老年糖尿病患者低血糖首发症状分析及其危险因素探讨

目的探讨并分析老年糖尿病患者低血糖首发症状及其危险因素。方法选取2018年2月—2019年1月于该院内分泌科就诊的老年糖尿病患者200例,根据住院期间是否发生低血糖分为低血糖组(40例)和非低血糖组(160例),比较两组患者临床资料、生化指标及用药情况,对老年糖尿病患者发生低血糖进行单因素和多因素Logistic回归分析;将低血糖组作为研究对象,记录其发生低血糖时首发症状,进行分析。结果老年糖尿病患者低血糖首发症状,心慌25例(62.5%),出汗21例(52.5%),胸闷、饥饿感颤抖各占5.0%、5.0%、10.0%;昏睡或昏迷、反应迟钝、烦躁各占15.0%、5.0%、10.0%;身体虚弱和异常、未感不适患者各占比10.0%、2.5%;单因素分析发现年龄、BMI值、病程、胰岛素、磺脲类口服降糖药(oral antidiabetic drug,OAD)与胰岛素联用以及肌酐(creatinine,Cr)、果糖胺、尿素氮(blood urea nitrogen,BUN)等指标比较,差异有统计学意义(P<0.05);而性别、基础疾病、心血管药物、二甲双胍、α糖苷酶抑制剂、格列奈类、糖化血红蛋白(hemoglobin Alc,HbAlc)比较,差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示:年龄、BMI值、病程、胰岛素、磺脲类、OAD与胰岛素联用以及Cr、果糖胺是老年糖尿病患者发生低血糖的独立危险因素。结论糖尿病患者在主诉心慌、出汗时,应考虑低血糖的可能,及时监测其血糖变化,保障患者生命健康;年龄、BMI值、病程、胰岛素、磺脲类、OAD与胰岛素联用以及Cr、果糖胺是老年糖尿病患者发生低血糖的重要危险因素,临床应根据患者情况干预治疗以减少低血糖的发生。

Analysis of the First Symptom of Hypoglycemia and Its Risk Factors in Elderly Diabetic Patients

Objective To explore and analyze the first symptoms and risk factors of hypoglycemia in elderly diabetic patients.Methods A total of 200 elderly diabetic patients who were treated in the Endocrinology Department of the hospital from February 2018 to January 2019 were selected and divided into hypoglycemia group(40 cases)and non-hypoglycemia group(160 cases)according to whether hypoglycemia occurred during hospitalization.The clinical data,biochemical indicators and medications of the two groups of patients were compared,and single-factor and multi-factor logistic regression analysis of hypoglycemia in elderly diabetic patients was carried out;the hypoglycemia group was taken as the research object,and the first symptoms of hypoglycemia were recorded and analyzed.Results The first symptoms of hypoglycemia in elderly diabetic patients were palpitation in 25 cases(62.5%),sweating in 21 cases(52.5%),chest tightness,hunger and tremor accounted for 5.0%,5.0%,and 10.0%respectively;lethargy or coma,unresponsiveness,and irritability accounted for 15.0%,5.0%,and 10.0%;patients with weakness and abnormality and no discomfort accounted for 10.0%and 2.5%respectively;univariate analysis found age,BMI value,course of disease,insulin,sulfonylureas,oral antidiabetic drugs(OAD)combined with insulin and creatinine(Cr),fructosamine,and urea nitrogen(blood urea nitrogen,BUN)and other indicators,the difference was statistically significant(P<0.05);while gender,underlying diseases,cardiovascular drugs,metformin,alpha glycosidase inhibitor,glinide,hemoglobin Alc(hemoglobin Alc,HbAlc),the difference was not statistically significant(P>0.05);the results of multivariate logistic regression analysis showed:age,BMI value,course of disease,Insulin,sulfonylureas,OAD combined with insulin,Cr and fructosamine are independent risk factors for hypoglycemia in elderly diabetic patients.Conclusion When diabetic patients complain of palpitation and sweating,they should consider the possibility of hypoglycemia,and monitor their blood glucose changes in time to protect the life and health of patients;age,BMI value,disease course,insulin,sulfonylureas,OAD and insulin combined use,Cr,Fructosamine is an important risk factor for the occurrence of hypoglycemia in elderly diabetic patients.Clinical intervention and treatment should be based on the patient's condition to reduce the occurrence of hypoglycemia.