初次使用胰岛素治疗的2型糖尿病患者发生低血糖反应的高危因素分析及护理对策

目的探讨2型糖尿病患者初次使用胰岛素治疗后发生低血糖反应的高危因素,并针对性提出护理措施意见建议。方法回顾性分析2017年1-6月浙江医院收治的90例初次使用胰岛素治疗的2型糖尿病住院患者临床资料,根据出院后1年随访期内低血糖发生情况将患者分为2组。收集2组基础资料、状态-特质焦虑及胰岛素治疗知识问卷评分、生化指标、氧化应激指标,分析不良反应发生的高危因素,并给予护理干预,再观察干预后低血糖发生情况及相关指标变化情况。结果 2组患者体质量指数、S-AI、T-AI、胰岛素治疗知识评分、白蛋白、血肌酐、甘油三酯、空腹C肽、尿蛋白定量、糖化血红蛋白及8-羧基脱氧鸟苷水平比较,差异均有统计学意义(均P<0.05)。其中,体质量指数、胰岛素治疗知识评估及糖化血红蛋白含量是预防低血糖反应发生的独立保护因素;而血肌酐水平、尿蛋白定量及S-AI、T-AI是低血糖反应的高危因素(均P<0.05);经针对性护理干预后,观察组1年内低血糖发生情况从39例减少至10例(χ~2=46.163,P<0.05),且干预后观察组STAI较干预前降低,而胰岛素治疗知识问卷评分较干预前升高(均P<0.05)。结论对于2型糖尿病患者在首次进行胰岛素强化治疗过程中,对于初次使用胰岛素治疗的体质量过低且糖化血红蛋白含量过低的2型糖尿病患者,更要重视胰岛素使用相关知识的讲解、试教以及胰岛素治疗后低血糖反应发生的情况,以便获得更好的临床预后。

Risk factors of hypoglycemia in patients with type 2 diabetes mellitus treated with insulin for the first time and nursing countermeasures

Objective To explore the high risk factors of adverse reactions such as hypoglycemia in patients with type 2 diabetes mellitus after initial insulin treatment, and to put forward suggestions on nursing measures. Methods The clinical data of 90 inpatients with type 2 diabetes mellitus who first used insulin in our hospital from January 2017 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to the occurrence of hypoglycemia during the follow-up period of one year after discharge, and according to the occurrence of hypoglycemia, they were divided into two groups. The basic data, state-trait anxiety and insulin treatment knowledge questionnaire scores, biochemical indicators and oxidative stress indicators were collected to identify the high-risk factors for adverse reactions, and nursing intervention was given. The occurrence of hypoglycemia and changes of related indicators were observed after intervention. Results There were significant differences in body mass index, S-AI, T-AI, insulin treatment knowledge score, albumin, serum creatinine, triglyceride, fasting C-peptide, urinary protein, glycosylated hemoglobin and 8-carboxydeoxyguanosine levels between the two groups (all P<0.05). Body mass index, insulin therapy knowledge assessment and glycosylated hemoglobin content were independent protective factors for preventing hypoglycemic reaction, while serum creatinine level, urinary protein quantification and S-AI, T-AI were high risk factors for hypoglycemic reaction (all P<0.05); after targeted nursing intervention, the incidence of hypoglycemia in the observation group decreased from 39 cases to 10 cases (χ2=46.163, P<0.05). After intervention, the ST-AI of observation group was lower than that before intervention, while the score of insulin therapy knowledge questionnaire was higher than that before intervention (all P<0.05). Conclusion In the first intensive insulin therapy for type 2 diabetes mellitus, for type 2 diabetes mellitus patients with low body weight, low glycosylated hemoglobin content and initial insulin treatment, more attention should be paid to the knowledge of insulin use, trial teaching and the occurrence of hypoglycemic reaction after insulin treatment, so as to obtain better clinical prognosis.