社区老年糖尿病患者低血糖风险评估模型的建立及应用价值分析

Establishment of hypoglycemia risk assessment model for elderly diabetic patients in community and its application value analysis

目的构建一个可指导降低社区老年糖尿病患者未来1个月内低血糖发生的风险评估模型,并分析该模型对社区老年糖尿病患者的应用价值。方法于2016年12月募集164例社区老年糖尿病患者,统计其低血糖发生频率,并通过logistic回归分析初步确定低血糖独立危险因素,并建立风险评估模型。以该模型为指导,对患者开展干预,持续观察该模型评分及低血糖发生率变化情况。结果低血糖独立危险因素包括未严格按医嘱用药(X_1)、运动习惯不良(X_2)、饮食习惯不良(X_4)、体重指数≥中位值(X_8)(OR=15. 927,4. 145,3. 040,6. 032,P均<0. 05)。风险评估模型:风险评分=2×X_1+1×X_2+1×X_4+2×X_8。模型对低血糖有可靠诊断价值,ROC曲线下面积0. 977,最佳截断值为风险评分≥4分。干预后风险评分呈明显下降趋势(F=568. 018,P=0. 000),患者干预后低血糖发生率明显低于入组时(P <0. 05)。结论对社区老年糖尿病患者构建低血糖风险评估模型,并以其指导进行社区保健干预,能够有效减少低血糖发生率,具有较好的应用价值。

Objective To construct a guidable risk assessment model to reduce hypoglycemia in elderly diabetic patients in the community in the next month, and to analyse the application value of the model to elderly diabetic patients in the community. Methods 164 elderly patients in community with diabetes were collected in December 2016, and the frequency of hypoglycemia was analysed. The independent risk factors of hypoglycemia were determined by logistic regression analysis to establish a risk assessment model. Under the guidance of the model, the changes of score in the model and incidence rate of hypoglycemia were observed. Results Independent risk factors of hypoglycemia included medication without following the doctor's advice (X1), poor exercise habits (X2), poor dietary habits (X4), body mass index over median (X8)(OR=15.927, 4.145, 3.040, 6.032, P<0.05). The risk assessment model showed that risk scores=2×X1+ 1×X2+ 1×X4+ 2×X8, indicating this model had reliable diagnostic value for hypoglycemia. The area under the receiver operating characteristic (ROC) curve of this model for was 0.977, and the optimal cut-off value for the risk score was ≥4 points. After intervention, the risk score showed a downward trend (F=568.018, P=0.000), and the incidence of hypoglycemia was significantly lower than that before (P<0.05). Conclusions The evaluation model of hypoglycemia in elderly patients with diabetes in community can guide the intervention of community health care, and it can effectively reduce the incidence of hypoglycemia with great application value.