格列美脲治疗老年糖尿病时发生低血糖风险的预测模型OA

Objective To construct a risk prediction model for hypoglycemia in elderly patients with type 2 diabetes treated with glimepiride,providing a basis for individualized clinical medication.Methods The clinical data of 241 elderly patients(aged≥60 years)with type 2 diabetes who were regularly treated with oral glimepiride(monotherapy or in combination with other hypoglycemic agents)were retrospectively collected from the Department of Geriatrics,Nanjing First Hospital,from October 2022 to October 2024.According to whether patients experienced symptomatic or asymptomatic hypoglycemic events during treatment with glimepiride,they were divided into a hypoglycemic group of 60 cases(24.90%)and a non hypoglycemic group of 181 cases(75.10%).The independ-ent influencing factors of hypoglycemia in elderly diabetes patients treated with glimepiride were screened through single factor analysis and multi factor logistic regression analysis,and the predictive model was constructed and its efficacy was evaluated.Results Univa-riate analysis showed that there were statistically significant differences between the hypoglycemia group and the non hypoglycemia group in terms of age,duration of diabetes,body mass index,estimated glomerular filtration rate(eGFR),serum albumin,daily dose of glimepiride,previous history of hypoglycemia,combined use of insulin,and combined use of β-blockers(P<0.05).Multivariate logistic regression analysis revealed that advanced age,lower eGFR,higher daily dose of glimepiride,a previous history of hypoglyce-mia,and combined use of insulin were independent risk factors for glimepiride-induced hypoglycemia in elderly patients with type 2 di-abetes(P<0.05).The area under the curve of the ROC curve prediction model is 0.882(95%CI:0.812-0.918,P<0.001).The probability value of 0.251 corresponding to the maximum point of the Jordan index on the ROC curve(0.579)is selected as the opti-mal critical point.At this point,the sensitivity of the model is 78.33%,the specificity is 79.56%,the positive predictive value is 55.95%,and the negative predictive value is 91.72%.Conclusion The prediction model based on advanced age,renal function,drug dose,history of hypoglycemia and insulin combination has good clinical value in predicting the risk of hypoglycemia in elderly pa-tients with diabetes during glimepiride administration.