The Current Status And Risk Assessment Of Hypoglycemia In Hospitalized Diabetic Patients

Objective To investigate the incidence and the risk factors of hypoglycemia in type 1 diabetes(T1DM)and type 2 diabetes(T2DM)by using a continuous glucose monitoring system(CGMS).Methods A total of 137 T1DM patients and 144 T2DM patients were recruited were recruited in Nanjing Drum Tower Hospital between May 2013 and August 2018.Each patient received continuous glucose monitoring(CGM)for 3 consecutive days.Based on data from CGM,the participants were divided into those with hypoglycemia and those without hypoglycemia.Through a retrospective comparative study in patients with general clinical data,blood glucose control,islet function,liver and kidney function,blood lipid metabolism and other related laboratory data,analyzed the hypoglycemia hospitalized adult patients with T1DM and T2DM diabetes related influencing factors.Results A total of 137 hospitalized patients with T1DM,67 patients(48.9%)developed 179 cases with hypoglycemia.The highest incidence of hypoglycemia happened in bedtime.A total of 144 hospitalized patients with T2DM,23 patients(15.9%)developed 49 cases with hypoglycemia.The highest incidence of hypoglycemia happened in bedtime.Two groups of T1DM had significant difference in HbAlc,glycated albumin,mean blood glucose(MBG),the mean amplitude of glycemic excursion(MAGE)and low blood glucose index(LBGI).HbA1c(7.9±2.0vs 8.9±2.3,P<0.05),glycated albumin(22.0±7.0vs 26.9±10.8,P<0.05)and MBG(7.5±2.1 vs 9.312.6,P<0.05)were significantly lower in hypoglycemia group than in non-hypoglycemia group.MAGE(6.2±3.5 vs 5.1±2.3,P<0.05)and LBGI(3.1±5.0 vs 0.7±1,2,P<0.05)were significantly higher in hypoglycemia group than in non-hypoglycemia group.Two groups of T2DM had significant difference in MBG.MBG(7.6±1.7 vs 9.2±2.3,P<0.05)was significantly lower in hypoglycemia group than in non-hypoglycemia group.Conclusion Hypoglycemia is common in patients with diabetes and nocturnal hypoglycemia is in highest incidence.Therefore we should strengthen blood glucose monitoring of high hypoglycemia happened time and set individualized targets for optimal glycemic control.Objective To investigate the incidence and risk factors of nocturnal hypoglycemia in type 1 diabetes(T1DM),and to evaluate whether nocturnal hypoglycemia can be evaluated by daily capillary blood glucose profiles.Methods A total of 137 T1DM patients were recruited between May 2013 and August 2018.Each patient received continuous glucose monitoring(CGM)for 3 consecutive days.Meanwhile capillary blood glucose monitoring before and after meals as well as at bedtime was provided.Based on data from CGM,the participants were divided into those with nocturnal hypoglycemia and those without hypoglycemia.Results(1)Logistic regression analysis indicated that HbA1c,glycated albumin and mean blood glucose were independently negative correlated,while standard deviation of blood glucose and low blood glucose index were independently positive correlated with nocturnal hypoglycemia.(2)Based on the daily capillary blood glucose profile,fasting blood glucose,postprandial blood glucose and bedtime blood glucose were independently negative correlated with nocturnal hypoglycemia.The cut-off values for prediction of nocturnal hypoglycemia were as follows:when fasting glucose level was 5.8mmol/L,the youden index was maximal(sensitivity 80%,specificity 90%,AUC 0.91).When postprandial blood level was 8.2mmol/L,the youden index was maximal(sensitivity 57%,specificity 76%,AUC 0.72).When bedtime blood level was 6.7mmol/L,the youden index was maximal(sensitivity 64%,specificity 90%,AUC 0.80).(4)Based on the capillary blood glucose before meals and at bedtime,a model was established for the prediction of nocturnal hypoglycemia:BGn=bedtime blood glucose ×(1-SDSM/MBGSM).When BGn was 5.2mmol/L,the youden index was maximal.The specificity of prediction was increased to 93%,AUC 0.81.Conclusion Nocturnal hypoglycemia is common in patients with type 1 diabetes.We should set individualized targets for optimal glycemic control.There is a potentially higher risk of nocturnal hypoglycemia if the level of blood glucose is below 5.8 mmol/L while fasting in the morning,below 6.7 mmol/L at bedtime or below 5.2 mmol/L for the model of BGn.