Hypoglycemia in People with Type 2 Diabetes and CKD
Hypoglycemia in People with Type 2 Diabetes and CKD
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DOI：
10.2215/cjn.11650918
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发表时间：
2019-06-07
影响因子：
9.8
通讯作者：
de Boer, Ian H.
中科院分区：
文献类型：
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作者：
Ahmad, Iram;Zelnick, Leila R.;de Boer, Ian H.
背景和目的在糖尿病患者中，CKD可能通过改变降糖药物的清除率、降低肾脏糖异生和减弱反调节反应来促进低血糖。我们对105例接受胰岛素或磺脲类药物治疗的2型糖尿病患者进行了一项前瞻性观察性低血糖研究。设计、设置、参与者和测量纳入81例ckd患者，定义为eGFR为60ml/min / 1.73m2，对照组为24例eGFR为60ml/min / 1.73m2，频率与年龄、糖尿病病程、糖化血红蛋白和降糖药物相匹配。每位参与者连续两次佩戴血糖监测仪，为期6天。我们检查了CKD参与者中持续1级低血糖（70 mg/dl）和2级低血糖（54 mg/dl）的发生率。然后，我们使用泊松和线性回归测试了与对照参与者以及第二个对照人群（n= 73）相比的差异，调整了年龄、性别和种族。结果在890天的连续血糖监测中，CKD患者观察到255次1级低血糖发作，其中68次达到2级低血糖。低血糖发作的中位率为每30天5.3次（四分位数范围为0.0-11.7），低血糖发作的平均时间为每天28分钟（SD 37）。糖化血红蛋白和葡萄糖管理指标是低血糖时间的主要临床相关因素（糖化血红蛋白或葡萄糖管理指标每升高1%，每天减少的调整差异分别为6[95%可信区间，2 ~ 10]和13[95%可信区间，7 ~ 20]）。与对照人群相比，CKD患者出现低血糖的时间没有观察到显著差异（调整后的差异4[95%可信区间，212 - 20]和212[95%可信区间，229 - 5]分钟/天）。结论：在2型糖尿病和中重度CKD患者中，低血糖是常见的，尤其是血糖控制严格的患者，但与具有相似临床特征和保留eGFR的组相比，无显著差异。
Background and objectives Among people with diabetes mellitus, CKD may promote hypoglycemia through altered clearance of glucose-lowering medications, decreased kidney gluconeogenesis, and blunted counterregulatory response. We conducted a prospective observational study of hypoglycemia among 105 individuals with type 2 diabetes treated with insulin or a sulfonylurea using continuous glucose monitors.Design, setting, participants& measurementsWeenrolled81 participantswithCKD, defined as eGFR, 60 ml/min per 1.73m2, and 24 control participantswith eGFR$ 60ml/min per 1.73m2 frequency-matched on age, duration of diabetes, hemoglobin A1c, and glucose-lowering medications. Each participant wore a continuous glucose monitor for two 6-day periods. We examined rates of sustained level 1 hypoglycemia (, 70 mg/dl) and level 2 hypoglycemia (, 54 mg/dl) among participants with CKD. We then tested differences compared with control participants as well as a second control population (n= 73) using Poisson and linear regression, adjusting for age, sex, and race.Results Over 890 total days of continuous glucose monitoring, participants with CKD were observed to have 255 episodes of level 1 hypoglycemia, of which 68 episodes reached level 2 hypoglycemia. Median rate of hypoglycemic episodes was 5.3 (interquartile range, 0.0-11.7) per 30 days andmean time spent in hypoglycemia was 28 (SD 37) minutes per day. Hemoglobin A1c and the glucose management indicator were the main clinical correlatesof timeinhypoglycemia (adjusteddifferences 6 [95% confidence interval, 2 to 10] and13 [95% confidence interval, 7 to 20] fewer minutes per day per 1% higher hemoglobin A1c or glucose management indicator, respectively). Compared with control populations, participants with CKD were not observed to have significant differences in time in hypoglycemia (adjusted differences 4 [95% confidence interval, 212 to 20] and 212 [95% confidence interval, 229 to 5] minutes per day).Conclusions Among people with type 2 diabetes and moderate to severe CKD, hypoglycemia was common, particularly with tighter glycemic control, but not significantly different from groups with similar clinical characteristics and preserved eGFR.