老年2型糖尿病患者发生低血糖事件的相关因素分析

Analysis of related factors of hypoglycemia in elderly patients with type 2 diabetes

目的 探讨老年2型糖尿病患者发生低血糖事件的相关危险因素。方法 选择2019年7月至2021年6月在清华大学附属垂杨柳医院内分泌科就诊的94例老年(年龄≥65岁)2型糖尿病患者,根据动态血糖监测结果进行分组:血糖<3.9mmol/L且持续时间在15min以上的34例患者为低血糖组,余60例患者为无低血糖组。比较两组患者的临床资料,采用多因素logistic回归分析老年2型糖尿病患者发生低血糖事件的危险因素。结果 低血糖组的34例患者中,发生夜间低血糖者占61.8%。低血糖组患者的体重指数、血糖平均值均低于无低血糖组,高密度脂蛋白胆固醇、尿微量白蛋白、尿微量白蛋白/尿肌酐比值、血糖变异系数和平均血糖波动幅度均高于无低血糖组,差异有显著性(P<0.05)。多因素logistic回归分析显示,尿微量白蛋白/尿肌酐比值、血糖变异系数与低血糖事件的发生呈正相关(OR=1.043、1.305);体重指数和血糖平均值与低血糖事件的发生呈负相关(OR=0.815、0.704)。结论 血糖变异系数、尿微量白蛋白/尿肌酐比值、体重指数及血糖平均值是老年2型糖尿病患者发生低血糖事件的独立危险因素。

Objective To explore the risk factors of hypoglycemia in elderly patients with type 2 diabetes.Method From July 2019 to June 2021,94 elderly patients(≥65 years)with type 2 diabetes were selected from the Department of Endocrinology of Chuiyangliu Hospital Affiliated to Tsinghua University.The clinical data of the patients were collected and grouped according to the results of continuous glucose monitoring system.34 patients with blood glucose<3.9 mmol/L and duration of more than 15 minutes were in the hypoglycemic group,and the remaining 60 patients were in the non hypoglycemic group.Result Among the 34 patients in the hypoglycemia group,61.8%experienced nocturnal hypoglycemia.The body mass index and average blood glucose levels of patients in the hypoglycemic group were lower than those in the non hypoglycemic group,while HDL-C,urinary microalbumin,UACR,blood glucose coefficient of variation,and mean amplitude of glycemic excursions were higher than those in the non hypoglycemic group,with significant differences(P<0.05).Multivariate logistic regression analysis showed that urine microalbuminuria creatinine ratio,and blood glucose coefficient of variation were positively correlated with the occurrence of hypoglycemic events(OR=1.021,1.043,1.305),body mass index and mean amplitude of glycemic excursions were negatively correlated with the occurrence of hypoglycemic events(OR=0.815,0.704).Conclusion The independent risk factors for hypoglycemic events in elderly patients with type 2 diabetes are the coefficient of variation of blood glucose,urine microalbuminuria creatinine ratio,body mass index,and mean amplitude of glycemic excursions.