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中国全科医学

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2型糖尿病患者低血糖感知受损现状及影响因素研究

付铭源1，于潇漪2，葛彩英2，孔慜2*   

  1. 1.100069 北京市，首都医科大学全科医学与继续教育学院 2.100078 北京市丰台区方庄社区卫生服务中心
  • 收稿日期:2025-03-05 修回日期:2025-06-17 接受日期:2025-07-01
  • 通讯作者: 孔慜，主任医师；E-mail：267475112@qq.com
  • 基金资助:
    首都卫生发展科研专项（首发 2023-2S-001）

Impaired Awareness of Hypoglycaemia: Prevalence and Determinants Among Community-Based Patients with Type 2 Diabetes Mellitus in an Urban District

FU Mingyuan1，YU Xiaoyi2，GE Caiying2，KONG Min2*   

  1. 1.School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China 2.Fangzhuang Community Health Service Center in Fengtai District, Beijing 100078, China
  • Received:2025-03-05 Revised:2025-06-17 Accepted:2025-07-01
  • Contact: KONG Min, Chief physician; E-mail: 267475112@qq.com

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摘要： 背景 低血糖感知受损（IAH）是2型糖尿病（T2DM）患者中常见的问题，反复发生的低血糖事件可导致患者低血糖感知能力下降，进而增加严重低血糖的发生风险。然而，目前针对社区T2DM患者IAH现状及影响因素的研究较少。目的 调查社区T2DM患者的IAH现状，并分析其影响因素，为社区卫生服务机构提供科学依据，以提升患者的健康管理效果。方法 本研究为横断面研究，采用多阶段分层随机抽样法，在北京市丰台区选取9家社区卫生服务中心（站）的T2DM患者作为研究对象。于2024年5—8月，通过“一对一”问卷调查，收集患者一般资料、低血糖经历、低血糖感知情况及糖尿病自我管理行为等信息。使用GOLD方法评估低血糖感知情况，以判断是否发生IAH。采用多因素二元Logistic回归模型分析IAH的影响因素。结果 收集到有效问卷487份，社区T2DM患者IAH自我报告发生率为27.1%（132/487）。多因素二元Logistic回归分析结果显示：T2DM患者发生IAH的危险因素为未检测/不清楚并发症［以无并发症为参照，OR（95%CI）=2.164（1.215~3.852）］、HbA1c 达标［OR（95%CI）=1.648（1.033~2.628）］，保护因素为T2DM病程长［以≤5年为参照，11~20年OR（95%CI）=0.320（0.152~0.672）、≥20年OR（95%CI）=0.459（0.226~0.955）］、口服降糖药［OR（95%CI）=0.052（0.01~0.274）］、使用胰岛素［OR（95%CI）=0.199（0.050~0.803）］、未使用降糖药［OR（95%CI）=0.029（0.003~0.245）］、多病共存［OR（95%CI）=0.613（0.348~1.081）］、知晓低血糖诊断标准［OR（95%CI）=0.498（0.265~0.935）］、有一定血糖监测能力［以不会且没有血糖监测工具为参照，有血糖监测工具但偶尔监测OR（95%CI）=0.406（0.185~0.891）、熟练掌握并定期监测血糖OR（95%CI）=0.410（0.173~0.974）］、控烟良好［以控烟较差为参照，OR（95%CI）=0.498（0.272~0.909）］。结论 血糖控制严格、缺乏血糖监测知识会增加IAH风险，而定期血糖监测、了解低血糖知识和戒烟可降低风险。社区医护人员应针对这些因素进行综合干预，优化血糖监测、加强健康教育、促进戒烟，以降低IAH发生率，改善患者疾病管理和生活质量。

关键词: 糖尿病, 2 型；低血糖认知受损；影响因素分析；社区卫生服务；健康管理

Abstract: Background Impaired awareness of hypoglycemia (IAH) is a prevalent issue among patients with Type 2 Diabetes Mellitus (T2DM). Recurrent hypoglycemic events may diminish hypoglycemia perception and elevate the risk of severe hypoglycemia. However, limited research have explored the prevalence and determinants of IAH in community-dwelling T2DM patients. Objective To investigate the prevalence of IAH and its influencing factors among community T2DM patients, providing scientific evidence for community health service institutions to optimize health management strategies. Methods This cross sectional study adopted a multistage stratified random sampling method to select T2DM patients from 9 community health service centers (stations) in Fengtai District, Beijing. From May to August 2024, data on demographic characteristics, hypoglycemic experiences, hypoglycemia awareness, and diabetes self-management behaviors were collected via face-to-face questionnaires. The GOLD method was used to assess hypoglycemia awareness and diagnose IAH. Multivariate binary Logistic regression analysis was performed to identify the determinants of IAH. Results Among 487 valid questionnaires, the self-reported prevalence of IAH was 27.1% (132/487). Multivariate binary Logistic regression analysis revealed that the independent risk factors for IAH were undiagnosed or unknown diabetes complications (OR=2.164, 95%CI=1.215-3.852) and achievement of glycated hemoglobin A1c (HbA1c) targets (OR=1.648, 95%CI=1.033-2.628). The independent protective factors included disease duration of 11-20 years (OR=0.320, 95%CI=0.152-0.672), disease duration ≥ 20 years (OR=0.459, 95%CI=0.220-0.955), use of oral hypoglycemic agents (OR=0.052, 95%CI=0.01-0.274), insulin use (OR=0.199, 95%CI=0.050-0.803), no hypoglycemic medication use (OR=0.029,95%CI=0.003-0.245), multimorbidity (OR=0.613, 95%CI=0.348-1.081), awareness of hypoglycemia diagnostic criteria (OR=0.498,95%CI=0.265-0.935), having blood glucose monitoring tools with occasional use (OR=0.406, 95%CI=0.185-0.891), proficient and regular blood glucose monitoring (OR=0.410, 95%CI=0.173-0.974), and good tobacco control status (OR=0.498, 95%CI=0.272-0.909). Conclusion Stringent glycemic control and insufficient blood glucose monitoring knowledge are associated with increased IAH risk, whereas regular glucose monitoring, hypoglycemia awareness, and smoking cessation demonstrated protective effects. Community healthcare providers should implement comprehensive interventions targeting these modifiable factors, such as optimizing glucose monitoring protocols, strengthening health education, and promoting tobacco control, to reduce IAH incidence and improve patients' disease management outcomes and quality of life.

Key words: Diabetes mellitus, type 2, Impaired awareness of hypoglycemia, Root cause analysis, Community health services, Health management

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