JCEM：SH和DKA在SES较低的患者中更常见

很少有研究评估成年人1型糖尿病重度低血糖（SH）和糖尿病酮症酸中毒（DKA）的相关因素。为了确定成年人1型糖尿病重度低血糖和糖尿病酮症酸中毒发生的频率和相关因素，来自美国芭芭拉·戴维斯儿童糖尿病中心Kellee M Miller教授及其团队进行了一项研究，该研究发现在较低社会经济地位（SES）的患者中，重度低血糖和糖尿病酮症酸中毒更常见。该研究结果在线发表在2013年6月12日的《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究是对来自1型糖尿病交流中心临床登记的横断面分析，包括70家美国内分泌中心。分析包括7012例在1型糖尿病交流中心临床登记、年龄26-93岁、1型糖尿病病程≥2年的受试者。

该研究结果表明，较高频率的重度低血糖和糖尿病酮症酸中毒与较低的社会经济地位（SES）有关（p＜0.001）。重度低血糖与糖尿病病程密切相关（p＜0.001），糖尿病病程大于≥40年的患者中，18.6%在过去12个月期间有重度低血糖发生。HbA1c水平在7.0%（53mmol/mol）至7.5%（58mmol/mol）的患者中，重度低血糖的频率最低，而在HbA1c水平＜7.0%（＜53mmol/mol）或HbA1c水平＞7.5%（＞58mmol/mol）的患者中，重度低血糖的频率增加。在较高HbA1c水平的患者中，糖尿病酮症酸中毒的发生频率增加（p＜0.001），HbA1c≥10.0%的患者中，21.0%在过去12个月期间有酮症酸中毒发生。

该研究发现，在较低社会经济地位（SES）的患者中，重度低血糖和糖尿病酮症酸中毒更常见。糖尿病酮症酸中毒在HbA1c≥10.0%的患者中最常见，应该在很大程度上是可以预防的。相反，重度低血糖在糖尿病病程≥40年的患者最常见，由于当前治疗的限制，这不能被消除。在糖尿病病程长的成年人，为了减少重度低血糖的发生，应当考虑改变HbA1c控制目标，特别是在那些HbA1c水平非常低的患者。

Severe Hypoglycemia and Diabetic Ketoacidosis in Adults with Type 1 Diabetes: Results from the T1D Exchange Clinic Registry.
Context
Few studies have assessed factors associated with severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D).
Objective
Determine frequency of and factors associated with the occurrence of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) in adults with type 1 diabetes.
Design
Cross-sectional analysis from the T1D Exchange clinic registry.
Setting
70 U.S. endocrinology centers
Patients
Analysis included 7,012 participants in the T1D Exchange clinic registry aged 26-93 years old with T1D for ≥ 2 years.
Results
Higher frequencies of SH and DKA were associated with lower socio-economic status (SES) (p<0.001). SH was strongly associated with diabetes duration (p<0.001), with 18.6% of those with diabetes ≥40 years having an event in the past 12 months. SH frequency was lowest in those with HbA1c levels of 7.0% (53 mmol/mol) to 7.5% (58 mmol/mol), being higher in those with HbA1c levels <7.0% (<53 mmol/mol) or >7.5% (>58 mmol/mol). DKA frequency increased with higher HbA1c levels (p<0.001), with 21.0% of those with HbA1c ≥10.0% (≥86 mmol/mol) having an event in the past 12 months.
Conclusions
SH and DKA are more common in those with lower SES. DKA, most common in those with HbA1c ≥10.0% (≥86 mmol/mol), should be largely preventable. In contrast, SH, most frequent with diabetes ≥40 years duration, cannot be abolished given the limitation of current therapies. To reduce SH in adults with longstanding diabetes, consideration should be given to modifying HbA1c goals, particularly in patients with very low HbA1c levels.