格列美脲治疗老年糖尿病时发生低血糖风险的预测模型

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[Abstract]ObjectiveToconstructarisk prediction modelforhypoglycemia inelderlypatients with type2diabetes treated withglimepiride，providingabasisforindividualizedclinicalmedication.MethodsTheclinicaldataof241elderlypatients（ 60years）withtype2diabeteswhowereregularlytreatedwithoralglimepiride（monotherapyorincombinationwithotherhypoglycemic agents）wereetrospctivelylectedfroheDepartmentofGeriatrics，NanjingFistHospital，froOctober2toOctober024. Acordingto whether patients experiencedsymptomaticor asymptomatic hypoglycemic events during treatmentwith glimepiride，they were divided into a hypoglycemic group of 6O cases （ 24.90% ） and a non hypoglycemic group of 181 cases （ 75.10% ）. The independentinfluencingfactosofhypogycemiainelderlydabetespatints treatedwithgimepidewerescreeedtroughsinglefactoralysis andmultifactorlogisticregressonanalysis，andthepredictive modelwasconstructedanditsfcacywasevaluated.ResultsUnivariateanalysisshowedthattherewerestatisticallysignificantdiferencesbetweenthehypoglycemiagroupandthenonhypoglycemia groupintermsofage，durationofdiabetes，bodymassindex，estimatedglomerularfiltrationrate（GFR），serumalbumin，dailydose of glimepiride，previous history of hypoglycemia，combined use of insulin，and combined use of β -blockers （ P<0.05 ）. Multivariate logisticregresioaalysisevealedtatadvancedage，lowerGFR，igherdailydoseofglimepide，aprevioushstoryofhgly mia，andcombineduseofinsuliwereindependentriskfactorforlimepiride-iducedhypoglycemiainelderlypatientswithtype2diabetes （ 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 probabilityvalueof0.251corrsponding tothemaximumpointoftheJordanindexontheROCcurve（O.579）isselectedastheoptimal critical point.At this point，the sensitivity of the model is 78.33% ，the specificity is79.56 % ，the positive predictive value is

55.95% ，and the negative predictive value is 91.72% .ConclusionThe prediction model based on advanced age，renal function， drugdose，historyofhpoglycemiaandinsulinombinationhasodclinicalvalueinpredictingtheiskofhypoglycemiaielderlypatientswithdiabetesduringglimepirideadministration.

Key words] Glimepiride；Type2 diabetes；Hypoglycemia；Risk prediction

老年糖尿病作为全球公共卫生领域日益突出的挑战，其治疗管理尤为复杂，需兼顾疗效与安全性[1]。（剩余10560字）