副主任医师
本站已经通过实名认证，所有内容由王新军大夫本人发表
当前位置：
& 大夫个人网站
& 文章详情
低血糖的安全性和死亡率
全网发布： 07:40
低血糖是胰岛素和磺脲类药物治疗的一个主要副作用，可使脑功能的急性改变，导致思维混乱和昏迷，扰乱生活及工作。因此这是患者控制血糖以预防并发症的最大障碍。虽然严重低血糖在2型患者很少发生，但是由于发病率高，因此仍然是一个严重的临床问题。另外，最近临床试验数据显示，强化血糖控制和相关的低血糖或许增加死亡率。低血糖可能导致心血管死亡的机制包括：由于儿茶酚胺的释放导致氧需求增加而缺血，心脏复极异常表现为QT间期延长，血栓形成增加。然而低血糖通过这些及其他机制导致死亡率增加的程度仍不清楚。需要进行更深入的研究以阐明其病理过程及矛盾的流行病学证据。然而，低血糖的发生率在用胰岛素治疗的2型糖尿病患者要低于患者，随着胰岛素使用时间的延长低血糖发生率会增加。这可能是由于随着内源性胰岛素分泌逐渐衰竭，身体对低血糖的正常生理性保护逐渐丧失。负责治疗2型糖尿病患者的医生当制定血糖目标和选择治疗方案时需要评估低血糖的风险。
与医生电话交流
网上免费问医生
看更多新文章>>
1.扫码下载好大夫App
2.在知识中添加您关注的疾病
3.添加成功后，最新的医生文章，每天推送给您。
发表于： 17:22
王新军大夫的信息
王新军大夫电话咨询
王新军大夫已经开通电话咨询服务直接与大夫本人通话，方便！快捷！
网上咨询王新军大夫
在此简单描述病情，向王新军大夫提问
王新军的咨询范围：
糖尿病,甲亢,矮小症,5岁以上,海南本地尖峰死亡危害大谨防肉鸡低血糖
辽宁省畜牧兽医局
　　2009年1月底，河北省唐山市某养殖户所养的10日龄肉鸡开始零星出现精神不振、畏寒怕冷、采食饮水量显著减少、生长缓慢等症状，后来数量逐渐增多，且部分病鸡出现共济失调，瘫痪、昏迷...
　　2009年1月底，河北省唐山市某养殖户所养的10日龄肉鸡开始零星出现精神不振、畏寒怕冷、采食饮水量显著减少、生长缓慢等症状，后来数量逐渐增多，且部分病鸡出现共济失调，瘫痪、昏迷。一般发病后3～5小时死亡，病程长的大约在26小时死亡。即使症状得到缓解或消失，也会出现跛行，部分病鸡自然康复。　　1　　临床症状　　肉鸡突然发病，鸡群精神萎靡，食欲减退，畏寒耷翅，羽毛松乱;鸡冠发绀,爪部干燥脱水;严重者头部轻微震颤、共济失调、大声尖叫、瘫痪、昏迷、蹲地;早期白色下痢明显，晚期常因排粪不畅而有异物堵塞肛门。　　2　　病理变化　　肝脏稍肿大，表面偶有散在或密布的坏死点;肌胃、腺胃交界处发黑或出血,可见溃疡;胰腺萎缩苍白，有散在坏死点;十二指肠黏膜水肿出血，回肠可见积液，直肠和盲肠有白色尿酸盐;泄殖腔有大量白米汤样液体;肾脏肿大，色淡，表面有尿酸盐沉积形成的白色斑点;输尿管有尿酸盐沉积;血浆呈现苍白色;法氏囊萎缩出血并存在坏死点;胸腺萎缩有出血点;脾脏、肠道淋巴结萎缩。部分肉鸡呈现佝偻、矮小及脱水病变。　　3　　实验室检验　　3.1　　涂片镜检　　　　取病死鸡的心、肝、脾、血液分别涂片，发现红细胞数目极少，革兰氏染色镜检未发现可疑细菌;将心肝脾血液分别接种于普通琼脂培养基、鲜血琼脂培养基，置于37℃的培养箱内培养24小时，未见细菌生长。　　