期刊
DIABETES-METABOLISM RESEARCH AND REVIEWS
卷 30, 期 6, 页码 497-504出版社
WILEY
DOI: 10.1002/dmrr.2547
关键词
diabetes mellitus; type 1; diabetic ketoacidosis; severe hypoglycaemia; incidence; risk factors; Chinese
资金
- Guangdong Provincial Department of Science and Technology [2010B031500008]
- Sun Yat-Sen University Clinical Research 5010 Programme [2007030]
- National Science Fund for Distinguished Young Scholars [81025005]
- 985 Project [82000-3281901]
- New Drug Development, Construction and Management of Clinical Biobank for Major Disease [2011ZX0907-001-08]
- Health Department of Fujian Province [2013-2-87]
- Novo Nordisk
- Sanofi-Aventis
- Bayer
- Johnson Johnson
- Medtronic
BackgroundDiabetic ketoacidosis (DKA) and severe hypoglycaemia are common acute complications of type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of, and risk factors for, these complications in Chinese patients with established T1DM. MethodsThis cross-sectional study recruited patients with established T1DM from 16 centres in Guangdong Province, China. Incidence rates were expressed as episodes/100 patient-years. Regression models identified risk factors for the occurrence and recurrence of secondary DKA and severe hypoglycaemia. ResultsA total of 611 patients with established T1DM (53.7% women) were recruited. The incidence of secondary DKA and severe hypoglycaemia was 26.4 (22.4, 31.0) and 68.8 (62.2, 76.0)/100 patient-years, respectively. Significant risk factors for secondary DKA were female gender [relative risk (RR)=2.12], medical reimbursement rate <50% (RR=1.84), uncontrolled diet (RR=1.76), smoking (RR=2.18) and poor glycaemic control [glycated haemoglobin A(1c) (HbA(1c))/1.0% increase; RR=1.15]. Overweight/obesity was a protective factor (RR=0.57). Significant risk factors for severe hypoglycaemia included male gender (RR=1.71), medical reimbursement rate<50% (RR=1.36), longer duration of T1DM (per 5-year increase, RR=1.22), underweight (RR=1.44), uncontrolled diet (never controlled' or sometimes controlled' vs. usually controlled', RR=2.09 or 2.02, respectively), exercise <150min/week (RR=1.66), presence of neuropathy (RR=1.89), smoking (RR=1.48) and lower HbA(1c) values (per 1.0% decrease, RR=1.46). Overweight/obesity was a protective factor (RR=0.62). Additionally, 34.4% of secondary DKA and 81.1% of severe hypoglycaemia episodes occurred in 3.8% and 16.2% patients with recurrent events (two episodes), respectively. ConclusionsThe results indicate that secondary DKA and severe hypoglycaemia occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. Comprehensive management of T1DM should include recommendations to control modifiable risk factors. Copyright (c) 2014 John Wiley & Sons, Ltd.
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