床边血糖管理系统监测住院糖尿病患者低血糖发生特点

目的分析住院糖尿病患者低血糖发生特点及其危险因素。方法利用医用SureStepFlexx床边血糖管理系统回顾性分析2008年1月至2011年12月3634例住院不同糖尿病分型的患者共203802次血糖监测数据中的低血糖发生的特点，探讨其相关危险因素。两组或多组间率的比较采用列联表分析。结果研究期间在广东省人民医院内分泌科住院的糖尿病患者共3634例（男／女：1805／1829例）。平均年龄为（59±15）岁。血糖监测共203802次，监测密度最大为早餐前（33567／203802，16．5％），最小在凌晨（17701／203802，8．7％），午餐前（21271／203802，10．4％）亦较低。共发生低血糖事件2453次，发生密度为1．2％。凌晨（506／2453，20．6％）及午餐前（406／2453，16．5％）低血糖发生率最高。有近1／3患者（1127／3634，31．0％）住院期间发生过低血糖，其中单次低血糖占52．4％（590／1127），2～3次低血糖为32．8％（370／1127），4次以上者达14．8％（167／1127）。以逐步筛选法进行二项分类logistic回归分析发现，住院低血糖的主要危险因素是：1型糖尿病（OR：2．478，95％CI：1．067～5．754）、多次胰岛素治疗[胰岛素泵：2．254（1．283～3．959）、三或四段胰岛素：2．307（1．310～4．065）、预混胰岛素：2．119（1.179～3．808）、糖化血红蛋白（HbAlc）〈7．0％：2．008（1．560～2．583）]。结论住院期间糖尿病患者低血糖最多发生在凌晨，其次到午餐前，恰是血糖监测密度最少时段，关注凌晨及午餐前血糖监测有利于及时发现低血糖。对于1型糖尿病、胰岛素强化治疗及HbAlc〈7．0％患者在控制血糖达标同时要特别注意防止低血糖发生。

Characteristics and risk factors of hypoglycemia in hospitalized diabetic patients monitored withbedside blood glucose management system

Objective To investigate the characteristics and related risk factors of hypoglycemia in hospitalized diabetic patients. Methods Retrospectively analyze the characteristics and related risk factors of hypoglycemia in 3634 diabetic patients hospitalized from January 2008 to December 2011 according to the 203 802 blood glucose monitoring data. The blood glucose was monitored with SureStep Flexx bedside blood glucose management system. Comparison of rates among groups was carried out with contingency table analysis. Results Total of 3634 patients （male/female： 1805/1829） were enrolled in this study with a mean age of （59 ＋ 15 ） yrs. During the study period, the blood glucose were monitored for 203 802 times in these patients, and was monitored more frequently before breakfast （33 567/203 802, 16. 5%）, and monitored less in early morning and before lunch （17 701/203 802, 8.7% and 21 271/203 802,10.4% ）. Hypoglycemia episodes occurred for 2453 times in the patients and the occurrence of hypoglycemia was 1.2% （2453/203 802 ）, and occurred more frequently in early morning and before lunch （506/2453, 20. 6% and 406/2453, 16. 5% ）. About one third （ 1127/3634, 31.0% ） of the patients experienced hypoglycemia, of which with one episode of hypoglycemia occurred in 590 cases （ 52.4% ） , 2 - 3 episodes in 370 cases （32. 8% ） and more than four episodes in 167 patients （ 14. 8% ）. With the binary logistic regression analysis , type 1 diabetes mellitus （T1DiVI） （ OR： 2. 478, 95% CI： 1. 067 - 5. 754 ） , repeated insulin therapy（ insulin pump therapy： 2. 254 （ 1. 283 - 3. 959 ）, more than 3 times insulin therapy daily： 2. 307 （ 1.310 - 4. 065 ）, pre-mixed insulin therapy ： 2. 119 （ 1. 179 - 3. 808 ） ） and glycated hemoglobin A1 c（HbAlc） 〈 7.0% （2. 008 （ 1. 560 - 2. 583 ） ） were the main risk factors of hypoglycemia in hospitalized diabetics. Conclusion For hospitalized diabetics, hypoglycemia happens more frequently in early morning and before lunch, but the blood glucose is monitored less in these two periods of time. The blood glucose should be paid more attention to in patients with T1DM or repeated insulin therapy or a HbAlc 〉 7.0% to prevent hypoglycemia.