胰岛素强化治疗的2型糖尿病患者低血糖的危险因素分析及监控策略探讨

Analysis of risk factors of hypoglycemia in patients with T2DM after intensive insulin therapy and discussion of monitoring strategies

目的探讨胰岛素强化治疗后2型糖尿病(T2DM)患者发生低血糖的危险因素以及血糖的监控策略。方法选取2019年3月—2021年3月宜宾市第二人民医院确诊为T2DM患者172例作为研究对象,采用计算机产生随机数法以2∶1的比例分为训练集(n=115)和测试集(n=57),患者均接受胰岛素强化治疗,依据训练集患者治疗后是否发生低血糖症状将其分为低血糖组(n=35)和非低血糖组(n=80)。采用单因素分析和多因素Logistic回归分析对两组患者的临床资料进行统计分析。根据多因素分析结果利用R 3.6.0软件建立模型,并对预测模型进行验证。172例患者依据血糖监测方法分为瞬感扫描式葡萄糖监测系统(FGM)组(n=102)和血糖仪组(n=70)评估FGM对患者治疗后血糖监测价值,测定两组患者治疗前后的静脉血糖以及指尖血糖指标,对比分析两组患者的血糖控制水平、血糖波动水平、低血糖发生情况、血糖达标时间、胰岛素用量等。结果训练集115例患者胰岛素强化治疗后35例患者出现低血糖症状,单因素分析和多因素Logistic回归分析表明:病程、体质量指数(BMI)、肌酐(Cre)为T2DM患者进行胰岛素强化治疗后出现低血糖的独立危险因素,通过FGM监测血糖为保护因素。根据多因素分析结果构建列线图预测模型并对模型进行验证,训练集和验证集的一致性指数(C-index)分别为0.843(95%置信区间:0.747~0.893)、0.832(95%置信区间:0.725~0.881),表明该模型具有较强的预测能力。此外,应用FGM监测的患者血糖达标所需时间比血糖仪监测组更短,胰岛素的用量更少,治疗后患者24 h内的血糖平均值以及血糖标准差更低,而且在治疗后患者出现低血糖的概率也更低,差异具有统计学意义(P<0.05)。结论病程、BMI、Cre为T2DM患者进行胰岛素强化治疗后出现低血糖的独立危险因素,FGM监测血糖为保护因素。FGM相比于血糖仪监测具有更好的临床效果,可广泛应用于临床治疗中。

Objective To explore the risk factors of hypoglycemia in patients with T2DM(type 2 diabetes)after intensive insulin therapy and the monitoring strategy of blood glucose.Methods A total of 172 patients with T2DM diagnosed in Yibin Second People's Hospital from March 2019 to March 2021 were selected as the research object.The computer-generated random number method was used to divide them into training set(n=115)and test set(n=57)in the ratio of 2∶1.The patients were treated with intensive insulin therapy.According to whether the patients in the training set had hypoglycemic symptoms after treatment,they were divided into hypoglycemic group(n=35)and non hypoglycemic group(n=80).The clinical data of the two groups were statistically analyzed by univariate analysis and multivariate Logistic regression analysis.According to the results of multi factor analysis,the model is established by using R3.6.0 software,and the prediction model is verified.In addition,in order to evaluate the value of transient scanning glucose monitoring system(FGM)in patients'blood glucose monitoring after treatment,172 patients were divided into FGM group(n=102)and blood glucose meter group(n=70)according to the blood glucose monitoring method.The venous blood glucose and fingertip blood glucose indexes of two groups were measured before and after treatment.The blood glucose control level,blood glucose fluctuation level,hypoglycemia occurrence,blood glucose standard time,insulin dosage and so on were compared and analyzed between two groups.Results After intensive insulin treatment,35 patients had hypoglycemia symptoms.Univariate analysis and multivariate Logistic regression analysis showed that the course of disease,BMI and Cre were independent risk factors for hypoglycemia in T2DM patients after intensive insulin treatment,and blood glucose monitored by FGM was the protective factor.According to the results of multivariate analysis,the nomogram prediction model is constructed and verified.The C-index of training set and verification set are 0.843(95%CI:0.747—0.893)and 0.832(95%CI:0.725—0.881),respectively,indicating that the model has strong prediction ability.In addition,the time required for the blood glucose of patients monitored by FGM detection system to reach the standard was shorter than that of the blood glucose monitor group,the dosage of insulin was less,the average blood glucose value and blood glucose standard deviation within 24 hours after treatment were lower,and the probability of hypoglycemia was lower after treatment,the difference was statistically significant(P<0.05).Conclusion Course of disease,BMI and Cre are independent risk factors for hypoglycemia in T2DM patients after intensive insulin treatment,and FGM monitoring blood glucose is a protective factor.Compared with blood glucose monitor,FGM has better clinical effect and can be widely used in clinical treatment.