Diabetes Care：低血糖症增加心血管事件风险

低血糖症是1型或2型糖尿病患者降糖治疗的一个主要的副作用。糖尿病患者治疗过程中低血糖症与严重的健康结局相关，然而，有低血糖发作史的2型糖尿病门诊患者，其临床结局大部分是未知的。为了探讨在2型糖尿病患者，临床症状性低血糖症与心血管事件和总死亡率的关系，来自中国台湾国立卫生研究院，人口健康科学研究所的Shao-Yuan Chuang教授及其团队进行了一项研究(Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes:a nationwide population-based study)，该研究发现症状性低血糖症与心血管事件、全因住院和全因死亡风险增加有关。该研究结果发表在2013年4月的美国《糖尿病治疗》（Diabetes Care）杂志上，该杂志的影响因子为8.087。
该研究是一项前瞻性研究，研究人群来源于1998至2009年期间台湾国立卫生研究院公布的国民健康保险研究数据库，包含77611例新诊断的2型糖尿病患者。该研究包含随机选择低血糖的2型糖尿病患者和与之对照的无低血糖的2型糖尿病患者。研究低血糖症与全因死亡率和心血管事件的关系，包括中风、冠心病、心血管疾病和全因住院。
该研究结果表明，在77611例患者（500例住院患者，1344例门诊患者）中共发生1844例低血糖事件。轻度(门诊患者)和重度(住院患者)低血糖的病例出现合并症的比例较高(合并症包括高血压、肾脏疾病、癌症、卒中和心脏疾病)。在多元Cox回归模型中，校正糖尿病治疗因素后，有低血糖的糖尿病患者在临床治疗期间的心血管事件发生风险显著增高。校正倾向评分构建模型后，轻度和重度低血糖患者心血管疾病(HR 2.09 [95%CI 1.63-2.67])、全因住院(2.51 [2.00-3.16])和总死亡率(2.48 [1.41-4.38])的风险比(HR)仍然较高。
该研究发现，症状性低血糖，不论轻度和重度，与心血管事件、全因住院和全因死亡风险增加有关。低血糖发作的糖尿病患者可能需要更多的关注。
与糖尿病相关的拓展阅读：

• Hypertension：无糖尿病患者ACEI与小剂量噻嗪利尿剂联用对胰岛素作用影响不大
• Nat Rev Cardiol：戒烟降低非糖尿病患者心血管疾病风险
• Diabetes Care：NT-proBNP为老年糖尿病患者短期死亡强预测因子
• MD Consult：Invokana获准用于2型糖尿病
• Eur J Endocrinol:抑郁与1型糖尿病血糖控制不佳相关
• Eur J Med Res：糖尿病患者需要口腔健康教育
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Association of Clinical Symptomatic Hypoglycemia With Cardiovascular Events and Total Mortality in Type 2 Diabetes: A nationwide population-based study.
OBJECTIVE
Hypoglycemia is associated with serious health outcomes for patients treated for diabetes. However, the outcome of outpatients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown.
RESEARCH DESIGN AND METHODS
The study population, derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1998-2009, comprised 77,611 patients with newly diagnosed type 2 diabetes. We designed a prospective study consisting of randomly selected hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without hypoglycemia. We investigated the relationships of hypoglycemia with total mortality and cardiovascular events, including stroke, coronary heart disease, cardiovascular diseases, and all-cause hospitalization.
RESULTS
There were 1,844 hypoglycemic events (500 inpatients and 1,344 outpatients) among the 77,611 patients. Both mild (outpatient) and severe (inpatient) hypoglycemia cases had a higher percentage of comorbidities, including hypertension, renal diseases, cancer, stroke, and heart disease. In multivariate Cox regression models, including diabetes treatment adjustment, diabetic patients with hypoglycemia had a significantly higher risk of cardiovascular events during clinical treatment periods. After constructing a model adjusted with propensity scores, mild and severe hypoglycemia still demonstrated higher hazard ratios (HRs) for cardiovascular diseases (HR 2.09 [95% CI 1.63-2.67]), all-cause hospitalization (2.51 [2.00-3.16]), and total mortality (2.48 [1.41-4.38]).
CONCLUSIONS
Symptomatic hypoglycemia, whether clinically mild or severe, is associated with an increased risk of cardiovascular events, all-cause hospitalization, and all-cause mortality. More attention may be needed for diabetic patients with hypoglycemic episodes.