社区老年2型糖尿病患者在家庭医生式服务过程中出现低血糖的危险因素分析

Risk Factor Analysis of Hypoglycemia in Elderly Patients With Type 2 Diabetes Mellitus During the Family Doctor Service

目的探讨社区老年2型糖尿病患者在家庭医生式服务过程中引发低血糖的可能危险因素。方法选取396例在我院家庭医生式服务中签约的老年2型糖尿病患者,根据是否发生低血糖反应,将患者分为非低血糖组(277例)和低血糖组(119例)。比较两组患者的临床数据及用药情况,采用多因素Logistic回归法对发生低血糖的可能危险因素进行分析。结果数据显示,低血糖组体重指数(BMI)、糖化血红蛋白、血红蛋白及血钾等指标均明显低于非低血糖组;而年龄、糖尿病病程、血肌酐表达水平、尿微量清蛋白定量、白细胞总数及中性粒细胞比例等指标均显著高于非低血糖组,差异均有统计学意义(P<0.05)。低血糖组心脑血管疾病药物联用率、胰岛素促泌剂应用率、胰岛素应用率以及口服降糖药与胰岛素联用率均显著高于非低血糖组,而二甲双胍应用率显著低于非低血糖组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、病程、体重指数、血肌酐表达水平、尿微量清蛋白定量、糖化血红蛋白、血白细胞数升高、胰岛素促泌剂、胰岛素及口服降糖药与胰岛素联用等均为低血糖发生的危险因素(P<0.05)。结论年龄、病程、BMI、糖化血红蛋白、肾功能不全、炎症反应、口服降糖药物、应用胰岛素均与低血糖发生有关,在进行家庭医生式服务的糖尿病社区规范化管理时应谨慎评估上述危险因素。

Objective To explore the possible risk factors of hypoglycemia in elderly patients with type 2 diabetes mellitus during the family doctor service. Methods 396 elderly patients with type 2 diabetes mellitus who contracted with our hospital for family doctor service were divided into non-hypoglycemia group（ 277 cases） and hypoglycemia group（ 119 cases） according to the occurrence of hypoglycemia reaction. The clinical data and medication of the two groups were compared,and the possible risk factors of hypoglycemia were analyzed by multi factor Logistic regression. Results Data showed that body mass index（ BMI）,glycosylated hemoglobin,hemoglobin,serum potassium and other indications in hypoglycemia group were significantly lower than those in non hypoglycemia group; furthermore,as for age,course of diabetes,blood creatinine expression level,quantity of trace urinary albumin,total white blood cell count,neutrophil cell percentage and other indications,hypoglycemia group was significantly higher than non-hypoglycemia group,with a statistically significant differences（ P〈0. 05）. Combination rate of drugs for cardiovascular and cerebrovascular diseases,application rate of insulin secretion promoting agent,application rate of insulin and combination rate of oral antidiabetic agents with insulin of,hypoglycemia group,were significantly higher than those of non-hypoglycemia group,and as for the application rate of metformin,hypoglycemic group was significantly lower than non-hypoglycemia group,with a statistically significant difference（ P〈0. 05）. Multivariate logistic regression analysis showed that,age,course of disease,body mass index,blood creatinine expression level,quantity of trace urinary albumin,glycosylated hemoglobin,elevated white blood cell count,insulin secretion promoting agents,insulin,combination of oral antidiabetic agents and insulin,and etc. are risk factors for the occurrence of hypoglycemia（ P〈0. 05）. Conclusion Age,course of disease,BMI,Hb A1 c,renal inadequacy,inflammatory reaction,oral antidiabetic drugs,application of insulin are related to the occurrence of hypoglycemia. In the process of family doctor service for standardized diabetes management in community,we should carefully evaluate these risk factors.