关键词: 糖尿病, 2型；血液透析；血糖；低血糖症；高血糖症

Abstract: Background　 As diabetes prevalence is rapid increasingly globally，the prevalence of end-stage diabetics and patients needing hemodialysis in China are also growing.Compared to those without diabetes，increased glycemic changes during hemodialysis may adversely affect the outcome of diabetics.Objective　To analyze the blood glucose changes during hemodialysis in diabetics undergoing regular hemodialysis.Methods　From October 2017 to December 2018，105 diabetics undergoing regular hemodialysis with sugar-free bicarbonate dialysate plus insulin therapy in the blood purification center of three tertiary hospitals in Jiangsu Province（Zhongda Hospital，Southeast University，Lishui Branch and Wuxi Branch of Zhongda Hospital，Southeast University）were selected.After excluding 3 cases with missed blood glucose data during hemodialysis，other 102 were finally enrolled.Blood glucose and the incidence of hypoglycemia and hyperglycemia before hemodialysis，1 hour，2 hours and 3 hours after hemodialysis，and at the end of hemodialysis were collected and analyzed.Results　The average blood glucose for the diabetic participants was（8.4±3.2）mmol/L，which ranged from 1.6 to 27.8 mmol/L.22 cases（30 times）had hypoglycemia，with a hypoglycemia incidence of 21.6%（22/102），moreover 18 of them had asymptomatic hypoglycemia，with an asymptomatic hypoglycemia incidence of 17.6%（18/102）.30 cases（47 times including 26 occurred before hemodialysis）had hyperglycemia，with an incidence of 29.4%（30/102）.The average blood glucose in patients with hypoglycemia was significantly lower than that of those without hypoglycemia before hemodialysis，1 hour，2 hours and 3 hours after hemodialysis，respectively（P<0.05），but there was no significant intergroup difference in the average blood glucose at the end of hemodialysis（P>0.05）.The average blood glucose varied according to the measurement time in patients with and without hypoglycemia（P<0.05）.The average blood glucose in patients with hyperglycemia was significantly higher than that of those without hyperglycemia at each measurement time（P<0.05）.The average blood glucose varied according to the measurement time in patients with hyperglycemia and without（P<0.05）.Compared to those without hypoglycemia，patients with hypoglycemia had much lower proportion of patients stopping insulin therapy or reducing insulin dose on the day of hemodialysis（P<0.05），as well as knowing the definition of hypoglycemia（P<0.05）.The proportion of patients stopping insulin therapy or reducing insulin dose on the day of hemodialysis in patients with hyperglycemia was significantly higher than that of those without hyperglycemia（P<0.05）.Conclusion　Diabetics with regular hemodialysis had a relatively high incidence of hypoglycemia（21.6%），and asymptomatic hypoglycemia was more common.Stopping insulin therapy or reducing insulin dose on the day of hemodialysis and low awareness rate of the definition of hypoglycemia may be related factors of hypoglycemia during hemodialysis.These patients also showed a relatively high incidence of hyperglycemia（29.4%），which often occurred before hemodialysis.Stopping insulin therapy or reducing insulin dose on the day of hemodialysis may be a related factor of hyperglycemia during hemodialysis.

Key words: Diabetes mellitus, type 2；Hemodialysis；Blood glucose；Hypoglycemia；Hyperglycemia