新诊断2型糖尿病患者住院期间低血糖发生的危险因素分析

Analysis of Risk Factors for Hypoglycemia in Newly Diagnosed Type 2 Diabetes Patients During Hospitalization

目的探讨新诊断2型糖尿(NDT2DM)患者住院胰岛素强化治疗,血糖达标后维持胰岛素强化治疗1周中低血糖发生的危险因素,优化血糖管理。方法方便选择2013年1月—2015年12月在该院内分泌科住院行胰岛素强化治疗的NDT2DM患者508例的临床资料,包括人口统计学资料、合并疾病、入院实验室检查结果和胰岛素治疗方案。根据是否在研究观察期间发生低血糖分为低血糖组和无低血糖组。对两组患者的临床数据进行单因素和多因素Logistic回归分析。结果低血糖发生率18.5%(94/508)。单因素分析结果显示低血糖发生组与无低血糖组对比,体质指数(BMI)、糖化血红蛋白、空腹C肽和餐后2 h C肽差异有统计学意义(P<0.05)。多因素回归分析显示,BMI<24 kg/m2(OR=1.164,95%CI=1.074~1.262)和餐后2 h C肽水平低(OR=4.329,95%CI=1.638~11.441)是低血糖发生的独立危险因素。结论对NDT2DM患者进行胰岛素强化治疗时,当患者具有低BMI和(或)餐后2 h C肽水平低的低血糖危险因素时,应提前做好低血糖知识宣教,加强血糖监测,减少低血糖的发生。

Objective To explore the risk factors of hypoglycemia in patients with newly diagnosed type 2 diabetes(NDT2DM)in inpatient intensive insulin therapy and maintain the intensive insulin therapy for one week after the blood glucose standard was reached,and optimize blood glucose management.Methods The clinical data of 508 patients with NDT2DM who underwent intensive insulin therapy in the Department of Endocrinology in the hospital from January 2013 to December 2015 were conveniently selected collected,including demographic data,comorbidities,hospitalized laboratory test results and insulin treatment plan.According to whether hypoglycemia occurred during the observation period of the study,they were divided into hypoglycemia group and no hypoglycemia group.The clinical data of the two groups of patients were analyzed by univariate and multivariate logistic regression analysis.Results The incidence of hypoglycemia was 18.5%(94/508).The results of univariate analysis showed that the body mass index(BMI),glycosylated hemoglobin,fasting C-peptide and C-peptide 2 h after a meal were significantly different between the hypoglycemia group and the non-hypoglycemia group,the difference was statistically significant(P<0.05).Multivariate regression analysis showed that BMI<24 kg/m2(OR=1.164,95%CI=1.074-1.262)and low C-peptide levels(OR=4.329,95%CI=1.638-11.441)after a meal are low Independent risk factors for blood glucose.Conclusion When intensive insulin therapy is used for patients with NDT2DM,when the patient has low BMI and/or low 2 h C-peptide level after a meal,the hypoglycemia should be promoted in advance,and blood glucose monitoring should be strengthened to reduce the occurrence of hypoglycemia.