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　　德國研究者進(jìn)行的一項(xiàng)前瞻性研究（BMC Endocr Disord. 2012 Oct 17;12(1):23）表明，低血糖是接受強(qiáng)化降糖治療的2型糖尿病門診患者的常見并發(fā)癥。既往發(fā)生過低血糖、微血管疾病（如視網(wǎng)膜病變）和接受胰島素治療的患者，尤其需要注意預(yù)防低血糖發(fā)生。服用噻唑烷二酮類藥物、DPP-4抑制劑與GLP-1類似物的患者發(fā)生低血糖的風(fēng)險(xiǎn)較低。

　　DiaRegis是一項(xiàng)前瞻性注冊(cè)研究，入選3810例接受強(qiáng)化降糖治療的2型糖尿病患者。全部3347例取得數(shù)據(jù)的患者中，12個(gè)月隨訪期內(nèi)共出現(xiàn)473（14.1%）例低血糖。發(fā)生低血糖的患者糖尿病病程較長、糖化血紅蛋白（HbA1c）水平更高、既往有吸煙史的比例更高。此外，發(fā)生低血糖的患者在基線時(shí)合并其他疾病如冠脈疾病、外周血管病、心衰、截肢、周圍神經(jīng)病變、糖尿病視網(wǎng)膜病變與抑郁的比例更高。

　　Incidence and predictors of hypoglycaemia in type 2 diabetes – an analysis of the prospective DiaRegis registry

　　Background

　　Hypoglycaemia is a serious adverse effect of antidiabetic drug therapy. We aimed to determine incidence rates of hypoglycaemia in type-2 diabetic patients and identify predictors of hypoglycaemia when treatment is intensified.

　　Methods

　　DiaRegis is a prospective German registry that follows 3810 patients with type-2 diabetes referred for treatment intensification because of insufficient glycaemic control on one or two oral antidiabetic drugs.

　　Results

　　Out of a total of 3347 patients with data available for the present analysis 473 (14.1%) presented any severity hypoglycaemia over a follow-up of 12 months. 0.4% were hospitalized (mean of 1.3±0.6 episodes), 0.1% needed medical assistance (1.0±0.0), 0.8% needed any help (1.1±0.5) and 10.1% no help (3.4±3.7), and 8.0% had no specific symptoms (3.6±3.5). Patients with incident hypoglycaemia had longer diabetes duration, higher HbA1c and a more frequent smoking history; more had co-morbid disease conditions such as coronary artery disease, pe**heral arterial disease, amputation, heart failure, pe**heral neuropathy, diabetic retinopathy and clinically relevant depression at baseline. Multivariable adjusted positive predictors of incident hypoglycaemia over the follow-up were prior anamnestic hypoglycaemia, retinopathy, depression, insulin use and blood glucose self-measurement, but not sulfonylurea use as previously reported for anamnestic or recalled hypogylcaemia. On the contrary, glitazones, DPP-4 inhibitors and GLP-1 analogues were associated with a reduced risk of hypoglycaemia.

　　Conclusions

　　Hypoglycaemia is a frequent adverse effect in ambulatory patients when antidiabetic treatment is intensified. Particular attention is warranted in patients with prior episodes of hypoglycaemia, microvascular disease such as retinopathy and in patients receiving insulin. On the other hand glitazones, DPP-4 inhibitors and GLP-1 analogues are associated with a reduced risk.