摘要
Abstract
Objective To explore the influencing factors of impaired awareness of hypoglycemia in elderly patients with diabetic peripheral neuropathy(DPN),and to construct a prediction model of nomogram.Methods The elderly DPN patients admitted to Suzhou Municipal Hospital from March 2021 to December 2023 were selected by convenient sampling method.General data questionnaire,impaired perception of hypoglycemia(Gold scoring method)and Chinese version Hypoglycemia Fear SurveyⅡ-Worry Scale(CHFSⅡ-WS)were used for investigation.Multivariate Logistic regression was performed to analyze the influencing factors of impaired hypoglycemia awareness.The R software was used to construct a nomogram prediction model,and the ROC curve was used to evaluate the predictive value of the model.Results A total of 188 questionnaires were distributed,182 were valid,with an effective recovery rate of 96.81%.Among the 182 patients,59 cases(32.42%)had impaired awareness of hypoglycemia.The proportion of patients in the impaired awareness of hypoglycemia group with moderate to severe DPN,history of severe hypoglycemia and no hypoglycemia prevention education was higher than that in the non-impaired awareness of hypoglycemia group,and the CHFSⅡ-WS score was also higher than that in the non-impaired awareness of hypoglycemia group(P＜0.05).Multivariate Logistic regression analysis showed that DPN being moderately severe(OR=7.457,95%CI=2.123-26.194),having a history of severe hypoglycemia(OR=7.597,95%CI=1.495-38.608),not receiving hypoglycemia prevention education(OR=6.299,95%CI=1.741-22.795)and CHFSⅡ-WS score(OR=2.189,95%CI=1.685-2.844)were risk factors for impaired awareness of hypoglycemia in elderly DPN patients(all P＜0.05).The Hosmer-Lemeshow test chi-square value of the nomogram model constructed based on four indicators:DPN severity,history of severe hypoglycemia,hypoglycemia prevention education,and CHFSⅡ-WS score,was 4.254 with a P-value of 0.750,indicating good fit and calibration.Moreover,the nematic model predicted that the AUC of impaired awareness of hypoglycemia in elderly DPN patients was 0.905(95%CI=0.862-0.949),sensitivity was 83.1%,specificity 82.1%.Conclusions Moderate to severe DPN,history of severe hypoglycemia,lack of hypoglycemia prevention education,and fear of hypoglycemia increase the risk of impaired awareness of hypoglycemia in elderly DPN patients.The nomogram model built based on the four indicators has a good predictive effect on impaired awareness of hypoglycemia.关键词
糖尿病周围神经病变/低血糖感知受损/影响因素/列线图/预测模型Key words
Diabetic peripheral neuropathy/Impaired awareness of hypoglycemia/Influencing factors/Nomogram/Prediction model
