动态血糖监测在老年2型糖尿病中的临床意义

低血糖，尤其是无症状低血糖是糖尿病治疗中常见的难题，在老年2型糖尿病患者中占有一定比例。临床上常规测定3餐前、3餐后及睡前，瞬时的血糖值，这种传统点血糖的测定，并不能准确全面反应机体血糖的具体变化状态，特别是对于老年患者，其对低血糖的反应性和敏感性下降，绝大多数为无症状低血糖，易被忽视，危险性大。我们应用动态血糖监测系统对15例，临床认为控制良好的老年2型糖尿病患者进行连续动态血糖监测（CGMS），以了解其具体的血糖波动状况。     

老年糖尿病患者低血糖反应临床观察及护理

目的对老年糖尿病患者发生低血糖反应的临床观察及护理方法。方法选取2018年4月—2019年4月期间收治的老年糖尿病患者90例,发生低血糖反应20例,对患者的临床观察和护理措施进行分析。结果 20例老年糖尿病低血糖反应患者,血糖快速恢复14例,1～3 h后恢复病情稳定者5例,血糖恢复至4.7～9.4 mmol/L。1 d后恢复正常1例。结论对发生低血糖反应的老年患者,根据老年糖尿病患者的特点,做好临床观察及护理工作,预防低血糖发生,促进患者康复,提高老年人的生活质量。     

探讨地特胰岛素联合瑞格列奈治疗老年2型糖尿病的临床效果

目的对老年2型糖尿病患者接受地特胰岛素联合瑞格列奈治疗的效果进行研究分析。方法根据2014年2月—2015年2月该院收治的70例2型糖尿病老年患者进行分析研究,将其临床资料进行回顾性分析,并分成了对照组和观察组,对两组的血糖、餐后2 h血糖等指标进行对比。结果观察组的空腹血糖、餐后2 h血糖和糖化血红蛋白水平降低情况比对照组理想,结果差异有统计学意义(P0.05);观察组患者接受治疗的时候,有1例出现了低血糖反应,占总数的2.8%;对照组有4例低血糖反应,占总数的11.4%,观察组的低血糖反应比对照组多,差异有统计学意义(P0.05)。结论老年2型糖尿病患者接受地特胰岛素联合瑞格列奈治疗的效果比较理想,患者的低血糖发生率较低,风险性较低,每天用药一次,患者的依从性较好,体重控制较好,可以推广使用。     

瑞格列奈治疗老年2型糖尿病合并糖尿病肾病的临床研究

目的分析瑞格列奈用于治疗老年2型糖尿病合并糖尿病肾病的临床疗效。方法抽取50例老年2型糖尿病合并糖尿病肾病作为主要对象,其收治时间为2018年7月-2019年7月,根据随机数字表法将其分为两组,其中对照组25例患者采用门冬胰岛素30注射液治疗,观察组25例患者采用瑞格列奈治疗,比较两组患者血糖达标率、低血糖发生率,对比两组患者治疗前后糖化血红蛋白、空腹血糖、餐后2 h血糖。结果治疗后观察组患者血糖达标率明显高于对照组,差异有统计学意义(P<0.05)。住院期间观察组患者低血糖发生率明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者糖化血红蛋白、空腹血糖、餐后2 h血糖较治疗前均明显降低,差异有统计学意义(P<0.05),但组间数据比较差异无统计学意义(P>0.05)。结论瑞格列奈可有效控制老年2型糖尿病合并糖尿病肾病患者血糖,可明显降低低血糖发生率,临床效果较为理想。     

老年糖尿病肾病患者血液透析治疗中低血糖的护理要点研究

目的探讨老年糖尿病肾病低血糖血液透析患者的临床特点。方法通过对26例采取血液透析的老年糖尿病肾病患者进行密切观察病情变化,药物治疗护理,在指导患者饮食的同时定时监测其血糖含量,并结合心理护理等多种方法对患者进行护理。结果该组26例老年糖尿病肾病患者,1 266例次血液透析中发生低血糖反应24例次(1.90%),其中2例发生低血糖浅昏迷,均得到及时处理。结论低血糖是老年糖尿病肾病患者透析过程中易出现的并发症之一,该文总结了多种护理方法,多措并举,有效预防并及时处理异常现象,提高了患者的生活质量,效果显著。     

