住院2型糖尿病患者低血糖事件流行病学 特征研究

Study on Epidemiological Characteristics of Hypoglycemic Events in Hospitalized Patients with Type 2 Diabetes Mellitus

摘要: 目的：通过病历资料分析总结住院期间发生低血糖的2型糖尿病患者临床特点，为识别高风险患者提供临床资料。方法：收集2013年1月至2022年12月住院期间静脉血糖 ≤ 3.9 mmol/L的成年非妊娠糖尿病患者，提取基本信息、实验室检查、用药方案及离院方式等指标，并按患者住院科室分为内分泌科与非内分泌科进行分组比较；以是否发生重度低血糖为因变量，采用二元Logistic回归分析其相关危险因素。结果：出院诊断中含有2型糖尿病诊断患者174,658例，其中8827例出现住院期间静脉血糖 ≤ 3.9 mmol/L，平均年龄64.4 ± 12.1岁，男性4669例(52.89%)，女性4158例(47.11%)。2013至2022年糖尿病住院人数持续增长，低血糖发生率呈下降趋势。8827例低血糖患者按年龄分层后，随年龄增长离院方式为死亡的患者比例逐渐上升，在76岁后死亡比例上升显著；按低血糖程度分组，轻度低血糖占71.59%，重度低血糖占7.62%，重度低血糖患者中58.25%的患者年龄大于等于66岁；重度低血糖患者多集中于心血管内科(9.81%)、肾病科(8.47%)、胃肠外科(7.13%)、急诊内科(6.98%)和神经内科(5.94%)。2013年~2021年预混胰岛素使用比例下降，新型糖尿病药物使用比例明显上升。多因素分析显示，非内分泌科住院为重度低血糖发生的独立危险因素(OR = 2.26, 95%CI: 1.42~3.79, P = 0.001)。结论：住院糖尿病患者逐年增多，低血糖发生率表现为下降趋势，重度低血糖患者呈逐年减少趋势。重度低血糖患者主要集中于心血管内科、肾病科、胃肠外科、急诊内科等科室，且年龄多在66岁以上，提示非内分泌科住院患者面临更高的重度低血糖管理风险。

Abstract: Objective: To analyze and summarize the clinical characteristics of hospitalized patients with type 2 diabetes mellitus (T2DM) who developed hypoglycemia during hospitalization, and to provide clinical evidence for identifying high-risk patients. Methods: Adult non-pregnant diabetic patients with venous blood glucose ≤ 3.9 mmol/L during hospitalization from January 2013 to December 2022 were enrolled.Indicators including baseline characteristics, laboratory examinations, medication regimens, and discharge status were extracted, and the patients were divided into endocrinology department and non-endocrinology department groups for comparative analysis.Taking the occurrence of severe hypoglycemia as the dependent variable, binary Logistic regression analysis was used to identify the related risk factors. Results: Among 174,658 hospitalized patients with a discharge diagnosis of T2DM, 8827 experienced venous blood glucose ≤ 3.9 mmol/L during hospitalization. The mean age was 64.4 ± 12.1 years; 4669 were male (52.89%) and 4158 were female (47.11%). From 2013 to 2022, the number of hospitalized patients with diabetes increased continuously, while the incidence of hypoglycemia showed a declining trend. After age stratification among the 8827 patients with hypoglycemia, the proportion of patients discharged due to death increased progressively with advancing age, with a marked rise after 76 years. According to hypoglycemia severity, mild hypoglycemia accounted for 71.59% and severe hypoglycemia for 7.62%; among patients with severe hypoglycemia, 58.25% were aged ≥ 66 years. Severe hypoglycemia cases were mainly concentrated in the departments of cardiology (9.81%), nephrology (8.47%), gastrointestinal surgery (7.13%), emergency medicine (6.98%), and neurology (5.94%). From 2013 to 2021, the proportion of premixed insulin use declined, whereas the use of newer antidiabetic agents increased markedly. Non-endocrinology hospitalization was independently associated with severe hypoglycemia (OR 2.26, 95% CI 1.42~3.79, P = 0.001). Conclusions: The number of hospitalized patients with diabetes has increased year by year, while the incidence of hypoglycemia has shown a downward trend, accompanied by a gradual reduction in severe hypoglycemia. Severe hypoglycemia predominantly occurs in departments such as cardiology, nephrology, gastrointestinal surgery, and emergency medicine, and mainly affects patients aged 66 years or older, highlighting the need for strengthened hypoglycemia management in non-endocrinology departments.