Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on blood pressure variability and blood glucose variability in maintenance hemodialysis (MHD) patients and to assess safety. Methods MHD patients from 12 hospitals were enrolled between October 2024 and June 2025. According to the randomized block design, patients were randomly divided into the glucose-containing dialysate group (experimental group) and the glucose-free dialysate group (control group). During hemodialysis sessions, blood pressure were monitored at 0, 1, 2, 3, and 4 hours, and blood glucose was measured at 0, 2, and 4 hours monthly for six consecutive months. Hypotension episodes and hypoglycemic episodes were recorded throughout dialysis. Results A total of 244 MHD patients were included, with 122 in each group. Compared with the control group, the experimental group showed significantly lower systolic blood pressure variability [dialysis for 2 hours: 9.92 (7.92, 12.52) vs. 11.95 (9.45, 15.36) mm Hg (1 mm Hg=0.133 kPa), P<0.001; during the 0-2 hour dialysis period: 2.60 (1.24, 3.97) vs. 3.74 (2.03, 6.52) mm Hg, P=0.011], diastolic blood pressure variability [during the 0-4 hour dialysis period: 3.85 (1.49, 6.69) vs. 4.72 (1.99, 8.46) mm Hg, P<0.001], blood glucose variability [dialysis for 2 hours: 0.16 (0.12, 0.20) vs. 0.18 (0.13, 0.23) mmol/L, P=0.002; dialysis for 4 hours: 0.17 (0.13, 0.22) vs. 0.21 (0.17, 0.26) mmol/L, P<0.001; during the 2-4 hour dialysis period: 0.04 (0.02, 0.08) vs. 0.07 (0.03, 0.10) mmol/L, P=0.004], incidence rates of hypotension (32.9% vs. 33.3%, P=0.005) and incidence rates of hypoglycemia (0.42% vs. 4.02%, P<0.001). Conclusions Glucose-containing dialysate reduces both blood pressure variability and blood glucose variability more effectively than glucose-free dialysate during hemodialysis. Compared with glucose-free dialysate, the glucose-containing dialysate demonstrated a lower incidence of hypotension episodes and hypoglycemic episodes.
ObjectiveTo investigate the knowledge of hypoglycemia in patients with type 2 diabetes mellitus, analyze its influential factors, and explore the measure of hypoglycemia education.
MethodsA questionnaire survey was conducted with a sample of 5 961 patients with type 2 diabetes mellitus from 144 hospitals in China between April and July 2010. The investigation contents included patients' demographic data and the knowledge of hypoglycemia.
ResultsThe score of the knowledge of hypoglycemia was 62.71±10.34 and the status was medium. Multiple stepwise regression analysis showed that degree of education, duration of diabetes mellitus, periodic inspection, education about diabetic complications, times of hypoglycemia were influencing factors for the knowledge of hypoglycemia (P<0.05).
ConclusionThe status of the knowledge of hypoglycemia is not optimistic. Educators should pay attention to the characteristics of patients and provide a safe regiment for controlling blood sugar with a comprehensive introduction of hypoglycemia.
【摘要】 目的 老年綜合評估法篩查75歲以上2型糖尿病（type 2 diabetes mellitus，T2DM）合并老年綜合征的情況，并觀察以甘精胰島素為基礎的治療方法對老年綜合征、血糖、低血糖事件、治療滿意度等的影響。 方法 應用老年綜合評估中的日常生活能力、工具性日程生活能力、簡易智能量表、老年抑郁量表、微型營養評定法，分別評估2005年12月—2009年12月老年門診及病房住院的日常生活能力、認知功能狀態、情緒障礙和營養狀態，對其合并功能障礙、癡呆、抑郁、營養障礙、傷害性跌倒等老年綜合征的患病情況進行橫斷面調查；篩選至少合并一種老年綜合征和一個其他合并疾病，血糖控制差、預期壽命有限的患者進行以甘精胰島素為基礎的降糖治療，采用自身前后對照的方法了解對糖化血紅蛋白（hemoglobin A1c， HbA1c）、低血糖事件、治療滿意度的影響，并觀察甘精胰島素治療方案對上述老年綜合征的影響。 結果 132例老年門診及病房住院的75歲以上T2DM患者功能障礙者高達50.0%（66例），罹患包括輕度認知功能障礙在內的癡呆比例為39.4%（52例）；合并抑郁癥28.0%（37例）；營養失衡30.0%（39例）。33例患者符合甘精胰島素治療納入標準，經過2年的隨訪發現，以甘精胰島素為基礎的治療方案在適當降低HbA1c水平時，不增加老年綜合征的患病率，但可以減少胰島素多次皮下注射的次數，降低低血糖事件發生次數（由1.58次/例降為0.81次/例），提高患者治療滿意度。 結論 75歲以上T2DM患者合并老年綜合征的比例高，老年綜合評估能及時發現老年綜合征；以甘精胰島素為基礎的治療方案不增加老年綜合征的發生，并能顯著降低低血糖事件數、改善營養狀態、提高患者對治療的滿意度。【Abstract】 Objective To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes. Methods From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed. Results Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved. Conclusions Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .
Objective To explore the situation and causes of misdiagnosed hypoglycemia in China so as to develop some strategies for reducing misdiagnosis.Methods We searched CBMdisc, CMCC, CJFD and VIP (Jan. 1994-Dec. 2003). All the publisled studies about the misdiagnosis of hypoglycemia were collected to analyse their classifications and causes.Results A total of 172 studies involving 1 478 patients met the inclusion criteria. The studies were either case reports or clinical reviews. The 1 478 cases were misdiagnosed as 31 sorts of diseases, mainly including stroke (71.18%), transient ischemia attack (4.87%), epilepsy (4.13%) and hepatic coma (2.64%) . The causes of misdiagnosis could be classified into 14 categories, including complex manifestations of hypoglycemia (29.07%), lack of knowledge of hypoglycemic encephalopathy (16.44%), insufficient medical history collection (10.21%) and interference of compound diseases (9.86%) etc..Conclusions The misdiagnosis of hypoglycemia is mainly caused by the poor professional skills of doctors or their lack of responsibility, and poor patient management, especially when hypoglycemia are manifested by brain disability.
ObjectiveTo recognize the convulsion caused by hypoglycemia, and to analyze its genotype and clinical phenotype, so as to deepen the understanding of hyperinsulinemia.MethodFull exon detection were performed on 2 children with hypoglycemia and convulsions, who had been treated with antiepileptic drugs for 1 year in pediatric neurology department, Henan Provincial People’s Hospital in 2012 and 2014 respectively, but with poor curative effect.ResultABCC8 gene mutations were found in a child. The mutations located in Chromosome 11, with the nucleic acid changes of c.4607C>T (exon38) and the amino acid change of p.A1536V, rs745918247. The inheritancemode of ABCC8 gene could be autosomal dominant or autosomal recessive inheritance. Both of the parents were wild type on this genelocus. The gene mutation is associated with type 1 familial hyperinsulinemic hypoglycemia/nesidioblastosis. The other child was carrying GLUD1 gene mutation, witch is located in chromosome 10, with the nucleic acid changes of c.1498G>A (exon12) and the amino acid change of p.A500T. The inheritance mode of GLUD1 gene is autosomal dominant andthe child’s parents were both wild type. This gene mutationis associated with type 6 familial hyperinsulinemic hypoglycemia/nesidioblastosis. The 2 mutations have not been reported, which are new mutations.ConclusionMutations in these 2 gene loci may be the underlying cause of hypoglycemic convulsions, and are the best explanation for the poor convulsionscontrol of antiepileptic drugs.
