摘要
目的对1型糖尿病(T1DM)患者低血糖感知受损(IAH)发生率及其影响因素进行Meta分析与系统评价。方法计算机检索美国国立医学图书馆数据库(PubMed)、荷兰医学文摘数据库(Embase)、科学引文数据库(Web of Science)、考克兰图书馆(Cochrane Library)、Scopus、中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网中有关T1DM患者IAH发生率与影响因素的相关研究,检索时限为建库至2023年8月。由2名研究者按照纳入与排除标准独立进行文献筛选、质量评价以及资料提取。采用Revman 5.4进行Meta分析。结果共纳入18篇文献,总样本量为9445例。Meta分析结果显示,T1DM患者IAH发生率为29%(95%CI 24%~34%)。以IAH评估工具进行亚组分析,使用Gold量表、Clarke量表和Pedersen问卷评估的IAH发生率分别为28%(95%CI 20%~37%)、25%(95%CI 20%~29%)和65%(95%CI 41%~89%);以地域进行亚组分析,发现亚洲、欧洲、北美洲、大洋洲和南美洲T1DM患者的IAH发生率分别为31%(95%CI 4%~59%)、24%(95%CI 19%~28%)、48%(95%CI 29%~66%)、21%(95%CI 18%~23%)和32%(95%CI 19%~44%);以年份进行亚组分析,发现2006—2015年、2016—2020年和2021—2023年T1DM患者的IAH发生率分别为29%(95%CI 11%~47%)、33%(95%CI 26%~40%)和22%(95%CI 15%~29%)。IAH与年龄(OR=1.04,P<0.001)、使用持续葡萄糖监测(OR=1.20,P=0.030)、使用持续皮下胰岛素输注(OR=0.50,P=0.03)、糖尿病周围神经病变(OR=2.94,P=0.001)有关。敏感性分析结果显示,Meta分析结果相对稳定。结论T1DM患者IAH发生率相对较高,年龄、糖尿病周围神经病变、使用持续葡萄糖监测是T1DM患者IAH的风险因素,使用持续皮下胰岛素输注是T1DM患者IAH的保护因素。
Objective To meta-analyze and systematically evaluate the incidence and influencing factors of impaired awareness of hypoglycaemia(IAH)in patients with type 1 diabetes mellitus(T1DM).Methods We searched PubMed,EMBASE,Web of Science,Cochrane Library,Scopus,CNKI,Chinese biomedical literature database,Wanfang data knowledge service platform and VIP for relevant studies on the incidence and influencing factors of hypoglycaemia in T1DM patients,from the date of database inception to August 2023.Literature screening,quality evaluation and data extraction were performed independently by 2 researchers according to the inclusion and exclusion criteria.Revman 5.4 was used for Meta-analysis.Results A total of 18 articles were included,with a total sample size of 9445 cases.Meta-analysis showed that the incidence of hypoglycemia in patients with T1DM was 29%(95%CI 24%-34%).In subgroup analysis,the incidence of IAH assessed by Gold scale,Clarke scale and Pedersen questionnaire was 28%(95%CI 20%-37%),25%(95%CI 20%-29%)and 65%(95%CI 41%-89%),respectively.In subgroup analysis by region,the prevalence of IAH in Asia,Europe,North,Oceania and South was 31%(95%CI 4%-59%),24%(95%CI 19%-28%),48%(95%CI 29%-66%),21%(95%CI 18%-23%)and 32%(95%CI 19%-44%),subgroup analysis by year showed that the IAH rates in 2006—2015,2016—2020 and 2021—2023 were 29%(95%CI 11%-47%),33%(95%CI 26%-40%)and 22%(95%CI 15%-29%),respectively.Impaired awareness of hypoglycemia was associated with age(OR=0.50,P<0.001),use of continuous glucose monitoring(OR=1.20,P=0.030),use of continuous subcutaneous insulin pump(OR=0.50,P=0.030),and peripheral neuropathy change(OR=2.94,P=0.001),the results of sensitivity analysis showed that the Meta-analysis was relatively stable.Conclusion The incidence of IAH is relatively high in patients with T1DM.Age,peripheral neuropathy,and continuous glucose monitoring are risk factors for impaired hypoglycemia perception in patients with T1DM;the use of continuous subcutaneous insulin pump is protective factor.
作者
彭婷
陶静
刘清华
边旭娜
王玉萍
向慧
叶春俐
高敏
龚亚
Peng Ting;Tao Jing;Liu Qinghua;Bian Xuna;Wang Yuping;Xiang Hui;Ye Chunli;Gao Min;Gong Ya(Department of Endocrinology,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Nursing School of Wuhan University,Wuhan 430030,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2024年第6期669-679,共11页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
华中科技大学同济医学院护理学院2024年度自主创新基金项目(ZZCX2024T007)。
关键词
糖尿病
1型
META分析
低血糖感知受损
影响因素
Diabetes mellitus,type 1
Meta-analysis
Impaired awareness of hypoglycaemia
Influencing factors