老年糖尿病患者低血糖反应的护理方法探讨

目的研究并探讨老年糖尿病患者出现低血糖反应的原因,并针对原因采取相应的护理措施。方法选取50例出现低血糖反应的老年糖尿病患者进行研究,选取自2012年1月—2015年1月。对这50例患者的临床资料和治疗情况进行分析,总结其出现低血糖反应的原因,并针对其原因采取相应的护理措施进行干预,观察这50例患者经针对性护理干预后的血糖情况。结果 50例出现低血糖反应的老年糖尿病患者中,因进食量过少而致低血糖的患者有23例,因使用降糖药、胰岛素而致低血糖的患者有13例,因空腹状态下运动而致低血糖的患者有12例,因擅自服用保健药物而致低血糖的患者有2例。50例低血糖患者经针对性护理干预后,其血糖值恢复正常水平,临床症状消失。结论老年糖尿病患者出现低血糖反应的原因主要与饮食、运动、用药等方面的不合理密切相关,在老年糖尿病患者的临床治疗过程中,应针对可能引发低血糖的原因采取有针对性的防治措施,以减少低血糖事件的发生。     

老年2型糖尿病低血糖昏迷62例临床分析与预防策略

糖尿病并发低血糖昏迷是患者在治疗过程中危重并发症之一,血糖浓度过低常为多种原因所致,若诊断、治疗不及时,可遗留不可逆的脑损害,严重者甚至危及生命。老年糖尿病患者由于其自身生理特点,常合并肝肾功能减退,更易发生低血糖反应或低血糖昏迷。现将我院自2002年1月至2008年12月收治的老年糖尿病低血糖昏迷患者62例的临床资料进行总结分析如下。     

甘精胰岛素联合瑞格列奈治疗老年2型糖尿病的临床观察

对42例老年2型糖尿病患者用重组甘精胰岛素加瑞格列奈治疗方案治疗,比较治疗前后血糖等变化。结果42例均完成8周治疗后,老年2型糖尿病患者的空腹血糖、餐后血糖、糖化血红蛋白均较治疗前明显下降（P〈0.05）,低血糖发生率低。结论重组甘精胰岛素联合瑞格列奈治疗老年2型糖尿病效果好,低血糖发生率低,依从性良好。     

血糖波动与老年人糖尿病血管并发症的研究进展

对于早期2型糖尿病患者,强化降糖治疗可以降低糖尿病微血管和大血管慢性并发症的发生风险。但老年糖尿病患者多伴有重要脏器功能减退、多种疾病共存、用药复杂、血糖波动幅度大及易发低血糖等特点,而过大的血糖波动和严重的低血糖被认为与糖尿病血管并发症密切相关。因此新的治疗理念认为,对于病程较长的老年2型糖尿病患者,在控制血糖的基础上,应减少血糖波动和严重低血糖的发生,从而减少糖尿病慢性并发症的发生发展。     

上海郊区老年2型糖尿病伴低血糖症60例临床特点

目的探讨上海郊区2型糖尿病患者低血糖的原因和特点,寻求预防和减少其发生的对策。方法对60例年龄60岁的老年2型糖尿病进行分析,与56例我科住院的无低血糖症患者比较,调查分析低血糖症的发生因素;出院前血糖稳定期间采用雷兰动态血糖监测系统,作72 h动态血糖监测。结果老年2型糖尿病低血糖症患者血甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、体重指数(BMI)、糖化血红蛋白(Hb A1c)明显低于对照组(P0.05),血肌酐及血糖标准差均明显高于对照组(P0.05);观察组合并高血压、糖尿病肾病、肾功能不全均较对照组有明显增多(P0.05)。结论老年患者容易发生低血糖症,低血糖症与合并肾病或肾功能不全、脑梗死、糖尿病眼病等多种慢性并发症、胰岛素抵抗弱、血糖波动大、文化程度低、认知能力差等因素相关。对于有严重低血糖病史、伴有大血管并发症者,Hb A1c目标控制应遵循个体化的原则,一般不低于7%,防止低血糖应加强糖尿病低血糖症的教育,尤其是老年人,应去除发病诱因,合理用药。对于昏迷的患者应常规检测血糖。     

Glucagon as a treatment of severe hypoglycemia: safe and efficacious but underutilized

