第二型糖尿病合併嚴重低血糖症患者的身體質量指數與死亡率的相關分析

背景：對糖尿病患血糖進行嚴格的控制可以降低血管病變的的風險，但卻會增加發生低血糖症的機會。嚴重的低血糖症是治療糖尿病的急性併發症，可能導致死亡的風險提高。另外，由於肥胖與第二型糖尿病密切相關，近來專家多建議過重之糖尿病患者實行包含減重生活型態介入。目的：本研究旨在探討第二型糖尿病患出現嚴重低血糖症族群中，不同的身體質量指數與死亡是否存在有相關性，以提供日後評估第二型糖尿病患合併嚴重低血糖症體重管理的參考。方法：此研究為一回溯性世代研究。在台灣，嚴重的低血糖症多經由急診進入醫療體系。我們收集了2008年1月至2009年12月曾至台灣某一醫學中心急診就診的566例患者資料，包含到院時的身體質量指數、生命徵象、過去病史、實驗室數據等，並進行了平均29.1個月的研究追踪病患是否存活。根據身體質量指數分成四組:過輕（BMI <18.5 kg/m2）、正常（18.5至24.9 kg/m2）、過重（≥25.0∼29.9 kg/m2）和肥胖（≥30 kg/m2）進行存活分析。另外，也針對追蹤結果死亡的個案進行死因分析。統計使用的軟體為Stata 11版。結果：追蹤期間內共有146位病患 (25.8%)死亡。在Cox回歸分析模型下，體重過輕的患者相較體重正常患者，有較高的死亡率(24.8 vs 9.8 per 1000 people-months) 及死亡風險( aHR = 4.9)。體重過重及肥胖這兩組與體重正常組相較，都有一個較低的死亡密度 (5.2, 2.4 vs 9.8 per 1000 people-months)但未達統計學上之顯著差異(aHR = 1.2;95% CI = 0.6 - 2.2 ; aHR = 0.16,95% CI= 0.0-1.2)。死因分析顯示，感染症是嚴重的低血糖患者造成死亡的首要原因（101例，69.2％）。結論：初步的結果顯示對第二型糖尿病合併嚴重的低血糖症患者而言，身體質量指數小於18.5 Kg/m2與死亡有相關性。另外，第二型糖尿病合併嚴重的低血糖症患者的死亡主要是感染所致。

關鍵字

嚴重低血糖症；身體質量指數；死亡率；急診；糖尿病

並列摘要

OBJECTIVE- Hypoglycemia is associated with a higher risk of death. This prospective cohort study analyzed various BMI categories and mortalities of severe hypoglycemic patients with type 2 diabetes mellitus (DM) in a hospital emergency department (ED). RESEARCH DESIGN AND METHODS- The retrospective cohort study included 566 adults with type 2 diabetes who were admitted to Kaohsiung Chang Gung Memorial Hospital in Taiwan between 2008 and 2009 with a diagnosis of severe hypoglycemia. Mortality data, demographics, clinical characteristics, and the Charlson comorbidity index (CCI) were obtained from the electronic medical records. This cohort was observed for an average of 29.1 months. Patients were stratified into four study groups as determined by the National Institute of Health (NIH) and World Health Organization classification for BMI, and the demographics were compared using the ANOVA and χ2 test. Kaplan-Meier analysis and the Cox proportional-hazards regression model were used for mortality, and hazard ratios (aHR) were adjusted for each BMI category among participants. Associations were controlled for age, sex, and CCI. RESULTS- After controlling for other possible confounding variables, BMI < 18.5 kg/m2 was independently associated with low survival rates in the Cox regression analysis of the entire cohort of Type 2 DM patients who encountered a hypoglycemic event. Compared to patients with normal BMI, the mortality risk was higher (aHR = 4.9, 95% CI 2.4-9.9) in underweight patients. Infection-related causes of death were observed in 101 cases (69.2%) and were the leading cause of death. CONCLUSION- An independent association was observed between BMI less than 18.5 kg/m2 and mortality among type 2 DM patient with severe hypoglycemic episode. Deaths were predominantly infection-related.

並列關鍵字

Severe hypoglycemia ； body mass index (BMI) ； mortality ； emergency department (ED) ； diabetes mellitus (DM)

參考文獻

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第二型糖尿病合併嚴重低血糖症患者的身體質量指數與死亡率的相關分析

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