3.2血糖检测　　　　感染严重鸡血糖检测大于20~80毫克/毫升，仅为正常鸡的三分之一(鸡的正常血糖值为220.3±18.7毫克/毫升。)　　根据发病情况、临床表现、剖检变化及实验室检验确诊为肉鸡低血糖尖峰死亡综合征。　　4　　防治措施　　4.1　　加强饲养管理，改善饲养环境，控制饲养密度，尤其加强环境消毒。　　4.2　　限制光照，降低死亡数量。发病鸡每日给光16小时，夜间间断给光并采食饮水，饮水中添加1%～2%葡萄糖及多维。　　4.3采用口服葡萄糖，控制病情，辅以电解多维、抗生素预防继发感染和虚脱，尽快恢复鸡群免疫力和体质。具体可采用敌菌净(75克)加乳糖加新双黄莲(250毫升)，配水200千克，每天2次，饮水3～5天;黄芪多糖饮水，每天2次，连用3～　　5天)。清开灵加黄芪多糖或干扰素肌肉注射。　　5　　体会　　5.1肉鸡低血糖尖峰死亡综合征是一种主要侵害肉鸡的新型传染病。多见于3周以内的雏鸡，该病无明显季节性，后期易继发新城疫，相同条件下，公雏的发病率为母雏的3倍。该病的特点是共济失调、瘫软无力、昏迷死亡，死亡高峰12～16日龄，4%～8%的死亡率持续在2～3天，之后死亡率逐渐下降，呈典型的尖峰死亡曲线。如不加以防治，会给肉鸡养殖业带来重大损失。　　5.2　　　　发病原因一般认为是：种鸡产蛋期饲料配比不平衡，致使所产蛋中糖原和能量储备偏少，刚孵化出的雏鸡由于长途运输，舍温较低或人为控水时间过长，其体内的糖原和能量被大量消耗;肉鸡饲料配比不恰当，蛋白质能量比偏高，供给的能量不能满足肉鸡的生长发育。　　5.3目前尚无特异性治疗方法，只是采取减少应激及加强糖原分解等辅助手段，采用补充葡萄糖及多维的方法具有一定效果。控制光照可减缓尖峰死亡综合征的发生发展，其机理可能是生理条件下，黑暗可促进鸡释放褪黑素激素，使糖原生成转变为糖原异生，从而有效抑制血糖的恶性下降。　　5.4预防本病应遵循“防重于治”的原则。治疗该病应中西药合用，以增强其抗病力。发现病情要尽早诊断，治疗不可盲目用药，以免延误治疗时机，给养殖户带来更大损失。
名称：吾谷网
地址：北京市朝阳区光华路9号金桥天阶大厦7层
电话：010-
email：.cn
反馈内容（*必填）
欢迎提出您在使用过程中遇到的问题或宝贵建议（400字以内），感谢您的支持。
联系方式（*必填）個人化服務
查詢符號(半形)
查詢符號意義說明
表示為「AND」兩個查詢詞之交集
片語以雙引號標示開始及結束，而且只尋找出現順序相同的字詞，例
image process
表示一個字母切截，輸入兩個?表兩個字母，依此類推，例：輸入「Appl?」，查得結果應為appl
常用於英文字查詢
表示不限字母切截，由0~n. 例：輸入「appl*」，查得結果應為appl
常用於英文字查詢
AND、OR、NOT
布林邏輯組合關鍵字，用來擴大或縮小查詢範圍的技巧。
：縮小查詢範圍
：擴大查詢範圍 (3) NOT：排除不相關的範圍
是數位物件識別碼
為物件在網路上的唯一識別碼，可用於永久連結並引用目標物件。
使用DOI作為永久連結
每個DOI號前面加上
便成為永久網址。
如以DOI號為
10.5297/ser.