Over the past 2 decades, a number of different studies have demonstrated that tight metabolic control not only reduces the incidence but also delays the development of complications in people with type 1 and type 2 diabetes. Unfortunately, the intensive insulin therapy required to achieve tight glucose control is also associated with a significantly increased risk of developing hypoglycemia. Hypoglycemia can cause physical as well as psychosocial morbidity, has been associated with adverse neurological manifestations, and can sometimes result in death. It can affect daily activities such as driving, working, and studying and can result in inconvenience and embarrassment as well as cause fear for both the person with diabetes and significant others. This fear is often the biggest barrier for optimal glycemic control. With self-management education and regular monitoring of blood glucose, people with diabetes can learn to recognize their unique signs and symptoms of hypoglycemia, and with improved understanding of how insulin, food, and activity affect blood glucose levels, the patient can learn to prevent hypoglycemia. However, because managing blood glucose can be such a delicate balancing act, it is important to be prepared. An important weapon in the treatment of severe hypoglycemia is the use of glucagon, a treatment that is generally underappreciated, underevaluated, undertaught, and most certainly underutilized. The purpose of this article is to review the role of glucagon in the treatment of severe hypoglycemia and discuss how better information about and understanding of the use of glucagon might be helpful toward alleviating some of the fears surrounding hypoglycemia.     

Diabetes care, glycemic control, and complications in children with type 1 diabetes from Asia and the Western Pacific Region

AIMS: The incidence of type 1 diabetes is increasing in many parts of Asia, where resources may not enable targets for glycemic control to be achieved. The aims of this study were to describe glycemic control, diabetes care, and complications in youth with type 1 diabetes from the Western Pacific Region and to identify factors associated with glycemic control and hypoglycemia. METHODS: A cross-sectional clinic-based study on 2312 children and adolescents (aged <18 years; 45% males) from 96 pediatric diabetes centers in Australia, China, Hong Kong, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, and Thailand was conducted. Clinical and management details were recorded, and finger-pricked blood samples were obtained for central glycated hemoglobin (HbA(1c)). RESULTS: The median age of the patients was 12.5 years [interquartile range (IQR)=9.4-15.3 years]; diabetes duration, 4.4 years (IQR=2.5-7.2 years); and HbA(1c) level, 8.3% (IQR 7.4%-9.7%). Insulin treatment consisted of one or two daily injections in 61% of the patients (range=22%-90% by country), and home blood glucose monitoring (range=67%-100%) was practiced by 96%. HbA(1c) level was significantly associated with country, age, diabetes duration, sex, insulin dose per kilogram, insulin regimen, and frequency of home blood glucose measurement in multiple regression analysis. The incidence of severe hypoglycemia, defined as any episode requiring assistance in the previous 3 months, was 73 per 100 patient-years and was associated with country, male sex, higher HbA(1c) level, an insulin regimen with three or more injections, and more frequent home blood glucose testing. The incidence of diabetic ketoacidosis was 10 per 100 patient-years and was associated with country, higher HbA(1c) level, and higher insulin dose per kilogram. CONCLUSIONS: There is marked variability in glycemic control, hypoglycemia, complication rates, and diabetes care among children from the Western Pacific Region. Most are not achieving adequate glycemic control, placing them at high risk of microvascular complications.     

A rare cause of hypoglycemia in a type 2 diabetic patient: insulinoma

Recurrent episodes of hypoglycemia in patients with diabetes are often associated with the ongoing treatment regimen. However, despite changes in treatment modalities, assessment of the causes of hypoglycemia in nondiabetic patients in the presence of severe and recurrent hypoglycemia is very important. The treatment that had been provided for 6 years in a 67-year-old female patient with type 2 diabetes mellitus was discontinued due to hypoglycemic episodes that presented for the previous 2 years. The patient experienced persistent hypoglycemia after cessation of the treatment and was hospitalized for further examination. Spontaneous hypoglycemia with a final diagnosis of insulinoma was established following histopathologic evaluation and was relieved postoperation. Insulinoma is rarely encountered as a cause of hypoglycemia in patients with type 2 diabetes. Insulin-secreting tumors should be considered where hypoglycemic episodes occur despite discontinuation of insulin and other antidiabetic treatment with endogenous hyperinsulinemia being noncompliant with the blood glycemic levels.     

