嚴重低血糖作為第2型糖尿病的終端腎病危險因子：國家世代型研究

Severe Hypoglycemia as a Predictor of End-stage Renal Disease in Type 2 Diabetes: A National Cohort Study

李宇力(Yu-Li Lee)

指導教授 ： 辛錫璋

高雄醫學大學/醫學院/臨床醫學研究所碩士班/碩士(2018年)

摘要

目標: 這份研究目的在於探討第二型糖尿病患者發生嚴重低血糖,其對於加速糖尿病腎臟病變進入末期腎臟病之影響。
研究設計與方法: 我們分析西元1996年至2013年的台灣國家健康保險研究資料庫裡第二型糖尿病患者檔案資料。我們針對因為嚴重低血糖至急診就醫的第二型糖尿病患者作為實驗組。然後我們針對實驗組配對年齡，性別，診斷疾病年份，以及藥物使用篩選出1:1的對照組。使用cox regression比較 Hazard ratios(HRs)來分析臨床結果, 包括致死率以及慢性腎臟病變進入末期腎臟病變風險分析。
研究結果: 研究結果顯示，這468,421位曾經發生嚴重低血糖的第二型糖尿病患者，比未曾發生低血糖的對照組，有較高的致死率(HR, 1.76; 95%信賴區間, 1.61-1.54)。再者，發生過嚴重低血糖的第二型糖尿病患者，研究發現比對照組更快進入末期腎臟病變(23.07±17.13 vs. 33.99±17.43, p<0.001)。而且這些實驗結果在經過校正分析後仍然有相同結果。
結論: 我們的實驗結果指出嚴重低血糖會造成第二型糖尿病患者加速進入末期腎臟變。

關鍵字

低血糖 ； 糖尿病 ； 腎病變

並列摘要

OBJECTIVE: This study investigated whether severe hypoglycemia was linked with progression into end-stage renal disease (ESRD) in patients with type 2 diabetes. The effects of severe hypoglycemia on the risk of chronic kidney disease must be determined.
RESEARCH DESIGN AND METHODS: Using the complete claims data for individuals with type 2 diabetes from Taiwan’s National Health Insurance Research Database, we identified patients who presented with severe hypoglycemia at an emergency department between 1996 and 2013. We matched the identified patients for age, sex, index year, and medication at a ratio of 1:1 with control patients. Cox regression models were used to estimate the hazard ratios (HRs) of clinical outcomes, including all-cause death and chronic kidney disease.
RESULTS: Results showed that the 468,421 patients with type 2 diabetes who had any history of severe hypoglycemia, compared with the matched control patients, had a higher risk of all-cause mortality (HR, 1.76; 95% confidence interval, 1.61–1.54). Moreover, the patients with type 2 diabetes who had ever exhibited severe hypoglycemia progressed to ESRD within a shorter period of time than did the patients in the control group. The results were similar in analyses accounting for the competing risk.
CONCLUSIONS: The study results indicate that severe hypoglycemia aggravates renal dysfunction in patients with type 2 diabetes and leads to progression to ESRD.

並列關鍵字

hypoglycemia ； diabetes ； ESRD

參考文獻

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