老年2型糖尿病患者发生严重低血糖的危险因素分析

摘要

Objective: To investigate the risk factors for occurrence of severe hypoglycemia in elderly patients with type 2 diabetes. Methods: A total of 306 cases of elderly patients with type 2 diabetes were divided into severe hypoglycemia group (78 cases) and control group (228 cases). The related data of patients in two groups were compared statistically, and conducted a non-conditional logistic regression analysis. Results: Compared with those of control group, patients in severe hypoglycemia group showed a longer course of type 2 diabetes mellitus (P =0.03) , a higher rate of taking multiple cardio-cerebrovascular drugs (P = 0. 04) , a lower rate of metformin administration ( P = 0. 002) but more insulin application(P =0.005) and combination use with oral antidiabetic drugs( P = 0. 034). Further more, the severe hypoglycemia group also showed higher white blood cell count and/or neutrophil percentage ( P values were 0. 021 and 0. 007 , respectively), a lower level of hemoglobin (P ＜ 0. 001) , a higher rate of abnormal renal function (P ＜ 0. 05) and higher incidence of hypokalemia ( P = 0. 006). Logistic regression analysis indicated that a long disease course ( ＞ 10 years) , insulin application and combination use with oral antidiabetic drugs, relatively lower fructosamine levels ( ≤2. 5mmol/L) , incrased level of white blood cell count and renal impairment were related to severe hypoglycemia. Conclusions: Long disease course ( ＞ 10 years) , insulin application and combination use with oral antidiabetic drugs, relatively lower fructosamine levels ( ≤2. 5mmol/L) , increased white blood cell count and renal function impairment were likely to be the risk factors for occurrence of severe hypoglycemia in elderly patients with type 2 diabetic, and to which we should pay more attention to the assessment during antidiabetic therapy.%目的:探讨老年2型糖尿病患者发生严重低血糖的危险因素.方法:收集306例老年2型糖尿病患者,分为严重低血糖组78例及对照组228例,对2组患者的相关数据进行统计学比较及多因素非条件Logistic回归分析.结果:低血糖组患者与对照组相比:2型糖尿病病程更长(P=0.03),心脑血管病相关药物联用率较高(P=0.04),二甲双胍使用率偏低(P =0.002),而胰岛素使用率及口服降糖药(OAD)与胰岛素联用率较高(P=0.005和0.034)；生化指标方面该组患者白细胞计数及中性粒细胞比例偏高(P=0.021和0.007),血红蛋白偏低(P＜0.001),肾功能相关指标均较高(P值均＜0.05),低钾血症的发生率高(P =0.006).多因素Logistic回归分析显示病程＞10年,胰岛素使用及与OAD联用,果糖胺水平≤2.5 mmol/L,血白细胞升高及肾功能受损可能与严重低血糖发生相关.结论:病程＞10年,胰岛素使用及与OAD联用,果糖胺水平≤2.5 mmol/L及肾功能受损可能为老年2型糖尿病患者发生严重低血糖的危险因素,且血白细胞升高与严重低血糖明显相关.在对此类患者进行降糖治疗时应对以上危险因素进行评估.