的文獻為例，此文獻的永久連結便是：
日後不論出版單位如何更動此文獻位置，永久連結所指向的位置皆會即時更新，不再錯失重要的研究。
引用含有DOI的文獻
有DOI的文獻在引用時皆應同時引用DOI。若使用APA、Chicago以外未規範DOI的引用格式，可引用DOI永久連結。
DOI可強化引用精確性、增強學術圈連結，並給予使用者跨平台的良好使用經驗，目前在全世界已有超過五千萬個物件申請DOI。
如想對DOI的使用與概念有進一步了解，請參考
同意授權/列印瀏覽電子全文服務，於
, 博士　　指導教授：李中一　　
過去一、二十年，第一型糖尿病的發生率在大部分西方國家都呈現快速增加的趨勢。「衛生假說」是當前解釋第一型糖尿病發生率變化的重要假說之一。雖然大部分第一型糖尿病都在病人年紀很輕的時候被診斷出來，但是有關亞洲國家兒童的第一型糖尿病及其重要的併發症「嚴重低血糖事件」的發生率，卻鮮少有文獻報告過。嚴重低血糖是血糖控制過程中一個主要的絆腳石。嚴重低血糖的發生是否對於後續的全死因死亡率或心血管疾病的發生率有長期的負面影響？其影響是否呈現劑量效應關係？仍然沒有定論。
本研究有關歷年兒童第一型糖尿病發生率的報告，是從年的台灣健保資料庫中擷取而得。我們從重大傷病檔中取得因第一型糖尿病而被登錄重大傷病名單的新診斷個案資料，輔以內政部人口統計資料，計算出兒童第一型糖尿病的發生率和臨床特性。並且透過生態研究設計，檢驗了第一型糖尿病與居住地區兒童人口密度和都市化程度的相關性。此外，我們針對2003年到2011年的第一型糖尿病盛行病例世代，透過平均6.2年的追蹤時期，我們在卜瓦松分布的前提下，估計了這些病患嚴重低血糖的發生率和發生頻率，並探討了其可能的危險因子。我們更進一步的探討嚴重低血糖的發生對於全死因死亡率和心血管疾病發生率的影響。我們在巢式病例對照研究的設計中，採用發生機率密度取樣的配對法，探討在死亡或發生心血管疾病的一年前、一到三年前或三到五年前有無經歷過嚴重低血糖事件，以及事件發生前五年內累計的嚴重低血糖發生次數，與全死因死亡率和心血管疾病發生率的相關性及劑量效應關係。我們另外並建立了兩個世代追蹤研究，一個採用固定時間區間的嚴重低血糖暴露資料；一個則將嚴重低血糖視為時間相依變項，採用不同時間重覆測量的嚴重低血糖暴露資料。在上述所有三種研究設計中，嚴重低血糖事件與全死因死亡率和心血管疾病發生率的相關性估計，都調整了初次診斷年齡、性別、社會經濟因素、以及糖尿病嚴重度指標的干擾效應。
本研究發現，年間，台灣兒童第一型糖尿病發生率為每十萬人5.3人。較高的發生率與女性、年紀較長、以及居住在兒童人口密度較低的地區有關。糖尿病酮酸毒血症仍然是這類病人住院的主要診斷之一。嚴重低血糖的發生率為每100個人年發生2.80人次或6.03個事件。較高的嚴重低血糖發生率與女性、較長的年紀、以及較低的健保月投保薪資有關。另外，根據巢式病例對照研究的結果，全死因死亡率與死亡前1年內、1-3年內、3-5年內曾經發生嚴重低血糖事件顯著相關，但是心血管疾病發生率則只有跟發病前一年曾經發生嚴重低血糖事件顯著相關。發病或死亡前五年累計的嚴重低血糖發生次數越高，全死因死亡率及心血管疾病發生率越高。從另外兩個世代追蹤研究的結果看來，嚴重低血糖的發生與短期及長期內的全死因死亡率都顯著相關。不過，只有當我們把嚴重低血糖當作時間相依變數的研究下，嚴重低血糖依然與短期及長期內的全死因死亡率都顯著相關，而在只採用固定時間測量嚴重低血糖狀態的研究中，嚴重低血糖只與第3-4年追蹤期間的心血管疾病發生率顯著相關。
總結來說，台灣的兒童第一型糖尿病發生率與西方國家比起來相對較低。女性、初次診斷的年齡較大、以及收入較低，與較高的嚴重低血糖發生率有關。曾經發生嚴重低血糖與短期或長期內發生全死因死亡率的風險有關，與短期內發生心血管疾病的風險有關。嚴重低血糖事件累計發生次數越多，全死因死亡率和心血管疾病發生率越高。臨床醫療人員與第一型糖尿病病患在進行血糖控制時，應多費心預防嚴重低血糖事件的發生率。
The incidence rate of Type 1 diabetes (T1DM) increased rapidly in most Western countries during last decades. Hygiene hypothesis is one of the major hypotheses explaining the variation of incidence rate. Most T1DM is diagnosed at young age, but the population incidence of childhood T1DM and the major complication, severe hypoglycemia, were rarely reported in Asian. Severe hypoglycemia is the major obstacle in glycemic controls. Whether there is a long-term association and a dose-gradient relationship between severe hypoglycemia and subsequent risks of all-cause mortality and cardiovascular disease (CVD) incidence is still inconclusive.
We retrieved our data from Taiwan’s National Health Insurance Research Database (NHIRD) from 2003 to 2008 to report annual incidence rate of childhood T1DM. By counting the newly-diagnosed T1DM registered in the list of Catastrophic Illness Database in NHIRD and using the population statistics from Taiwan’s government, we reported the incidence rate and clinical features of childhood T1DM, and examined the association of the incidence rate of T1DM with child-population density and urbanization level