressed their intention to daytime fast during Ramadan, were treated with a stable dose of sulfonylurea with or without metformin for ≥3 months prior to screening visit, and had an HbA(1c)?≤?10%. Patients were randomized in a 1:1 ratio to either switch to sitagliptin 100?mg q.d. or remain on their pre-study sulfonylurea. Daily diary cards were completed to document information on hypoglycemic symptoms and complications. The primary endpoint was the overall incidence of symptomatic hypoglycemia during Ramadan. Results: Of the 870 patients randomized, 848 (n?=?421 for sitagliptin and 427 for sulfonylurea) returned ≥1 completed diary card and were included in the analysis. The proportion of patients who recorded ≥1 symptomatic hypoglycemic event during Ramadan was lower with sitagliptin (3.8%) compared to sulfonylurea (7.3%). The risk of symptomatic hypoglycemia was significantly lower with sitagliptin (risk ratio [95% CI]?=?0.52 [0.29, 0.94]; p?=?0.028). By country, the proportions of patients who recorded ≥1 symptomatic hypoglycemic event during Ramadan were 4.1% vs. 7.7% in India and 1.9% vs. 3.8% in Malaysia for sitagliptin and sulfonylurea, respectively. No patient discontinued treatment due to a hypoglycemic event. One patient on sitagliptin and seven on sulfonylurea had an event that required non-medical assistance. No events required medical assistance. Both treatments were generally well tolerated. Limitations: Symptomatic hypoglycemic events did not require a confirmatory blood glucose measurement, which may have overestimated hypoglycemic events. Measures of glycemic control and body weight were not assessed. Conclusion: Switching antihyperglycemic treatment to sitagliptin from a sulfonylurea reduced the risk of symptomatic hypoglycemia by approximately 50% for Muslim patients with type 2 diabetes who fasted during Ramadan. Clinical trial registration: Clinicaltrials.gov: NCT01340768.     

Effect of KAD-1229, a nonsulfonylurea hypoglycemic agent, on plasma glucose and insulin in streptozotocin-induced diabetic dogs

Hypoglycemic agents with a rapid onset and short duration of action should be useful for controlling postprandial hyperglycemia. Our aim was to establish a diabetes mellitus model in dogs, and then during an oral glucose tolerance test to compare the hypoglycemic effect and insulinotropic action of KAD-1229, a new hypoglycemic agent, with that of gliclazide, a conventional sulfonylurea. In this model, KAD-1229 reduced the increase in plasma glucose level without producing hypoglycemia. Gliclazide had a weaker effect on reduction of the glucose increase and caused hypoglycemia via a significantly raised insulin secretion in the late phase. A rapid insulinotropic action of KAD-1229 was clearly observed in the portal venous blood. The results suggest that in type 2 diabetes caused by, at least, insulin deficiency, KAD-1229 may improve impaired insulin secretion in the early phase and attenuate hyperglycemia without causing a sustained hypoglycemia.     

警惕喹诺酮类药物引起血糖异常的不良反应

目的了解国内喹诺酮类药物引起血糖异常的不良反应。方法采用回顾性调查方法,收集1960年～2006年4月国内公开报道喹诺酮类药物引起血糖异常的不良反应文献,并进行统计分析。结果引起血糖异常涉及7种喹诺酮类药物,共19例,致低血糖16例(其中因低血糖昏迷致死3例),致血糖升高3例。结论对于老年患者、肾功能不全的糖尿病患者使用喹诺酮类药物要特别慎重,必须使用该类药时应监测患者血糖变化情况,以确保用药安全。     

阿托伐他汀致不良反应24例文献分析

目的:了解阿托伐他汀致不良反应的情况,促进临床安全合理用药。方法:采用文献计量学方法,对国内公开报道的24例阿托伐他汀致不良反应病例进行总结性分析。结果:阿托伐他汀致单纯性横纹肌溶解症7例,横纹肌溶解并发肾功能衰竭1例,横纹肌溶解并发多器官功能衰竭1例,肌病3例;致肝功能异常6例;致血小板减少性紫癜2例;致过敏反应2例;致过敏性休克1例;致指关节疼痛1例。24例患者中,5例为行冠状动脉支架植入术患者,1例为低钾血症伴高血压和冠心病者,1例为冠状动脉综合征伴慢性肾功能不全者,其他均为冠心病、高胆固醇血症患者,超过60岁的16例(占66.67%),停药及相应治疗后22例(占91.67%)恢复正常,2例(占8.33%)死亡。结论:阿托伐他汀引发的肝功能异常、肌病等不良反应不容忽视。     

尿毒症患者肾移植的临床研究(附年龄≥55岁患者72例临床分析)

目的　探讨年龄≥ 55岁尿毒症患者肾移植的临床特点。方法　将年龄≥ 55岁的肾移植患者 72例 (称 A组 )和同期 <55岁的肾移植患者384例 (称 B组 )的临床资料进行对照分析。结果　 A组尿毒症患者冠心病、糖尿病及心衰发病率高于 B组 (P<0 .0 5) ;A组人 /肾 1、3年成活率分别为 90 .5% / 89.3%、81 .6% / 75.0 % ,B组分别为 93.9% / 91 .2 %、82 .1 % / 77.4% (P>0 .0 5) ;A组术后肺部感染、肝功能损害、心衰、心绞痛及糖尿病等发生率均高于 B组 (P<0 .0 5) ;心血管并发症和感染是引起死亡的主要原因。结论　年龄≥ 55岁以上尿毒症患者进行肾移植时 ,术前充分准备 ,术后合理使用免疫抑制剂、积极处理并发症 ,移植效果满意     

2001～2005年精神病专科医院口服降糖药利用分析

目的:分析精神病专科医院住院患者口服降糖药使用数据,为临床用药提供参考。方法:利用医院信息系统数据库,统计2001～2005年口服降糖药使用数据,分析药物利用情况。结果:根据DDDs排序以及消耗金额排序,二甲双胍为我院最常用的口服降糖药;格列喹酮金额排序稳居第一,金额与序号比值逐年上升;磺酰脲类为我院治疗糖尿病的一线药;整体上看,我院更倾向于使用低价位的磺酰脲类和双胍类药,但糖尿病患者60%血糖控制不理想。结论:我院现有口服降糖药已不能满足需求,应引进新型药物,同时结合精神病病人的特点采用综合治疗。