平均血糖水平较低或和严重低血糖症、昏迷症的发病并无强关联性

  近日，一篇发表在国际杂志PLoS Medicine上的研究论文中，来自德国亚琛工业大学的科学家通过研究表示，1995年至2012年间在患1型糖尿病的德国和奥地利年轻人中，平均血糖水平降低和严重低血糖症、低血糖昏迷发病风险之间的关联发生了大幅下降，即血糖水平降低和低血糖症及昏迷发病风险之间的相关性并不强。
  文章中，研究者对37539名患1型糖尿病的儿童及成年个体进行研究，测定了他们的平均血糖水平（HbA1c），同时获得了其患严重低血糖症及低血糖昏迷的发病情况；结果显示，从1995年至2012年，个体的HbA1c水平每降低1%，其患严重低血糖症的风险从1.28降低到了1.05，低血糖昏迷的风险从1.39降低到了1.01，而且每年个体的患病风险都会相应地降低1.2%和1.9%，患病风险降低的发生主要是由于平均血糖较低的病人患低血糖症的风险持续下降了，这些病人的HbA1c水平在6.0%至7.9%之间。
  研究者表示，本文研究并没有研究者上述疾病风险降低的原因，或许是由于胰岛素类似物和胰岛素泵的使用的增加导致的，当然也有可能是病人增强了每天监测血糖的意识。
  此前研究显示，在患1型糖尿病的年轻个体中，较低水平的HbA1c和严重低血糖症及昏迷症发生的强相关性在过去10年里一直处于持续降低的状态，这就有助于这些糖尿病患者可以更加有效地进行其正常的血糖控制。（转化医学网360zhyx.com）
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转化医学网推荐的原文摘要：

Hemoglobin A1c Levels and Risk of Severe Hypoglycemia in Children and Young Adults with Type 1 Diabetes from Germany and Austria: A Trend Analysis in a Cohort of 37,539 Patients between 1995 and 2012
PLoS Medicine DOI: 10.1371/journal.pmed.1001742
Beate Karges mail,Joachim Rosenbauer,Thomas Kapellen,Verena M. Wagner,Edith Schober,Wolfram Karges,Reinhard W.Holl
Background

Severe hypoglycemia is a major complication of insulin treatment in patients with type 1 diabetes, limiting full realization of glycemic control. It has been shown in the past that low levels of hemoglobin A1c (HbA1c), a marker of average plasma glucose, predict a high risk of severe hypoglycemia, but it is uncertain whether this association still exists. Based on advances in diabetes technology and pharmacotherapy, we hypothesized that the inverse association between severe hypoglycemia and HbA1c has decreased in recent years.

Methods and Findings
We analyzed data of 37,539 patients with type 1 diabetes (mean age ± standard deviation 14.4±3.8 y, range 1–20 y) from the DPV (Diabetes Patienten Verlaufsdokumentation) Initiative diabetes cohort prospectively documented between January 1, 1995, and December 31, 2012. The DPV cohort covers an estimated proportion of >80% of all pediatric diabetes patients in Germany and Austria. Associations of severe hypoglycemia, hypoglycemic coma, and HbA1c levels were assessed by multivariable regression analysis. From 1995 to 2012, the relative risk (RR) for severe hypoglycemia and coma per 1% HbA1c decrease declined from 1.28 (95% CI 1.19–1.37) to 1.05 (1.00–1.09) and from 1.39 (1.23–1.56) to 1.01 (0.93–1.10), respectively, corresponding to a risk reduction of 1.2% (95% CI 0.6–1.7, p<0.001) and 1.9% (0.8–2.9, p<0.001) each year, respectively. Risk reduction of severe hypoglycemia and coma was strongest in patients with HbA1c levels of 6.0%–6.9% (RR 0.96 and 0.90 each year) and 7.0%–7.9% (RR 0.96 and 0.89 each year). From 1995 to 2012, glucose monitoring frequency and the use of insulin analogs and insulin pumps increased (p<0.001). Our study was not designed to investigate the effects of different treatment modalities on hypoglycemia risk. Limitations are that associations between diabetes education and physical activity and severe hypoglycemia were not addressed in this study.
Conclusions
The previously strong association of low HbA1c with severe hypoglycemia and coma in young individuals with type 1 diabetes has substantially decreased in the last decade, allowing achievement of near-normal glycemic control in these patients.