2型糖尿病病人住院期间发生低血糖事件影响因素的Meta分析

Influencing factors of hypoglycemia events in patients with type 2 diabetes during hospitalization:a Meta-analysis

目的:系统评价2型糖尿病病人住院期间发生低血糖事件的影响因素。方法:计算机检索中国知网(CNKI)、万方数据库(WanFang Database)、维普数据库(VIP)、PubMed、EMbase、the Cochrane Library、Web of Science等数据库中2型糖尿病病人住院期间发生低血糖事件影响因素的研究,检索时限为建库至2022年4月2日,由2名研究者独立筛选和质量评价,采用Stata 12.0软件进行统计分析。结果:共纳入22篇文献,Meta分析结果显示:年龄≥60岁[OR=1.51,95%CI(1.30,1.75),P<0.001]、性别(男性)[OR=1.55,95%CI(1.27,1.88),P<0.001]、病程(>5年)[OR=1.95,95%CI(1.09,3.47),P=0.024]、肾功能受损[OR=1.79,95%CI(1.21,2.65),P=0.004]、高血压[OR=1.12,95%CI(1.01,1.26),P=0.038]、使用磺胺类药物[OR=3.58,95%CI(1.85,6.95),P<0.001]、使用胰岛素[OR=2.31,95%CI(1.68,3.20),P<0.001]、糖尿病周围神经病变[OR=3.12,95%CI(2.08,4.67),P<0.001]、糖尿病视网膜病变[OR=2.76,95%CI(1.93,3.94),P<0.001]、糖尿病大血管病变[OR=3.39,95%CI(1.88,6.11),P<0.001]、住院天数[SMD=0.52,95%CI(0.30,0.74),P<0.001]、查尔森共病指数≥3分[OR=2.78,95%CI(1.89,4.09),P=0.030]等因素为住院期间2型糖尿病病人发生低血糖的影响因素,体质指数(BMI)<25 kg/m2、心血管疾病、基础胰岛素、血糖控制不良、血脂异常、果糖胺水平(<25 mmol/L)等因素对住院期间2型糖尿病病人发生低血糖影响差异无统计学意义。结论:现有证据表明,老年男性、肾功能受损、高血压、使用胰岛素、糖尿病周围神经病变、糖尿病视网膜病变、糖尿病大血管病变、查尔森共病指数≥3分是住院期间2型糖尿病病人发生低血糖事件的危险因素,这对构建住院期间低血糖预测模型选择有效预测因子具有重要意义。

Objective:To systematically evaluate the influencing factors of hypoglycemic events in patients with type 2 diabetes mellitus during hospitalization.Methods:Studies on the influencing factors of hypoglycemic events in patients with type 2 diabetes during hospitalization were retrieved from CNKI,WanFang Database,VIP,PubMed,EMbase,the Cochrane Library,Web of Science and other database.The retrieval period was from the establishment of the database to April 2,2022,and the quality was independently screened and evaluated by two researchers.Stata 12.0 was used for statistical analysis.Results:A total of 22 articles were included.The results of Meta-analysis showed that:Age≥60 years old[OR=1.51,95%CI(1.30,1.75),P<0.001],gender(male)[OR=1.55,95%CI(1.27,1.88),P<0.001],course of disease(>5 years)[OR=1.95,95%CI(1.09,3.47),P=0.024],impaired renal function[OR=1.79,95%CI(1.21,2.65),P=0.004],hypertension[OR=1.12,95%CI(1.01,1.26),P=0.038],use of sulfonylureas[OR=3.58,95%CI(1.85,6.95),P<0.001],use of insulin[OR=2.31,95%CI(1.68,3.20),P<0.001],diabetic peripheral neuropathy[OR=3.12,95%CI(2.08,4.67),P<0.001],diabetic retinopathy[OR=2.76,95%CI(1.93,3.94),P<0.001],diabetic macroangiopathia,[OR=3.39,95%CI(1.88,6.11),P<0.001],length of stay[SMD=0.52,95%CI(0.30,0.74),P<0.001],and Chilson index score≥3[OR=2.78,95%CI(1.89,4.09),P=0.030]were the factors influencing the occurrence of hypoglycemia in type 2 diabetes patients during hospitalization.Body mass index(BMI)<25 kg/m 2,cardiovascular disease,basal insulin,poor blood glucose control,dyslipidemia,fructosamine level(<25 mmol/L)had no effect on the occurrence of hypoglycemia in type 2 diabetes patients during hospitalization.Conclusion:Existing evidence shows that elderly men,impaired renal function,hypertension,insulin use,diabetic peripheral neuropathy,diabetic retinopathy,diabetic macroanglopathy,and Chilson index≥3 points are risk factors for hypoglycemia events in type 2 diabetes patients during hospitalization,which is of great significance for the construction of hypoglycemia prediction model and selection of effective predictors.