广东省1型糖尿病严重低血糖发病率及危险因素分析

目的调查1型糖尿病患者严重低血糖的发病率及其危险因素。方法自2010年8月6日至2012年3月31日在广东省16家医院收集1型糖尿病患者的人口学资料、病史等信息,中心化检测糖化血红蛋白(HbA1C)和固定餐后2 h C肽等;严重低血糖发病和复发的危险因素分别采用Poisson回归模型和logistic回归模型分析。结果共纳入611例1型糖尿病患者,严重低血糖发病率为70.6次/100人年,发病危险因素有男性(RR=1.69)、医保报销比例<50%(RR=1.38)、长病程(RR=1.23)、消瘦(RR=1.43)、未控制饮食(RR=2.05)、体育锻炼<150 min/周(RR=1.61)、合并神经病变(RR=2.00)、吸烟(RR=1.46)和低HbA1C(RR=1.47)。而超重和肥胖者发生严重低血糖的风险较低(RR=0.60)。81.1%的严重低血糖集中发生在16.2%有复发史的患者,复发的危险因素有男性(RR=2.03)、消瘦(RR=2.02)、未控制饮食(RR=3.11)、体育锻炼<150 min/周(RR=2.87)和低HbA1C(RR=1.73)。而超重和肥胖者的风险较低(RR=0.28)。结论广东省1型糖尿病患者严重低血糖发病率高,且易复发;与一些可纠正的危险因素相关。

The incidence and related risk factors of severe hypoglycemia in type 1 diabetic patients in Gaugndong Province

Objective To investigate the incidence and the related risk factors of severe hypoglycemia in patients with type 1 diabetes.Methods The demographic data,medical history,and hemoglobin A1C(HbA1C) and stimulated C peptide levels were collected the patients with established type 1 diabetes in 16 hospitals in Guangdong Province.The risk factors of onset and recurrence of severe hypoglycemia were analyzed with Poisson regression model and Backwards stepwise logistic regression analysis,respectively.Results A total of 611 patients were enrolled.The overall incidence of severe hypoglycemia was 70.6/100 patient-years.The significant predictors of severe hypoglycemia were male(RR=1.69),medical insurance claiming percentage below 50%(RR=1.38),long diabetes duration(RR=1.23),underweight(RR=1.43),uncontrolled diet(RR=2.05),exercise less than 150min/w(RR=1.61),neuropathy(RR=2.00),smoking(RR=1.46) as well as lower HbA1c(RR=1.47).Overweight or obesity was a protective factor(RR=0.60).Totally,81.1% of severe hypoglycemia episodes occurred in 16.2% of type 1 diabetic patients with recurrent events(no less than 2 episodes).The recurrence of severe hypoglycemia was significantly associated with male(RR=2.03),underweight(RR=2.02),uncontrolled diet(RR=3.11),exercise less than 150 min/w(RR=2.87) as well as lower HbA1C(RR=1.73).Overweight or obesity was also a protective factor(RR=0.28).Conclusion In summary,high incidence of severe hypoglycemia in type 1 diabetic patients is revealed in this study.Moreover,we confirm that severe hypoglycemia is recurrent in high-risk patients.Comprehensive management should be taken against some modifiable risk factors in these patients.