of living areas in an ecological study. Besides, a T1DM　cohort was followed from 2003 to 2011, with a mean follow-up period of 6.2 years, to estimate the incidence rate and frequency of severe hypoglycemia under the assumption of Poisson distribution. The possible risk factors for the incidence of severe hypoglycemia in T1DM cases were examined. Furthermore, by taking all-cause mortality and cardiovascular disease (CVD) incidence as separate outcomes, we employed incidence density sampling matching method to conduct two nested case-control studies, in which the exposure status of severe hypoglycemia in three time-windows (1-year, 1-3 years, and 3-5 years) prior to the two adverse outcomes were determined and associated with the risks of all-cause mortality and CVD incidence. The dose-gradient effect of severe hypoglycemia within 5 years was also investigated. In addition, we also conducted two cohort studies, one with a fixed-time exposure status of severe hypoglycemia, and the other one with time-dependent exposure status of severe hypoglycemia. The independent effect of severe hypoglycemia on all-cause mortality and CVD incidence were assessed in the three aforementioned three studies, with adjustment or matched for age at first diagnosis, sex, socioeconomic factors, and severity of diabetes.
The childhood incidence rate was 5.3 per 105 persons in Taiwan from 2003 to 2008. An increased incidence rate of T1DM was associated with female sex, older age, and lived in the areas with lowest child-population density. Diabetic ketoacidosis was still the most important cause for hospitalization. The incidence rate of severe hypoglycemia in T1DM was 2.80 persons per100 person-years (PYs) and 6.03 episodes per 100 PYs. An increased incidence rate of severe hypoglycemia was associated with female sex, older age, and lower monthly-income based insurance premium. Moreover, according to results of the nested case-control design, the risk of all-cause mortality was associated with history of severe hypoglycemia occurred in 1-year, 1-3 years, and 3-5 years prior to death, but the risk of CVD incidence was only associated with history of severe hypoglycemia occurred in the previous year. A higher frequency of severe hypoglycemia occurred within 5 years was associated with a higher risk of all-cause mortality and CVD incidence. The prior history of severe hypoglycemia was associated with both short-term and long-term risks of all-cause mortality in the two cohort studies. On the other hand, severe hypoglycemia was found to be associated with CVD incidence in the cohort study with time-dependent exposure status of severe hypoglycemia, but only significantly associated with the risk of CVD incidence in 3-4 year of follow-up in the cohort design with fixed-time exposure status of severe hypoglycemia.
