Insulin-treated type 2 diabetes participants attending an outpatient diabetes clinic in Singapore were asked to complete the Gold and Clarke questionnaires, record capillary blood glucose (CBG) and hypoglycaemic symptoms for 4 weeks.
Data were collected from 153 participants (M:F = 98:55) with mean age 61.0 ± 9.4 years, duration of diabetes 19.5 ± 8.8 years and HbA1c 68 ± 17 mmol/mol (8.4 ± 1.5%). Gold and Clarke methods classified 19.6% and 26.8% of participants with IAH, respectively. Using CBG threshold of <3 mmol/L, significantly greater proportion of participants with intact awareness were experiencing autonomic symptoms than those with IAH with either method (Gold: 69% vs. 18%, p = 0.006; Clarke: 85% vs. 46%, p = 0.010). Significantly greater proportion of participants with IAH experienced no hypoglycaemia symptoms than those with intact awareness (Gold: 3.4% vs. 36%, p = 0.015; Clarke: 3.7% vs. 31%, p = 0.031). Participants with IAH had significantly higher rates of severe hypoglycaemia in the preceding year compared to those without (Gold: 17% vs. 3.3%; Clarke: 15% vs. 2.7%, p = 0.012).
Gold and Clarke questionnaires are appropriate tools in ascertaining IAH status in insulin-treated type 2 diabetes participants. This is the first time whereby the hypoglycaemia symptomology has robustly validated the Gold and Clarke questionnaire in insulin-treated type 2 diabetes participants.
方法:在新加坡门诊糖尿病诊所就诊的胰岛素治疗的2型糖尿病参与者被要求填写Gold和Clarke问卷,记录毛细血管血糖(CBG)和低血糖症状4周。
结果:数据来自153名参与者(M:F=98:55),平均年龄为61.0±9.4岁,糖尿病持续时间为19.5±8.8年,HbA1c为68±17mmol/mol(8.4±1.5%)。Gold和Clarke方法分别将19.6%和26.8%的IAH参与者分类。使用<3mmol/l的CBG阈值,与使用任何一种方法的IAH患者相比,具有完整意识的参与者出现自主神经症状的比例明显更高(Gold:69%vs18%,p=0.006;克拉克:85%对46%,p=0.010)。与具有完整意识的参与者相比,IAH参与者没有出现低血糖症状的比例明显更高(Gold:3.4%vs36%,p=0.015;克拉克:3.7%对31%,p=0.031)。与没有IAH的参与者相比,在过去一年中严重低血糖的发生率明显更高(Gold:17%vs3.3%;Clarke:15%vs2.7%,p=0.012)。
结论:Gold和Clarke问卷是确定胰岛素治疗2型糖尿病参与者IAH状态的合适工具。这是低血糖症状学首次在胰岛素治疗的2型糖尿病参与者中有力地验证了Gold和Clarke问卷。