第二型糖尿病病患發生嚴重低血糖之相關因素探討

Determinants of Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus

張鳳梅(Feng-Mei Chang) ； 戴淑華(Shu-Hua Tai) ； 林成新(Cheng-Sin Lin) ； 張慧真(Hui-Jen Chang)

《臺灣臨床藥學雜誌》 22卷2期 (2014/06) Pp. 67-80

https://doi.org/10.6168/FJCP.2014.2202.01

摘要

目的：預測第二型糖尿病病患發生嚴重低血糖之危險因子，篩檢出第二型糖尿病病患發生嚴重低血糖之高危險群。方法：研究設計採病例回溯性對照研究(retrospective, case-control study)。研究對象為2009年1月至2010年12月於臺灣南部一所1,200床醫學中心之第二型糖尿病病患。研究對象分為兩組，病例組為合併嚴重低血糖之第二型糖尿病患。對照組為未合併嚴重低血糖之第二型糖尿病，依病例組之年齡分布，做頻率配對篩選。回顧審閱病歷，擷取包括人口學屬性、生化學檢查、共病狀況、併用藥物等四大層面資料變項進行資料收集。結果：共收納病例組與對照組各126人，其中男性佔48.4%，女性51.6%，病例組平均年齡71.2歲，以多元邏輯斯迴歸分析結果，egFR＜60 ml/min/1.73 m^2者，其發生低血糖風險為egFR≧60 ml/min/1.73 m^2者之3.15倍(OR=3.15; 95% CI, 1.28~7.74; p=0.013)，每當HbA1c增加1%，則發生低血糖的風險為0.63倍(OR=0.63; CI, 0.50~0.80; p＜0.001)；BMI每增加一單位，發生嚴重低血糖的風險為0.91倍(OR=0.91; CI, 0.83~0.99; p=0.039)，有使用benzodiazepines者，其發生低血糖風險為未使用者之3.20倍(OR=3.20; CI, 1.01~10.12; p=0.048)。結論：egFR＜60 ml/min，HbA1c低於6.8%，BM低於23.0及有使用benzodiazepine 之第二型糖尿病病患，為發生嚴重低血糖之高危險族群。提供臨床參考，針對此高危險群，除了提供個別化之藥物治療外，給予病患充分的衛教及血糖監測觀念，將有助於病患將血糖控制至接近目標值，且降低發生低血糖之風險。

關鍵字

第二型糖尿病 ； 嚴重低血糖 ； 糖化血色素 ； 合併症

並列摘要

Objectives: To discuss the determinants and predict the risk factors of severe hypoglycemia in patients diagnosed as type 2 diabetes mellitus (T2DM). Methods: A retrospective case-control study was conducted at a teaching hospital during a 2-year period from January 2009 to December 2010. The study group consisted of T2DM patients with severe hypoglycemia (SH) and those without SH as control. Medical records including demographics, biochemical examinations, comorbidities and concomitant medications were analyzed. Results: T2DM patients with or without SH (n=126 in each group; male 48.4%, female 51.6%, average age 71.2) were included in this study. Multivariate logistic regression analysis revealed that patients with egFR＜60 ml/min/1.73 m^2 had a 3.15-fold increase in episodes of severe hypoglycemia as compared to those egFR＞60 ml/min/1.73 m^2 (OR=3.15; p=0.013). Patients with lower HbA1c as compared to the control group (6.8% vs. 8.0%, OR = 0.63; p ＜ 0.001), BMI (23.0 vs. 25.7, OR=0.91; p=0.039), and those taking benzodiazepines had a 3.20-fold increase in hypoglycemia. Conclusions: In T2DM patients with egFR＜60 ml/min, HbA1c＜6.8%, BMI＜23.0 and those taking benzodiazepines are at risk for severe hypoglycemia. Providing individualized pharmaceutical care, patient education and self-care, monitoring blood glucose at normalized level may reduce harm due to episodes of severe hypoglycemia.

並列關鍵字

Type 2 Diabetes Mellitus ； Hypoglycemia ； Glycated Hemoglobin ； Comorbidities