In conclusion, the incidence rate of childhood T1DM in Taiwan was relatively low compared to most Western countries. Among patients with T1DM, female sex, older age of first diagnosis, and lower income level were associated with an increased risk of severe hypoglycemia. Prior history of severe hypoglycemia was associated with both short-term and long-term risk of all-cause mortality and short-term adverse effect on CVD incidence. Higher frequency of severe hypoglycemia attack was associated with elevated risks of all-cause mortality and CVD incidence. Clinicians and patients with T1DM should put emphasis on the prevention of severe hypoglycemia while managing glycemic control.
1. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. The Lancet. 1):69-82.
2. Group DP. Incidence and trends of childhood Type 1 diabetes worldwide . Diabet. Med. ):857-866.
3. Kawasaki E, Matsuura N, Eguchi K. Type 1 diabetes in Japan. Diabetologia. ):828-836.
4. Li XH, Li TL, Yang Z, et al. A nine-year prospective study on the incidence of childhood type 1 diabetes mellitus in China. Biomed. Environ. Sci. ):263-270.
5. Huen KF, Low LC, Wong GW, et al. Epidemiology of diabetes mellitus in children in Hong Kong: the Hong Kong childhood diabetes register. J. Pediatr. Endocrinol. Metab. ):297-302.
6. Panamonta O, Laopaiboon M, Tuchinda C. Incidence of childhood type 1 (insulin dependent) diabetes mellitus in northeastern Thailand. J. Med. Assoc. Thai. ):821-824.
7. Lee WW, Ooi BC, Thai AC, et al. The incidence of IDDM in Singapore children. Singapore Med. J. ):359-362.
8. Lin WH, Wang MC, Wang WM, et al. Incidence of and mortality from Type I diabetes in Taiwan from 1999 through 2010: a nationwide cohort study. PLoS One. ):e86172.
9. Jiang YD, Chang CH, Tai TY, Chen JF, Chuang LM. Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the
Nationwide Health Insurance database. J. Formos. Med. Assoc. ):599-604.
10. Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group. Lancet. 7):873-876.
11. Gardner SG, Bingley PJ, Sawtell PA, Weeks S, Gale EA. Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis. The Bart's-Oxford Study Group. BMJ. 0):713-717.
12. Writing Group for the DERG, Orchard TJ, Nathan DM, et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA. ):45-53.
13. Lind M, Svensson A-M, Kosiborod M, et al. Glycemic control and excess mortality in type 1 diabetes. N. Engl. J. Med. ):.
14. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes the Pittsburgh Epidemiology of Diabetes Complications Study Cohort. Diabetes. ):.
15. Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. All-Cause Mortality Trends in a Large Population-Based Cohort With Long-Standing Childhood-Onset Type 1 Diabetes: The Allegheny County Type 1 Diabetes Registry. Diabetes Care. ):.
16. Arias E. United States Life Tables, 2011. National Vital Statistics Reports. Vol 64: U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES; 2015.
17. Okada H, Kuhn C, Feillet H, Bach JF. The 'hygiene hypothesis' for autoimmune and allergic diseases: an update. Clin. Exp. Immunol. ):1-9.
18. Yazdanbakhsh M, Kremsner PG, van Ree R. Allergy, parasites, and the hygiene hypothesis. Science. 7):490-494.
19. Parslow RC, McKinney PA, Law GR, Bodansky HJ. Population mixing and childhood diabetes. Int. J. Epidemiol. ):533-538; discussion 538-539.
