Circulation：二甲双胍不要太多，低血糖使糖尿病患者死亡风险增加

2017-03-11 榕榕来宝网

qiushida

中国中医科学院西苑医院医生/ 主治医师

关于降糖“一哥”的三个问题，看最新共识怎么说

严重低血糖与糖尿病患者死亡风险增加相关，约翰·霍普金斯彭博公共卫生学院对患有2型糖尿病的老年人的研究发现，血糖降低到需要急诊的单一实例几乎是心血管疾病或死亡的两倍。

此外，使用来自大型纵向研究的数据，研究人员发现，三分之一的糖尿病老年人患有严重的低血糖事件（低血糖），在事件发生的三年内死亡。

研究人员说，他们的研究结果表明，医生可能希望特别注意在失去意识，癫痫发作或经历另一次严重的健康事件后被送往急诊室接受低血糖治疗的患者。研究结果于3月10日在美国心脏协会的EPI | LIFESTYLE 2017年科学会议上发表。

彭博学校流行病学博士候选人Alexandra K. Lee说：“如果你有一位患有严重低血糖病史的患者，这对他或她的未来可能很不利。”

该研究的资深作者Elizabeth Selvin博士说：“低血糖是糖尿病患者死亡和心血管疾病的一个未被公认的危险因素。”

糖尿病是一种以身体不能适当控制血液中葡萄糖（糖）水平为特征的疾病。血糖控制不良 - 当血糖水平过高 - 可能导致并发症，如失明和神经损伤。根据疾病控制和预防中心，约有2900万美国人患有糖尿病，其他估计说，约85％的人正在服用药物来降低血糖。

有时，那些用药物降低血糖的努力太过分了。Lee说，每100名患有糖尿病的人每年有一至两人经历严重低血糖。

研究人员分析了社区动脉粥样硬化风险（ARIC）队列的参与者的数据，该研究对美国四个社区的15792名居民进行了研究，他们在1987年开始研究年龄介于45岁和64岁之间的人。具体来说，研究人员聚焦于1，198例2型糖尿病患者，平均随访15年。他们发现192例经历低血糖导致急诊或住院治疗。这些人是没有严重低血糖的糖尿病患者死亡的可能性的两倍。

研究人员说，过去的研究表明，经历严重低血糖的人经历低水平的心脏损伤，因此低血糖与心血管疾病死亡之间的生物学联系可能是这种情况的延伸。此外，研究人员说，不清楚患有低血糖发作的人是否已经比那些没有发生低血糖事件的人更加严重，或者是否发作使他们感到不适。

Selvin说，糖尿病药物，如旨在降低高血糖的二甲双胍，在一些患者中可能是有价值的，但如果糖尿病药物使用不当，血糖可能会降低。

原始出处：

Alexandra K Lee1, Bethany Warren1, et al. Abstract 43: Association of Severe Hypoglycemia With Cardiovascular Disease and All-cause Mortality in Older Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2017;135:A43

小M推荐：关于降糖“一哥”的三个问题，看最新共识怎么说

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2017-05-21 sunylz

#患者死亡#

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2017-03-14 邓启付

二甲双胍是最常用的糖尿病药物。

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2017-03-13 xue8604

#糖尿病患者#

95 0
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2017-03-13 quxin068

#死亡风险#

88 0
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2017-03-13 方舒

单药也会出现低血糖吗

128 0
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2017-03-13 ylzr123

认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。

132 0
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2017-03-13 邓启付

低血糖对糖尿病患者死亡风险增加。

133 0
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2017-03-13 卡圣

受益不浅，好好学习了

122 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Mar 13 11:11:07 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179531, encodeId=b9871e9531db, content=低血糖对糖尿病患者死亡风险增加。, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Mon Mar 13 08:46:32 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179507, encodeId=a1cc1e950739, content=受益不浅，好好学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Mon Mar 13 08:11:34 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179450, encodeId=b45b1e9450d9, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Mon Mar 13 00:09:55 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179327, encodeId=4b171e9327f9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaEJicFGXtYqfjGiaibNdjOiaRgkexnXiciaDeXaLiaKicovcicDugdYwRPSnQj3FlfXBwVLB5ANB9PGFyB0kraQ/0, createdBy=35b01663265, createdName=1ddf3e1dm99(暂无匿称), createdTime=Sun Mar 12 11:49:51 CST 2017, time=2017-03-12, status=1, ipAttribution=)]
2017-03-13 1dd8f26bm82(暂无匿称)

好资源

79 0
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createdName=邓启付, createdTime=Tue Mar 14 07:00:26 CST 2017, time=2017-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474130, encodeId=64cc14e41306d, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Mar 13 12:57:00 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1255616, encodeId=6ccc12556163b, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Mon Mar 13 12:57:00 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179575, encodeId=a1181e95755c, content=单药也会出现低血糖吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5KiblTyxD95ExbzUoCVcRuhPibXboL28wicFMTXUhCA0RWCyQZYC5Na3ap7CxjialMkB50VEJ0XToQQTC/0, createdBy=470c1945776, createdName=方舒, createdTime=Mon Mar 13 12:22:51 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179554, encodeId=3cc91e9554ed, content=认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Mar 13 11:11:07 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179531, encodeId=b9871e9531db, content=低血糖对糖尿病患者死亡风险增加。, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Mon Mar 13 08:46:32 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179507, encodeId=a1cc1e950739, content=受益不浅，好好学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Mon Mar 13 08:11:34 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179450, encodeId=b45b1e9450d9, content=好资源, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150714/IMG55A4FADCE0F987688.jpg, createdBy=23af1632396, createdName=1dd8f26bm82(暂无匿称), createdTime=Mon Mar 13 00:09:55 CST 2017, time=2017-03-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=179327, 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2017-03-12 1ddf3e1dm99(暂无匿称)

学习了

73 0