2型糖尿病患者夜间低血糖相关因素及临床干预效果

目的 观察动态血糖监测的2型糖尿病(2-DM)患者,评估2-DM患者日常临床环境中发生夜间低血糖的危险因素,寻求预测夜间低血糖发生的量化指标,探讨临床干预危险因素后的效应。方法 研究对象为2013年1月至2014年12月住我院行动态血糖监测的144例2-DM患者；根据2011年《中国血糖监测临床应用指南》,以平均血糖波动幅度(MAGE)作为血糖波动评估指标。同时比较不同睡前血糖以及晚餐后2h血糖组患者夜间低血糖发生率。应用SPSS17.0统计软件进行统计学分析。结果 非条件多因素Logistic回归分析显示,在调整性别、年龄、BMI以及糖尿病病程后,MAGE是2-DM患者夜间低血糖风险增加的重要影响因素,其OR(95%CI)为(1.011~3.112,P<0.05)。患者睡前血糖水平越低,其夜间低血糖的发生率越高,经过有效临床干预后,患者夜间低血糖的发生率明显下降(χ2=9.782,P=0.044)。患者晚餐后2h血糖水平越低,其夜间低血糖的发生率越高,经过有效临床干预后,患者夜间低血糖的发生率明显下降(χ2=9.763,P=0.045)。结论 MAGE、睡前血糖水平以及晚餐后2h血糖水平与夜间低血糖风险增加密切相关。而且,适当临床干预可以降低夜间低血糖的发生。
Objective To investigate the risk factors of nocturnal hyperglycemia in type 2 diabetic patients and its clinical intervention. Methods Clinical data of 144 type 2 diabetic patients admitted to our hospital from Jan 2011 to Dec 2012 were collected. The mean amplitude of glycemic excursions (MAGE) was measured. The incidence rate of hypoglycemia in patients with different bedtime blood glucose and postprandial plasma glucose levels was compared. Result Multivariate Logistic regression analysis revealed that the odd ratio of MAGE was 1.987 (95% CI 1.011-3.112). The bedtime blood glucose levels and the postprandial plasma glucose levels were negatively correlated with the incidence of nocturnal hypoglycemia. After intervention, the incidence rate of nocturnal hypoglycemia decreased significantly (χ2=9.782, P =0.044; χ2=9.763, P = 0.045). Conclusion MAGE, bedtime blood glucose, postprandial plasma glucose levels are closely related to nocturnal hypoglycemia in type 2 diabetic patients, and the incidence can be reduced after proper intervention