老年糖尿病患者治疗过程中发生严重低血糖的危险因素分析

Analysis of risk factors for severe hypoglycemia during treatment in elderly diabetes patients

目的探讨老年糖尿病患者发生严重低血糖的危险因素,优化老年糖尿病患者的治疗方案和措施。方法采用病例对照研究设计,连续纳入我科老年糖尿病患者346例,以治疗过程发生严重低血糖68例患者作为研究组,以余278例未发生者作为对照组。通过问卷调查和病例查阅的方式,记录患者基本资料、病情、血糖控制资料方案等。进行单因素检验,以及多因素的Cox回归分析。结果发生严重低血糖老年糖尿病患者病程显著长于未发生者,使用胰岛素的例数显著多于未发生者,使用二甲双胍的例数显著少于未发生者,使用格列奈类的例数显著少于未发生者,联用口服降糖药和胰岛素的例数显著多于未发生者,联用两种以上心血管药物的例数显著多于未发生者(P<0.05)。体重指数、病程、使用胰岛素、使用二甲双胍、联用口服降糖药及胰岛素、联用联众以上心血管药物等六个因素被纳入。体重指数、病程、联用口服降糖药及胰岛素和联用两种以上心血管药物是老年糖尿病患者治疗过程中发生严重低血糖的影响因素,其中体重指数为为老年糖尿病患者治疗过程中发生严重低血糖的保护因素,其余均为危险因素。(P<0.05)。结论病程、使用胰岛素、使用二甲双胍、格列奈类、联用口服降糖药和胰岛素、联用两种以上心血管药物都对老年糖尿病患者治疗过程中是否发生严重低血糖产生显著的影响。体重指数为老年糖尿病患者治疗过程中发生严重低血糖的保护因素,病程、联用口服降糖药及胰岛素和联用两种以上心血管药物为其危险因素。

Objective To investigate the risk factors for severe hypoglycemia happening during the treatment in elderly diabetic patients,so as to find out the optimized therapy and treatment for the patient .Methods Adopting case-control study design,346 eld-erly patients with diabetes were included .68 cases with severe hypoglycemia during the treatment were selected as the study group ,and the other 278 cases as the control group .Through the questionnaire survey and case inspection ,the basic information and blood glucose control data were collected .The single factor test ,analysis and multi factor Cox regression were used to analysed the data .Results The average disease duration of elderly diabetes patients with severe hypoglycemia was significantly longer than that of the control group （ P〈0.05）.The number of patients using insulin ,basal insulin added to oral agents or more than two kinds of cardiovascular drugs were more in the study group rather than the in the control group （ P〈0.05）.The numbers of patients using melbine or nateglinide were more in the study group rather than that in the control group （ P〈0.05）.The multi factor Cox regression analysis showed that body mass index,disease duration,using basal insulin added to oral agents or more than two kinds of cardiovascular drugs were factors ,which could significant affect the insidence of severe hypoglycemia in elderly diabetic patients （ P〈0.05）.Conclusion Disease duration, using insulin,basal insulin added to oral agents or more than two kinds of cardiovascular drugs ,using melbine or nateglinide could sig-nificant affect the insidence of severe hypoglycemia in elderly diabetic patients .Body mass index was protective factors of severe while the disease duration ,using basal insulin added to oral agents or more than two kinds of cardiovascular drugs were risk factors .