Occurrence and risk factors of hypoglycemia in type 2 diabetes mellitus patients treated with continuous subcutaneous insulin infusion during perioperative period

doi:10.16138/j.1673-6087.2024.02.07

Abstract

Abstract:

Objective To investigate the occurrence and risk factors of type 2 diabetes mellitus (T2DM) patient treated with continuous subcutaneous insulin infusion (CSII) hypoglycemia during perioperative period. Methods A total of 96 patients with fractures and T2DM who received CSII therapy during perioperative period in Beijing Jishuitan Hospital were selected as research subjects. Clinical data including medical history, glycosylated hemoglobin (HbA_1c), liver and kidney function, occurrence of hypoglycemia and postoperative complications were collected. Logistic regression analysis was used to analyze the risk factors of hypoglycemia. Results The average time reaching the blood glucose target was (2.8±1.3) d in the perioperative patients with T2DM received intensive CSII treatment, and the overall incidence of hypoglycemia was 15.6%. There were 15 patients in the hypoglycemia group and 81 patients in the non-hypoglycemia group. Compared with the non-hypoglycemia group, the hypoglycemia group was older [(71.1±11.1) years vs (56.0±10.6) years, P=0.000] and had longer course of disease [14.0 (8.8-17.8) years vs 5 (2.8-12.0) years, P=0.017], lower estimated glomerular filtration rate (eGFR) [(78.7±27.5) mL/(min·1.73 m²) vs (106.8±15.0) mL/(min·1.73 m²), P=0.005], and higher incidence of postoperative infection (25% vs 3%, P=0.024). Logistic regression analysis showed that older age (OR=1.172, 95%CI: 1.027-1.091, P=0.012), longer course of disease (OR=1.193, 95%CI: 1.001-1.420, P=0.049) and lower eGFR (OR=0.950, 95%CI: 0.903-0.998, P=0.049) were independent risk factors for hypoglycemia in perioperative T2DM patients treated with CSII. Conclusions The perioperative T2DM patients can quickly achieve the blood glucose target through CSII therapy. Older age, long course of diabetes and low eGFR level are risk factors for hypoglycemia.

Key words: Perioperative period, Type 2 diabetes mellitus, Continuous subcutaneous insulin infusion, Hypoglycemia

CLC Number:

R587

BAI Yuanyuan, HUO Lili, LI Wei, LAN Ling, DENG Wei. Occurrence and risk factors of hypoglycemia in type 2 diabetes mellitus patients treated with continuous subcutaneous insulin infusion during perioperative period[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 126-129.

Figures/Tables 2

Table 1

Table 2

References 19

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项目		非低血糖组 (n=81)	低血糖组（n=15）	t/Z	P
年龄（岁）		56.0±10.6	71.1±11.1	-4.484	0.000
性别（男性/女性）		50/31	5/10	3.448	0.110
糖尿病病程（年）		5（2.8~12.0）	14.0（8.8~17.8）	-2.993	0.017
BMI（kg/m²）		25.1±3.5	25.5±4.0	-0.233	0.817
HbA_1c（%）		8.2±1.5	7.8±1.6	0.844	0.401
eGFR[mL/(min·1.73 m²)]		106.8±15.0	78.7±27.5	3.456	0.005
是否联合口服降糖药（是/否）		23/58	5/10	2.139	0.699
达标时间（d）		2.8±1.2	2.7±1.4	-0.221	0.826
胰岛素用量[U/（Kg·d）]		0.69±0.15	0.69±0.14	-0.003	0.815
基础量（U）		24.3±8.4	22.5±7.8	0.676	0.501
餐前大剂量（U）
	早餐前	9.0±2.3	8.8±2.0	0.169	0.866
	午餐前	8.2±2.4	8.5±2.6	-0.418	0.677
	晚餐前	7.8±2.2	7.9±2.9	-0.195	0.846

变量	β	Wald χ²	P	OR	95% CI
年龄	0.159	6.314	0.012	1.172	1.027~1.091
糖尿病病程	0.175	3.886	0.049	1.193	1.001~1.420
BMI	0.071	0.242	0.622	1.074	0.809~1.426
HbA_1c	0.242	0.443	0.506	1.276	1.184~4.772
eGFR	-0.051	3.887	0.049	0.950	0.903~0.998
胰岛素用量	-0.223	1.185	0.276	0.800	0.456~5.308
常量	-9.693	1.964	0.161	0.000