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首页> 外文期刊>Diabetes care >Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
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Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

机译：严重的低血糖和2型糖尿病患者的风险：社区（ARIC）研究中的动脉粥样硬化风险

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OBJECTIVE Hypoglycemia has been postulated to contribute to falls risk in older adults with type 2 diabetes. However, few studies have prospectively examined the association between severe hypoglycemia and falls, both important causes of morbidity and mortality. RESEARCH DESIGN AND METHODS We conducted a prospective cohort analysis of participants from the Atherosclerosis Risk in Communities (ARIC) study with diagnosed diabetes at visit 4 (1996-1998). Episodes of severe hypoglycemia requiring medical treatment were identified using ICD-9 codes from hospitalizations, emergency department visits, and ambulance calls; total falls were identified from medical claims using E-codes from 1996 to 2013. Secondary analyses examined hospitalized falls and falls with fracture. We calculated incidence rates and used Cox regression models to evaluate the independent association of severe hypoglycemia with falls occurring after visit 4 through 2013. RESULTS Among 1,162 participants with diabetes, 149 ever had a severe hypoglycemic event before baseline or during the median of 13.1 years of follow-up. The crude incidence rate of falls among persons without severe hypoglycemia was 2.17 per 100 person-years (PY) (95% CI 1.93-2.44) compared with 8.81 per 100 PY (6.73-11.53) with severe hypoglycemia. After adjustment, severe hypoglycemia was associated with a more than twofold higher risk of falls (hazard ratio 2.23, 95% CI 1.61-3.07). Associations were consistent in subgroups defined by age, sex, race, BMI, duration of diabetes, or functional difficulty. CONCLUSIONS Severe hypoglycemia was associated with a substantially higher risk of falls in this community-based population of adults with diabetes. Fall risk should be considered when individualizing glycemic treatment in older adults. Assessing hypoglycemia history and future hypoglycemia risk could also improve multifactorial fall prevention interventions for older adults with diabetes.
机译：目的的低血糖已经发布，有助于患有2型糖尿病的老年人风险。然而，很少有研究已经前瞻性地检查了严重低血糖和跌倒之间的关联，其既有发病率和死亡率的重要原因。研究设计与方法我们对来自诊断糖尿病（1996-1998）进行了诊断的糖尿病的社区（ARIC）研究中的参与者的前瞻性队列分析。使用来自住院，急诊部门访问和救护车呼叫的ICD-9代码确定需要医疗治疗的严重低血糖的剧集;使用1996年至2013年的电子代码从医学索赔中确定了总跌倒。审查住院的二次分析跌倒并落后于骨折。我们计算发病率和使用COX回归模型，以评估在2013年4到2013年后发生的瀑布的严重低血糖的独立关联。结果1,162名糖尿病参与者之间的结果，149例在基线之前进行了严重的低血糖事件，或者在13.1岁的中位数进行了严重的低血糖发生的事件跟进。没有严重低血糖症的人的堕落中的原始发病率为每100人 - 年（PY）（PY）（95％CI 1.93-2.44），与8.81％（6.73-11.53），具有严重的低血基血症。调整后，严重的低血糖与较高的跌落风险超过两倍（危险比2.23,95％CI 1.61-3.07）相关。在由年龄，性别，种族，BMI，糖尿病持续时间或功能困难定义的亚组中，缔约置是一致的。结论严重的低血糖与糖尿病患者的基于社区的成年人人群的贫民风险显着较高。在老年人的血糖治疗时，应考虑秋季风险。评估低血糖历史和未来的低血糖风险也可以改善对糖尿病患者的老年人的多因素终止疗效。

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