Abstract:
Background　Hypoglycemia is a common and easily neglected complication of diabetes mellitus.Mild hypoglycemia reduces the quality of life and treatment compliance of patients，and serious hypoglycemia can induce cardiovascular and cerebrovascular events and even become a threat to life.The risk of hypoglycemia is also an important influential factor in the individualized treatment scheme and the blood glucose control of patients.Objective　To investigate the hypoglycemia and its influential factors of type 2 diabetes mellitus（T2DM） in outpatients in medical institutions at different levels in the same area，with the expectation of finding the hypoglycemia risk population，so as to take measures to reduce the risk.Methods　This study was a cross-sectional study.A questionnaire survey was conducted among T2DM patients in a community general outpatient clinic（the community group） and an endocrine outpatient department（the hospital group） in a tertiary，level A hospital in Beijing from August 2017 to March 2018 by convenient sampling method.The survey included demographic characteristics，diabetes management such as lifestyle，drug use，health education，blood glucose monitoring，the knowledge of blood glucose control targets and the occurrence of hypoglycemia in the last 1 year.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influential factors of hypoglycemia in T2DM patients.Results　A total of 388 questionnaires were sent out，and 380 questionnaires were collected，of which 369 were valid questionnaires，including 180 in the community group and 189 in the hospital group.Of 369 patients，180（48.8%） had hypoglycemia in the last year.The incidence of hypoglycemia in the community group was 58.3%（105/180），which was higher than that in the hospital group（39.7%）（75/189）（χ2=12.836，P<0.001）．Univariate analysis result showed that age≥60 years，BMI<24.0 kg/m2，abdominal circumference <85 cm，course of disease≥10 years，education level below junior high school，exercise，use of insulin，oral insulin secretion agent，poor drug compliance，lack of health education，no self-monitoring of blood glucose，unsatisfactory self-evaluation of blood glucose control，and visits in the community were related to the incidence of hypoglycemia（P<0.05）．The results of multivariate Logistic regression analysis showed that course of disease≥10 years（OR=2.497），exercise（OR=3.028），use of insulin（OR=3.252），oral insulin secretion agent（OR=3.072） were risk factors of hypoglycemia；BMI≥24.0 kg/m2（OR=0.234），good drug compliance（OR=0.280），receiving health education（OR=0.354），self-monitoring of blood glucose（OR=0.505），satisfactory self-evaluation of blood glucose control（OR=0.387），visit in a hospital（OR=0.354） were protective factors of hypoglycemia（P<0.05）．Conclusion　The incidence of hypoglycemia in patients with T2DM is high，and the incidence of hypoglycemia in patients who visited community health centers is higher than those who visited hospitals.We should pay more attention to patients with T2DM who have a long course of disease，low BMI，using insulin or insulin secretion agent and few exercise.Improving drug compliance，strengthening self-monitoring of blood glucose and health education can reduce the risk of hypoglycemia，which could be controllable factors of hypoglycemia.

Key words: Diabetes mellitus, type 2；Hypoglycemia；Root cause analysis

摘要： 背景　低血糖是糖尿病常见且易忽视的并发症，轻度低血糖降低患者生活质量及治疗依从性，严重低血糖可诱发心脑血管事件，甚至危及生命。低血糖风险也成为患者个体化治疗方案及血糖控制目标的重要影响因素。目的　调查同地区不同级别医疗机构门诊就诊的2型糖尿病（T2DM）患者低血糖发生情况、影响因素，期望发现低血糖危险人群，以采取措施减少风险。方法　本研究为横断面研究，采用便利抽样法，2017年8月—2018年3月对北京市某社区全科门诊（社区组）及某三级甲等医院内分泌门诊（医院组）就诊的T2DM患者问卷调查。调查内容包括人口学特征、糖尿病管理情况如生活方式、药物使用情况、健康教育及血糖监测情况、对血糖控制目标的认知情况及近1年低血糖发生情况。采用单因素分析及多因素Logistic回归分析T2DM患者低血糖发生的影响因素。结果　共发放问卷388份，回收问卷380份，有效问卷369份，其中社区组180份，医院组189份。369例患者中，180例（48.8%）近1年发生过低血糖。社区组低血糖发生率为58.3%（105/180），高于医院组的39.7%（75/189）（χ2=12.836，P<0.001）。单因素分析结果显示，年龄≥60岁、体质指数（BMI）<24.0 kg/m2、腹围<85 cm、糖尿病病程≥10年、小学及以下文化程度、规律运动、使用胰岛素、口服胰岛素促泌剂、用药依从性差、未接受过健康教育、未规律自我监测血糖、自我评价血糖控制不满意与低血糖的发生有关（P<0.05）。多因素Logistic回归分析结果显示，糖尿病病程≥10年（OR=2.497）、规律运动（OR=3.028）、使用胰岛素（OR=3.252）、口服胰岛素促泌剂（OR=3.072）为低血糖发生的危险因素，BMI≥24.0 kg/m2（OR=0.234）、用药依从性好（OR=0.280）、接受过健康教育（OR=0.354）、规律自我监测血糖（OR=0.505）、自我评价血糖控制满意（OR=0.387）、就诊于医院（OR=0.354）为低血糖发生的保护性因素（P<0.05）。结论　T2DM患者低血糖发生率高，且近1年低血糖发生率社区就诊患者高于医院就诊患者。T2DM患者BMI低、病程长、使用胰岛素或胰岛素促泌剂、规律运动者低血糖发生率高，应重点关注；而提高用药依从性、加强血糖自我监测、健康教育等措施可减少低血糖风险，为低血糖可控因素。

关键词: 糖尿病, 2型；低血糖；影响因素分析