20. Miller LJ, Pearce J, Barnett R, Willis JA, Darlow BA, Scott RS. Is population mixing associated with childhood type 1 diabetes in Canterbury, New Zealand? Soc. Sci. Med. ):625-630.
21. Rytkonen M, Moltchanova E, Ranta J, et al. The incidence of type 1 diabetes among children in Finland--rural-urban difference. Health Place. ):315-325.
22. Bruno G, Spadea T, Picariello R, et al. Early life socioeconomic indicators and risk of type 1 diabetes in children and young adults. J. Pediatr. ):600-605 e601.
23. Kaila B, Taback SP. The effect of day care exposure on the risk of developing type 1 diabetes: a meta-analysis of case-control studies. Diabetes Care. ):.
24. Holmqvist BM, Lofman O, Samuelsson U. A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived. Diabet. Med. ):255-260.
25. Rewers A, Chase H, Mackenzie T, et al. PRedictors of acute complications in children with type 1 diabetes. JAMA. ):.
26. Daneman D. Type 1 diabetes. The Lancet. 3):847-858.
27. Giorda CB, Ozzello A, Gentile S, et al. Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study. Acta Diabetol. .
28. Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in Type 1 and insulin-treated Type 2 diabetes: a population-based study. Diabet. Med. ):749-755.
29. Pedersen-Bjergaard U, Pramming S, Heller SR, et al. Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab. Res. Rev. ):479-486.
30. Leese GP, Wang J, Broomhall J, et al. Frequency of severe hypoglycemia requiring emergency treatment in type 1 and type 2 diabetes: a population-based study of health service resource use. Diabetes Care. ):.
31. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia. 2001;44 Suppl 2:S14-21.
32. Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann. Intern. Med. ):421-431.
33. Stettler C, Allemann S, Jüni P, et al. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials. Am. Heart J. ):27-38.
34. Goff DC, Jr., Gerstein HC, Ginsberg HN, et al. Prevention of cardiovascular disease in persons with type 2 diabetes mellitus: current knowledge and rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am. J. Cardiol. A):4i-20i.
35. Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab. Res. Rev. ):353-363.
36. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Ophthalmology. ):647-661.
37. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N. Engl. J. Med. ):381-389.
38. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. ):.
39. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N. Engl. J. Med. ):977-986.
40. Writing Team for the Diabetes C, Complications Trial/Epidemiology of Diabetes I, Complications Research G. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. ):.
41. Group AC, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N. Engl. J. Med. ):.
42. Duckworth W, Abraira C, Moritz T, et al. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N. Engl. J. Med. ):129-139.
43. Allen C, LeCaire T, Palta M, Daniels K, Meredith M, D’Alessio DJ. Risk factors for frequent and severe hypoglycemia in type 1 diabetes. Diabetes Care. ):.
44. Skyler JS, Bergenstal R, Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J. Am. Coll. Cardiol. ):298-304.
45. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. ):.
46. Frier BM. Defining hypoglycaemia: what level has clinical relevance? Diabetologia. ):31-34.
47. American Diabetes A. Standards of medical care in diabetes--2014. Diabetes Care. 2014;37 Suppl 1:S14-80.
48. Cryer PE. Severe hypoglycemia predicts mortality in diabetes. Diabetes Care. ):.
49. Amiel SA, Dixon T, Mann R, Jameson K. Hypoglycaemia in Type 2 diabetes. Diabet. Med. ):245-254.
50. Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N. Engl. J. Med. ):362-372.
51. Fredheim S, Johansen A, Thorsen S, et al. Nationwide reduction in the frequency of severe hypoglycemia by half. Acta Diabetol. ):591-599.
52. Control D, Group CTR. Hypoglycemia in the diabetes control and complications trial. Diabetes. ):271-286.
53. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am. J. Med. ):450-459.
54. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1):837-853.
55. Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N. Engl. J. Med. ):129-139.
56. Genuth SM, Backlund JY, Bayless M, et al. Effects of prior intensive versus conventional therapy and history of glycemia on cardiac function in type 1 diabetes in the DCCT/EDIC. Diabetes. ):.
57. Bonds DE, Miller ME, Bergenstal RM, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 09.
58. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N. Engl. J. Med. ):.
59. Hsu PF, Sung SH, Cheng HM, et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care. ):894-900.
60. Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK. Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care. ):316-322.
61. McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. ):.
62. Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. .
63. Group UKHS. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. ):.
64. Gruden G, Barutta F, Chaturvedi N, et al. Severe hypoglycemia and cardiovascular disease incidence in type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetes Care. ):.
65. Gimenez M, Lopez JJ, Castell C, Conget I. Hypoglycaemia and cardiovascular disease in Type 1 Diabetes. Results from the Catalan National Public Health registry on insulin pump therapy. Diabetes Res. Clin. Pract. ):e23-25.
66. Fahrmann ER, Adkins L, Loader CJ, et al. Severe hypoglycemia and coronary artery calcification during the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study. Diabetes Res. Clin. Pract. ):280-289.
67. Seaquist ER, Miller ME, Bonds DE, et al. The impact of frequent and unrecognized hypoglycemia on mortality in the ACCORD study. Diabetes Care. ):409-414.
68. Giménez M, Gilabert R, Monteagudo J, et al. Repeated episodes of hypoglycemia as a potential aggravating factor for preclinical atherosclerosis in subjects with type 1 diabetes. Diabetes Care. ):198-203.
69. F?hrmann ER, Adkins L, Loader CJ, et al. Severe hypoglycemia and coronary artery calcification during the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study. Diabetes Res. Clin. Pract. ):280-289.
70. Frier BM, Schernthaner G, Heller SR. Hypoglycemia and cardiovascular risks. Diabetes Care. 2011;34 Suppl 2(Supplement 2):S132-137.
71. Desouza CV, Bolli GB, Fonseca V. Hypoglycemia, diabetes, and cardiovascular events. Diabetes Care. ):.
72. Bedenis R, Price AH, Robertson CM, et al. Association between severe hypoglycemia, adverse macrovascular events, and inflammation in the Edinburgh Type 2 Diabetes Study. Diabetes Care. ):.
73. Yakubovich N, Gerstein HC. Serious cardiovascular outcomes in diabetes: the role of hypoglycemia. Circulation. ):342-348.
74. Boucai L, Southern WN, Zonszein J. Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities. Am. J. Med. ):.
75. Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff. (Millwood). ):77-88.
76. Cheng TM. Taiwan's new national health insurance program: genesis and experience so far. Health Aff. (Millwood). ):61-76.
77. Lu CL, Shen HN, Chen HF, Li CY. Epidemiology of childhood Type 1 diabetes in Taiwan, 2003 to 2008. Diabet. Med. ):666-673.
78. Liu CY, Hung, Y.T.,
Chuang, T.L., Chen, Y.J., Weng, W.S., Liu, J.S., Liang, K.Y. Incorporating Development Stratification of Taiwan Townships into Sampling Design of Large Scale Health Interview Survey. Journal of Health Management. ):1-22.
79. Ginde AA, Blanc PG, Lieberman RM, Camargo CA, Jr. Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits. BMC Endocr. Disord. ):4.
80. Young BA, Lin E, Von Korff M, et al. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am. J. Manag. Care. ):15-23.
81. Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care. ):.
82. Harron KL, McKinney PA, Feltbower RG, et al. Incidence rate trends in childhood type 1 diabetes in Yorkshire, UK : effects of deprivation and age at diagnosis in the South Asian and non-South Asian populations. Diabet. Med. ):.
83. Schober E, Rami B, Waldhoer T, Austrian Diabetes Incidence Study G. Steep increase of incidence of childhood diabetes since 1999 in Austria. Time trend analysis . A nationwide study. Eur. J. Pediatr. ):293-297.
