老年2型糖尿病患者低血糖特征的临床研究

Characteristics of hypoglycemia in aged patients with type 2 diabetes

目的探讨发生低血糖的老年T2DM患者临床特征及动态血糖谱特点。方法对2014年1月至2015年8月于我院老年内分泌科的146例70岁以上T2DM患者进行72h动态血糖监测（CGMS）,分析其动态血糖谱特征;对比分析无低血糖组和低血糖组的临床特征及血糖波动特点。结果 28例（17.1%）发生低血糖。4次（10.5%）低血糖有自主症状,严重低血糖均无自主症状。严重低血糖和夜间低血糖分别占总低血糖持续时间的45.3%和81.8%。低血糖和严重低血糖均最常发生在00：00~01：59。低血糖组FC-P水平低于无低血糖组[（0.50±0.23）vs（0.42±0.16）nmol/L,P〈0.05]。低血糖组血糖最高值、血糖水平的标准差、最大血糖波动幅度、平均血糖波动幅度高于无低血糖组。结论 70岁以上发生低血糖的T2DM患者常伴随较大的血糖波动,易发生无症状性低血糖、严重低血糖和夜间低血糖。

Objective To investigate the clinical features and characteristics of continuous glucose profiles in elderly patients with type 2 diabetes who suffered hypoglycemia.Methods Continuous glucose monitoring system（CGMS） was used to monitor the blood glucose of 146 patients with type 2diabetes who were over 70 years old and hospitalized in Department of Geriatrics of our hospital from January 2014 to August 2015.The characteristics of continuous glucose profiles were analyzed in the patients suffering hypoglycemia.The clinical features and characteristics of blood glucose fluctuations were compared between non-hypoglycemia group and hypoglycemia group.Results Twenty-eight patients（17.1%） suffered hypoglycemia.There were 4 hypoglycemia events with autonomous symptoms.Severe hypoglycemia events had no autonomous symptoms.The lasting time of severe hypoglycemia and nocturnal hypoglycemia were 45.3%and 81.8%respectively.Both hypoglycemia and severe hypoglycemia most frequently happened from 00：00 to 01：59.FC-P was significantly lower in hypoglycemia group than in non-hypoglycemia group[（0.50± 0.23） vs（0.42 ± 0.16） nmol/L,P〈0.05）].The maximum blood glucose[（13.58±3.23） vs（15.54±3.43） mmol/L,P〈0.05）],standard deviation of mean blood glucose[（1.90±0.74） vs（3.19±1.22） mmol/L,P〈0.05）],the largest amplitude of blood glucose excursions[（7.98±2.83） vs（13.53 ± 3.44） mmol/L,P〈0.05）]and mean amplitude of blood glucose excursions[（4.61 ± 1.65） vs（7.19 ± 2.69） mmol/L,P〈0.05）]were significantly higher in hypoglycemia group than in non-hypoglycemia group.Conclusion As for over 70 years old patients with type 2 diabetes,if hypoglycemia occurs,it is likely to be asymptomatic hypoglycemia,severe hypoglycemia and nocturnal hypoglycemia and there is relatively large fluctuation of blood glucose.