探索与反思血糖达标与低血糖的再思考.ppt

内源性胰岛素分泌决定胰高血糖素反应 强化血糖控制可增加重度低血糖发生率 DCCT和UKPDS:强化血糖治疗与低血糖发生的风险 为什么2型糖尿病胰岛素强化治疗的低血糖发生率较1型糖尿病少 虽然胰高糖素反应受损，但是儿茶酚胺反应通常不受影响 2型糖尿病患者存在胰岛素抵抗 2型糖尿病患者存在残余的β细胞功能，可以调节自身胰岛素分泌量 2型糖尿病患者较少接受胰岛素强化治疗，所以重度低血糖的发生风险较低，发生未察觉低血糖的可能性较低 从基础到临床-强化治疗中全因死亡率的增加不能完全归咎于低血糖 OBJECTIVE— To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes. RESEARCHDESIGNANDMETHODS— Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, am- bulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated. RESULTS— A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients treated with insulin, respectively. Age, duration, and socioeconomic status were identi?ed as risk factors for severe hypoglycemia. One in three cases were treated solely by the ambulance service with no other contact from health care professionals. The total estimated cost of emergency treatment of severe hypoglycemia was
￡92,078 in one year. CONCLUSIONS— Hypoglycemia requiring emergency assistance from health service personnel is as common in people with type 2 diabetes treated with insulin as in people with type 1 diabetes. It is associated with considerable NHS resource use that has a signi?cant economic and personal cost. To report on the out-of-pocket expenses incurred by insulin-treated patients to manage blood glucose levels.this retros