84. Karvonen M, Pitkaniemi M, Pitkaniemi J, Kohtamaki K, Tajima N, Tuomilehto J. Sex difference in the incidence of insulin-dependent diabetes mellitus: an analysis of the recent epidemiological data. World Health Organization DIAMOND Project Group. Diabetes Metab. Rev. ):275-291.
85. Svensson J, Carstensen B, Mortensen HB, Borch-Johnsen K, Danish Study Group of Diabetes in C. Gender-associated differences in Type 1 diabetes risk factors? Diabetologia. ):442-443.
86. Angus VC, Waugh N. Hospital admission patterns subsequent to diagnosis of type 1 diabetes in children : a systematic review. BMC Health Serv. Res. .
87. Peery AI, Engelke MK, Swanson MS. Parent and teacher perceptions of the impact of school nurse interventions on children's self-management of diabetes. J. Sch. Nurs. ):268-274.
88. McKinney PA, Okasha M, Parslow RC, et al. Early social mixing and childhood Type 1 diabetes mellitus: a case-control study in Yorkshire, UK. Diabet. Med. ):236-242.
89. Fear NT, McKinney PA, Patterson CC, Parslow RC, Bodansky HJ. Childhood Type 1 diabetes mellitus and parental occupations involving social mixing and infectious contacts: two population-based case-control studies. Diabet. Med. ):.
90. Staines A, Bodansky HJ, McKinney PA, et al. Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density. Int. J. Epidemiol. ):.
91. Miller LJ, Willis JA, Pearce J, Barnett R, Darlow BA, Scott RS. Urban-rural variation in childhood type 1 diabetes incidence in Canterbury, New Zealand, . Health Place. ):248-256.
92. Gimenez M, Conget I. Comment on: Gruden et al. Severe hypoglycemia and cardiovascular disease incidence in type 1 diabetes: the EURODIAB prospective complications study. Diabetes Care 8-1604. Diabetes Care. ):e88; author reply e89.
93. Bolli GB. Hypoglycaemia unawareness. Diabetes Metab. 1997;23 Suppl 3:29-35.
94. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care. ):697-703.
95. Wright RJ, Newby DE, Stirling D, Ludlam CA, Macdonald IA, Frier BM. Effects of acute insulin-induced hypoglycemia on indices of inflammation: putative mechanism for aggravating vascular disease in diabetes. Diabetes Care. ):.
96. Joy NG, Hedrington MS, Briscoe VJ, Tate DB, Ertl AC, Davis SN. Effects of acute hypoglycemia on inflammatory and pro-atherothrombotic biomarkers in individuals with type 1 diabetes and healthy individuals. Diabetes Care. ):.
97. Zhou Z. Survival Bias Associated with Time-to-Treatment Initiation in Drug Effectiveness Evaluation: A Comparison of Methods. Am. J. Epidemiol. ):.
98. Levesque LE, Hanley JA, Kezouh A, Suissa S. Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes. BMJ. (mar12 1):b.
99. Dekker FW, de Mutsert R, van Dijk PC, Zoccali C, Jager KJ. Survival analysis: time-dependent effects and time-varying risk factors. Kidney Int. ):994-997.
100. Greenland S, Thomas DC. On the need for the rare disease assumption in case-control studies. Am. J. Epidemiol. ):547-553.
101. Flanders WD, Louv WC. The exposure odds ratio in nested case-control studies with competing risks. Am. J. Epidemiol. ):684-692.
文章公開取用時，將寄通知信至您填寫的信箱地址
購物車中已有多篇文章，請問是否要先清除，或一併加入購物車中購買 ?
客戶服務專線
服務時間：週一～五
9:00~18:00
地址：234台灣新北市永和區成功路一段80號18樓
(C) 2011airiti Inc. All rights reserved.
華藝數位股份有限公司