Hypoglykämien und zentrales Nervensystem

Due to its high energy demand the human brain is extremely vulnerable to hypoglycemia and below a blood sugar threshold of 2.78 mmol/l (50 mg/dl) impairment of consciousness and seizures occur. After recurrent episodes of hypoglycemia, changes in the counter regulation of cerebral processed hypoglycemia appear which are responsible for the development of disturbances in the perception of hypoglycemia. The causal role of hypoglycemia episodes for a doubling of the dementia rate in type 1 and type 2 diabetes cannot clearly be determined. In type 1 diabetes hyperglycemia is more responsible for cognitive impairment than hypoglycemia. Long-term studies did not identify hypoglycemia-related cognitive deterioration until the midlife decade; however, it cannot be excluded that the dementia risk in old age is increased. In type 2 diabetes there exists a bidirectional relationship between hypoglycemia and dementia: severe recurrent episodes of hypoglycemia increase the risk of cognitive impairment and simultaneously, cognitive dysfunction increases the risk of hypoglycemia episodes.     

Hypoglycemia, diabetes, and cardiovascular disease

Cardiovascular disease (CVD) remains the leading cause of death in people with diabetes, and the risk of CVD for adults with diabetes is at least two to four times the risk in adults without diabetes. Complications of diabetes, including not only CVD but also microvascular diseases such as retinopathy and nephropathy, are a major health and financial burden. Diabetes is a disease of glucose intolerance, and so much of the research on complications has focused on the role of hyperglycemia. Clinical trials have clearly demonstrated the role of hyperglycemia in microvascular complications of diabetes, but there appears to be less evidence for as strong of a relationship between hyperglycemia and CVD in people with diabetes. Hypoglycemia has become a more pressing health concern as intensive glycemic control has become the standard of care in diabetes. Clinical trials of intensive glucose lowering in both type 1 and type 2 diabetes populations has resulted in significantly increased hypoglycemia, with no decrease in CVD during the trial period, although several studies have shown a reduction in CVD with extended follow-up. There is evidence that hypoglycemia may adversely affect cardiovascular risk in patients with diabetes, and this is one potential explanation for the lack of CVD prevention in trials of intensive glycemic control. Hypoglycemia causes a cascade of physiologic effects and may induce oxidative stress and cardiac arrhythmias, contribute to sudden cardiac death, and cause ischemic cerebral damage, presenting several potential mechanisms through which acute and chronic episodes of hypoglycemia may increase CVD risk. In this review, we examine the risk factors and prevalence of hypoglycemia in diabetes, review the evidence for an association of both acute and chronic hypoglycemia with CVD in adults with diabetes, and discuss potential mechanisms through which hypoglycemia may adversely affect cardiovascular risk.     

短期胰岛素泵强化治疗对新诊断2型糖尿病的临床观察

目的 观察短期应用胰岛素泵强化治疗对新诊断2型糖尿病患者血糖控制的有效性和安全性,及对B细胞功能的影响. 方法 新诊断2型糖尿病79例,随机分为2组,1组用胰岛素泵进行持续皮下胰岛素(诺和锐)输注(CSII组)(40例);另外1组用预混胰岛素(诺和锐30)多次皮下注射(39例)即多次皮下注射胰岛素(MSII组).比较治疗前后血糖、血胰岛素及C肽变化情况及血糖达标时间、胰岛素用量、低血糖事件. 结果 2组均能有效地控制血糖,但CSII组能更快使高血糖状态得以控制,C肽水平较MSII组明显改善(P＜0.05).CSII组较MSII组血糖达标时间更短,胰岛素用量更少,且低血糖事件的发生率显著减少. 结论 短期胰岛素泵强化治疗新诊断的2型糖尿痛患者,具有快速而安全地控制血糖、改善胰岛B细胞功能的优势,是新诊断的2型糖尿病患者一种安全有效的临床治疗方法.     

Hyperinsulinism May Be Underreported in Hypoglycemic Patients with Phosphomannomutase 2 Deficiency

Objective:Phosphomannomutase 2 deficiency (PMM2-CDG) is a disorder of protein N-glycosylation with a wide clinical spectrum. Hypoglycemia is rarely reported in PMM2-CDG. In this study, we evaluated cause, treatment options and outcomes in cases with hypoglycemia in the course of PMM2-CDG.Methods:Clinical records of patients followed with PMM2-CDG within the last two decades were reviewed. Medical data of patients with hypoglycemia were evaluated in more detail. Demographic and clinical findings, organ involvement and laboratory investigations at time of hypoglycemia were recorded. Time of first attack of hypoglycemia, cause, treatment modalities, duration of hypoglycemia (permanent/transient), and duration of treatment, as well as outcome were also recorded. Other published cases with PMM2-CDG and hypoglycemia are also reviewed in order to elucidate characteristics as well as pathophysiology of hypoglycemia.Results:Nine patients with PMM2-CDG were reviewed, and hypoglycemia was present in three cases. All three had hyperinsulinism as the cause of hypoglycemia. In the first two cases reported here, serum insulin level concurrent with hypoglycemic episodes was elevated, and glucose response was exaggerated during glucagon test, favoring hyperinsulinism. However, in the third case, the serum insulin level at time of hypoglycemia was not so high but hypoglycemia responded well to diazoxide. Hyperinsulinism was permanent in two of these three cases. No genotype-phenotype correlation was observed with respect to hyperinsulinism.Conclusion:The main cause of hypoglycemia in PMM2-CDG appears to be hyperinsulinism. Although insulin levels at the time of hypoglycemia may not be very high, hypoglycemia in patients with PMM2 responds well to diazoxide.     

