严重低血糖(SH)的几个危险因素与胰岛素治疗的糖尿病有关。这项研究探讨了胰岛素治疗的成人2型糖尿病(T2DM)的潜在危险因素。
在本病例对照研究中,在IQVIAPharMetrics®Plus数据库中确定了2型糖尿病患者开始使用胰岛素.索引日期是第一个SH事件(病例)的日期。使用入射密度采样,对照组选自那些在与每个病例相同的时间内暴露“处于危险中”的人.在对既定因素进行精确匹配后,以前未报告的危险因素通过条件logistic回归进行评估.
在3153个病例控制对中,怀孕[优势比(OR)=3.20,p=.0003],酗酒(OR=2.43,p<0.0001),短效/速效胰岛素(OR=2.22/1.47,p<0.0001),癌症(OR=1.87,p<0.0001),痴呆/阿尔茨海默病(OR=1.73,p=.0175),外周血管疾病(OR=1.59,p<0.0001),抗精神病药(OR=1.59;p=0.0059),抗焦虑药(OR=1.51,p=.0012),瘫痪/偏瘫/截瘫(OR=1.51,p=0.0416),肝炎(OR=1.50,p=.0303),充血性心力衰竭(OR=1.47,p=0.0002),肾上腺素能-皮质类固醇组合(OR=1.45,p=.0165),β-肾上腺素受体激动剂(OR=1.40,p=0.0225),阿片类药物(OR=1.38,p<0.0001),皮质类固醇(OR=1.35,p=.0159),心律失常(OR=1.29。p=.0065),吸烟(OR=1.28,p=0.005),Charlson合并症指数评分2(OR=1.28,p=.0026),3(OR=1.41,p=.0016)或≥4(OR=1.57,p=.0002),肝脏/胆囊/胰腺疾病(OR=1.26,p=.0182)和高血压(OR=1.19,p=.0164)与SH独立相关。
尽管所有接受胰岛素治疗的糖尿病患者都有患SH的风险,这些结果确定了一些以前未被认识到的危险因素和接受胰岛素治疗的2型糖尿病患者的亚组,这些亚组的风险更高.建议对当前疗法和合并症进行审查,并进行额外的血糖监测和教育,在弱势人群中识别和管理SH时。
Several risk factors for severe hypoglycaemia (SH) are associated with insulin-treated diabetes. This study explored potential risk factors in adults with insulin-treated type 2 diabetes mellitus (T2DM).
In this
case-control study, adults with T2DM initiating insulin were identified in the IQVIA PharMetrics® Plus database. The index date was the date of the first SH event (cases). Using incidence-density sampling, controls were selected from those who had been exposed \'at risk\' of SH for the same amount of time as each
case. After exact-matching on the well-established factors, previously unreported risk factors were evaluated through conditional logistic regression.
In 3153
case-control pairs, pregnancy [odds ratios (OR) = 3.20, p = .0003], alcohol abuse (OR = 2.43, p < .0001), short-/rapid-acting insulin (OR = 2.22/1.47, p < .0001), cancer (OR = 1.87, p < .0001), dementia/Alzheimer\'s disease (OR = 1.73, p = .0175), peripheral vascular disease (OR = 1.59, p < .0001), antipsychotics (OR = 1.59; p = .0059), anxiolytics (OR = 1.51, p = .0012), paralysis/hemiplegia/paraplegia (OR = 1.51, p = .0416), hepatitis (OR = 1.50, p = .0303), congestive heart failure (OR = 1.47, p = .0002), adrenergic-corticosteroid combinations (OR = 1.45, p = .0165), β-adrenoceptor agonists (OR = 1.40, p = .0225), opioids (OR = 1.38, p < .0001), corticosteroids (OR = 1.35, p = .0159), cardiac arrhythmia (OR = 1.29. p = .0065), smoking (OR = 1.28, p = .005), Charlson Comorbidity Index score 2 (OR = 1.28, p = .0026), 3 (OR = 1.41, p = .0016) or ≥4 (OR = 1.57, p = .0002), liver/gallbladder/pancreatic disease (OR = 1.26, p = .0182) and hypertension (OR = 1.19, p = .0164) were independently associated with SH.
Although all people with insulin-treated diabetes are at risk of SH, these results have identified some previously unrecognized risk factors and sub-groups of insulin-treated adults with T2DM at greater risk. Scrutiny of current therapies and comorbidities are advised as well as additional glucose monitoring and education, when identifying and managing SH in vulnerable populations.