65岁及以上2型糖尿病患者的低血糖特征

摘要

目的 分析内分泌代谢专科住院老年2型糖尿病患者低血糖特征.方法 提取2014年1月~2015年12月内分泌科住院2型糖尿病1187例次患者共58565次床边血糖监测系统(BGMS)数据,按患者年龄分为<45岁(128例次)、45~64岁(594例次)和≥65岁(465例次)3组,通过3组对比,分析老年患者住院期间低血糖发生率及时段分布特征.结果 随年龄增加,低血糖发生风险逐渐增加,≥65岁组低血糖密度、患者占比和患者-住院日占比分别是<45岁组的2.38、2.57、2.54倍(0.95% vs 0.40%, 28.17% vs 10.94%,4.48% vs 1.76%,P<0.001);凌晨是老年组低血糖高发时段,相比<45岁和45~64岁组,≥65岁组凌晨的低血糖密度分别是其2.44和1.40倍(2.66% vs 1.09% vs 1.90%,P<0.05),患者占比分别是其3.86和1.55倍(14.57% vs 3.77% vs 9.42%, P<0.02);≥65岁组反复低血糖(≥2次)患者占比是其他两组的5.70倍和1.41倍(13.33% vs 2.34% vs 9.43%,P<0.05).结论 65岁及以上2型糖尿病患者低血糖风险显著高于非老年组,凌晨和反复低血糖情况最为突出.应针对老年糖尿病患者制订差异化血糖监测和管理策略,以提高医疗安全.%Objective To investigate the hypoglycemic characteristics of hospitalized elderly patients with type 2 diabetes mellitus (T2DM). Methods From January, 2014 to December, 2015, the data of 58 565 blood measurements using a standard blood glucose monitoring system (BGMS) were collected from 1187 cases of patients with type 2 diabetes during hospitalization in the Department of Endocrinology, Guangdong General Hospital (Guangzhou, China). Stratified analyses were conducted by dividing the patients into 3 age groups,namely<45 years group(128 cases),45-64 years group(594 cases), and≥65 years group(465 cases).The incidence and time distribution of hypoglycemia in these patients were compared among the 3 age groups. Results The risk of hypoglycemia increased with age. Compared with those below 45 years of age, the patients beyond or equal to 65 years had a significantly increased hypoglycemic density (0.95% vs 0.40%, P<0.001), a higher proportion of patients with hypoglycemia(28.17% vs 10.94%,P<0.001),and greater patient-days with hypoglycemia(4.48% vs 1.76%,P<0.001).In the elderly patients,hypoglycemia occurred most frequently before dawn,at which time the hypoglycemic density was 2.66% in patients ≥65 years of age, significantly higher than that in patients below 45 years (1.09%, P<0.05) and between 45 and 64 years (1.90%, P<0.05); the proportion of patients with hypoglycemia was also significantly higher in the elderly patients (14.57%) than in those below 45 years (3.77%, P<0.02) and between 45 and 64 years (9.42%, P<0.02). The proportion of patients with recurrent hypoglycemia(≥2 times)was significantly higher in patients≥65 years(13.33%)than in younger patients (2.34% in <45 years group and 9.43% in 45-64 years group, P<0.05). Conclusion The hypoglycemic risk in hospitalized elderly patients with T2DM is significantly higher than that in younger patients, especially before dawn and in terms of recurrent hypoglycemia.Clinicians should develop differential blood glucose monitoring and management strategies for these elderly patients to improve the clinical safety.