Hypoglycemia in patients with type 2 diabetes mellitus.

BACKGROUND: Although hypoglycemia is the most common complication of intensive diabetes therapy, there is little information about risk factors for hypoglycemia in patients with type 2 diabetes mellitus. OBJECTIVE: To determine the prevalence and predisposing factors for hypoglycemia in patients with type 2 diabetes. METHODS: Retrospective, cross-sectional analysis set in an outpatient specialty diabetes clinic. We included those patients who had baseline and follow-up visits from April 1 through October 31, 1999. Hypoglycemia was defined as typical symptoms relieved by eating, and/or blood glucose level of less than 60 mg/dL (<3.3 mmol/L). Univariate and multivariate logistic regression were used to determine the contributions to hypoglycemia of age, sex, diabetes duration, body mass index (calculated as weight in kilograms divided by the square of height in meters), fasting plasma glucose level, glycosylated hemoglobin (HbA(1c)) level, type of therapy, and previous episodes at the follow-up visit. RESULTS: We studied 1055 patients. Prevalence of hypoglycemic symptoms was 12% (9/76) for patients treated with diet alone, 16% (56/346) for those using oral agents alone, and 30% (193/633) for those using any insulin (P<.001). Severe hypoglycemia occurred in only 5 patients (0.5%), all using insulin. Multiple logistic regression analysis demonstrated that insulin therapy, lower HbA(1c) level at follow-up, younger age, and report of hypoglycemia at the baseline visit were independently associated with increased prevalence of hypoglycemia. There were no significant predictors of severe hypoglycemia. CONCLUSIONS: Mild hypoglycemia is common in patients with type 2 diabetes undergoing aggressive diabetes management, but severe hypoglycemia is rare. Concerns about hypoglycemia should not deter efforts to achieve tight glycemic control in most patients with type 2 diabetes.     

老年糖尿病伴急性心肌梗死的特点及预后

目的：探讨糖尿病与非糖尿病急性心肌梗死（AMI）患住院期间病情,预后以及病死率的差异,方法：选择1994－1999年间住院糖尿病心肌梗死患18例（A组）,并与同期住院非糖尿病心肌梗死患92例（B组）作比较。结果：糖尿病AMI患心肌梗死症状严重,病死率高,病死率与心肌梗死前血糖水平有关,结论：糖尿病患急性心肌梗死发病率高,并发症多,病死率高,需积极控制血糖水平。     

胰岛素不同给药方法治疗糖尿病的临床效果观察

目的观察分析胰岛素不同给药方法治疗糖尿病的临床效果。方法随机择取2018年4月—2019年4月于该院收治的122例糖尿病患者作为研究对象,按照入院时间将122例患者分为对照组(n=61例)与观察组(n=61例),分别给予不同的胰岛素治疗方法。对照组行胰岛素常规注射治疗,观察组行胰岛素泵持续注射,比较两组糖尿病的临床有效率、血糖水平、血糖达标时间、胰岛素应用剂量、低血糖发生率。结果观察组61例糖尿病的临床有效率96.7%大于对照组的有效率67.2%,差异有统计学意义(χ^2=7.998,P<0.05)。观察组的低血糖率3.4%小于对照组的14.8%,差异有统计学意义(P<0.05)。观察组治疗后的空腹血糖水平、餐后2 h血糖水平、糖化血红蛋白水平、血糖达标时间、胰岛素应用剂量均小于对照组,差异有统计学意义(P<0.05)。结论应用胰岛素泵持续给药,可有效治疗糖尿病,可更好的控制糖尿病的血糖水平,可减少低血糖率,临床应用安全性更高。