| Objective:To investigate the prevalence,characteristics and risk factors of hypoglycemia in hospitalized elderly patients with type 2 diabetes,and to explore the preventive and therapeutic strategies of hypoglycemia in hospitalized elderly patients with type 2 diabetes.Methods:1.Nova blood glucose management system was used to collect the capillary blood glucose data of T2DM patients over 60 years old who was admitted in the first-affiliated hospital of Kunming Medical University from July 2016 to June 2018,data collection included random blood sugar,fasting,before lunch,before dinner,after meals,before bed time and 3:00 am.To understand the blood sugar control during hospitalization and analyze the incidence of hypoglycemia during hospitalization in elderly patients with diabetes;2.Screening out 143 cases elderly patients with hypoglycemia and collecting general information(including age,gender,duration of disease,body mass index(BMI)),laboratory data(glycated hemoglobin)(Glycated hemoglobin,HbA1c))and its comorbidities and medications,analysis of its clinical characteristics.3.Further analysis of the occurrence of asymptomatic hypoglycemia and its clinical features.Results:1.A total of 885 elderly patients(76.22±9.88years)with diabetes were enrolled in this study.Their average blood glucose was(9.54±3.2)mmol/L;average fasting blood glucose was(7.5±2.08)mmol/L;average 2-hour postprandial blood glucose was(10.12±2.97)mmol/L.2.143 cases of hypoglycemia were detected.Their age is(72.95±8.34)years,BMI(23.35±2.74)kg/m2 and HbA1C 8.6%(7.40%,10.20%),respectively.The prevalence of hypoglycemia was 16.2%.among these patients,17 cases were severe hypoglycemia.The prevalence of severe hypoglycemia was 1.9%;3.There were 143 hypoglycemia patients with Comorbidity and Polypharmacy,142 patients had 2 or more diseases,accounting for 99.3%,and the disease was followed by 119 cases of hypertension,accounting for 83.2%,and 118 cases of peripheral atherosclerosis.accounting for 82.5%,54 cases of senile cataract,accounting for 37.8%.119 cases of multiple medications,accounting for 83.2%,The types of drugs taken including:127 cases of insulin,accounting for 88.8%,statin 124 cases,accounting for 86.7%,aspirin 81 cases,accounting for 56.6%.4.The causes of hypoglycemia:98 cases becuase of drug factors,accounting for 68.5%,44 cases becuase of dietary factors,accounting for 30.8%,1 case because of exercise factors,accounting for 0.7%,in drug factors,91 cases who used insulin,accounting for 92.8%,oral drug alone 7 cases,according for 7.1%.85 hypoglycemia patients with multiple drugs were attributed to Drug factors,accounting for 86.7%,the drugs including:91 cases used insulin,accounting for 92.9%,83 cases used statins,accounting for 84.7%,58 cases used aspirin,accounting for 59.2%;5.108 cases were asymptomatic hypoglycemia patients,accounting for 75.5%,35 cases were symptomatic hypoglycemia patients,accounting for 24.5%(P=0.00).Comparison of symptomatic and asymptomatic patients in patients with hypoglycemia:the years of age(72.93±8.20)years VS(73.03±8.90)years(P=0.95);BMI(23.33±2.82)kg/m2 VS(23.42±2.54)kg/m2(P=0.86);HbA1C was 8.30%(7.13,9.85)VS 9.70%(8.00,10.73)(P=0.02);the average blood glucose(9.47±3.64)mmol/L VS(10.12±3.80)mmol/L(P=0.00);fasting plasma glucose(7.46+±2.61)mmol/L VS(7.74±2.57)mmol/L(P=0.06);average 2-hour postprandial blood glucose was(9.99±3.43)mmol/L VS(10.97±3.65)mmol/L(P=0.00),There was a significant difference of glycosylated hemoglobin,the average blood glucose,and 2-hour postprandial blood sugar,between hypoglycemia patients with and without symptomatic.Conclusion:1.The incidence of hypoglycemia was 16.2%in the elderly patients with diabetes mellitus during treatment,the incidence of severe hypoglycemia was 1.9%.The main cause of hypoglycemia is drug factors,especially in patients with insulin.Therefore,in patients with insulin,it is necessary to be alert to low blood sugar.2.The incidence of asymptomatic hypoglycemia was as high as 75.5%.Compared with the symptom hypoglycemia group,the average blood glucose,fasting and 2 hours postprandial blood glucose were lower.It should pay attention to the stratified control of blood glucose in elderly diabetic patients,avoiding the occurrence of hypoglycemia and blood sugar.Patients with strict hypoglycemia are more likely to develop asymptomatic hypoglycemia.3.The comorbidity rate of hospitalized elderly patients with diabetes mellitus and hypoglycemia was as high as 99.3%,and the incidence of peripheral atherosclerosis was 82.5%.It is particularly important for this group to avoid adverse cardiovascular and cerebrovascular events induced by hypoglycemia.4.More than half of the patients have multiple medications.The combination of statins and aspirin is the most used.It should be avoided to avoid the interaction between drugs and avoid adverse events. |
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