住院2型糖尿病患者日内及日间血糖波动的相关因素探讨
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摘要
目的:探讨影响2型糖尿患者血糖波动的临床相关因素。方法 :对183例接受胰岛素治疗的2型糖尿病住院患者进行动态血糖监测。日内血糖波动采用平均血糖波动幅度(mean amplitude of glycemic excursion,MAGE)评估,日间血糖波动采用日间血糖平均绝对差(means of daily differences,MODD)评估,采取广义线性模型用于分析不同临床影响因素与MAGE及MODD之间的相关性。结果:动态血糖监测结果显示,患者的平均MAGE和平均MODD分别为(4.75±0.91)mmol/L和(2.62±0.76)mmol/L。对于日内血糖波动,糖尿病家族史阳性及血清C肽、高密度脂蛋白胆固醇和尿酸低水平是患者MAGE增高的独立相关因素(P均<0.05)。对于日间血糖波动,糖尿病病程、糖化血红蛋白、血清天冬氨酸转氨酶(aspartate aminotransferase,AST)及高密度脂蛋白胆固醇与MODD呈正相关关系,而空腹C肽水平及预混胰岛素治疗与MODD呈负相关关系。结论 :糖尿病家族史、糖尿病病程、糖化血红蛋白、肝酶、高密度脂蛋白胆固醇、血清C肽水平、预混胰岛素注射治疗方案、心血管疾病史及血清尿酸水平与糖尿病患者血糖波动间存在显著相关性,提示胰岛β细胞功能及胰岛素敏感性可能影响了糖尿病患者的血糖波动;预混胰岛素注射治疗方案在我国2型糖尿病患者中可能获得更好的血糖控制。
Objective: To evaluate the associated factors for within-day and day-to-day glycemic variability(GV) in type 2 diabetes(T2 D) patients. Methods: A total of 183 hospitalized patients with T2D receiving insulin therapy were enrolled. Continuous glucose monitoring(CGM) was performed in all the subjects. The within-day GV was evaluated by using mean amplitude of glycemic excursion(MAGE), and day-to-day GV by absolute means of daily differences(MODD). Generalized linear model was used to estimate associated factors for within-day and day-to-day glycemic variability. Results:CGM revealed that mean MAGE and MODD were(4.75±0.91) mmol/L and(2.62±0.76) mmol/L, respectively. For withinday glycemic variability, family history of diabetes, lower levels of C-peptide, uric acid, HDL-C were independent related factors for increase of MAGE. For day-to-day glycemic variability, duration of diabetes, glycosylated hemoglobin, aspartate aminotransferase(AST) and high density lipoprotein cholesterol(HDL-C) were positively correlated with MODD, while Cpeptide and premixed insulin injection were negatively correlated with MODD. Conclusions: Family history of diabetes, duration of diabetes, HbA1c, AST, HDL-C, serum levels of C-peptide, premixed insulin injection, history of CVD and serum concentration of uric acid are significantly associated with GV parameters, which indicates that the function of pancreatic beta cells and insulin sensitivity may influence the glycemic variability in type 2 diabetes patients. Premixed insulin in-jection may exert a better curative effect on blood glucose control in Chinese type 2 diabetes patients.
Objective: To evaluate the associated factors for within-day and day-to-day glycemic variability(GV) in type 2 diabetes(T2 D) patients. Methods: A total of 183 hospitalized patients with T2D receiving insulin therapy were enrolled. Continuous glucose monitoring(CGM) was performed in all the subjects. The within-day GV was evaluated by using mean amplitude of glycemic excursion(MAGE), and day-to-day GV by absolute means of daily differences(MODD). Generalized linear model was used to estimate associated factors for within-day and day-to-day glycemic variability. Results:CGM revealed that mean MAGE and MODD were(4.75±0.91) mmol/L and(2.62±0.76) mmol/L, respectively. For withinday glycemic variability, family history of diabetes, lower levels of C-peptide, uric acid, HDL-C were independent related factors for increase of MAGE. For day-to-day glycemic variability, duration of diabetes, glycosylated hemoglobin, aspartate aminotransferase(AST) and high density lipoprotein cholesterol(HDL-C) were positively correlated with MODD, while Cpeptide and premixed insulin injection were negatively correlated with MODD. Conclusions: Family history of diabetes, duration of diabetes, HbA1c, AST, HDL-C, serum levels of C-peptide, premixed insulin injection, history of CVD and serum concentration of uric acid are significantly associated with GV parameters, which indicates that the function of pancreatic beta cells and insulin sensitivity may influence the glycemic variability in type 2 diabetes patients. Premixed insulin in-jection may exert a better curative effect on blood glucose control in Chinese type 2 diabetes patients.
引文
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[16]Greven WL,Beulens JW,Biesma DH,et al.Glycemic variability in inadequately controlled type 1 diabetes and type 2 diabetes on intensive insulin therapy:a cross-sectional,observational study[J].Diabetes Technol Ther,2010,12(9):695-699.
[17]Murata GH,Duckworth WC,Shah JH,et al.Sources of glucose variability in insulin-treated type 2 diabetes:the Diabetes Outcomes in Veterans Study(DOVES)[J].Clin Endocrinol(Oxf),2004,60(4):451-456.
[18]Gjesing AP,Pedersen O.'Omics'-driven discoveries in prevention and treatment of type 2 diabetes[J].Eur J Clin Invest,2012,42(6):579-588.
[19]Xu M,Huang Y,Xie L,et al.Diabetes and Risk of Arterial Stiffness:A Mendelian Randomization Analysis[J].Diabetes,2016,65(6):1731-1740.
[20]Chen J,Wildman RP,Hamm LL,et al.Association between inflammation and insulin resistance in U.S.nondiabetic adults:results from the Third National Health and Nutrition Examination Survey[J].Diabetes Care,2004,27(12):2960-2965.
[21]Avula NR,Shenoy D.Evaluation of Association of Hyperuricaemia with Metabolic Syndrome and Insulin Resistance[J].J Clin Diagn Res,2016,10(12):OC32-OC34.
[22]王天怡,敖虎山.非体外循环冠状动脉旁路移植术术中血糖波动与术后高血糖的关系[J].安徽医学,2017,38(7):877-880.
[23]Zhang Y,Lee ET,Howard BV,et al.Insulin resistance,incident cardiovascular diseases,and decreased kidney function among nondiabetic American Indians:the Strong Heart Study[J].Diabetes Care,2013,36(10):3195-3200.
[2]Ceriello A.Postprandial hyperglycemia and diabetes complications:is it time to treat?[J].Diabetes,2005,54(1):1-7.
[3]O'Sullivan EP,Dinneen SF.Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years[J].Evid Based Med,2009,14(1):9-10.
[4]Monnier L,Mas E,Ginet C,et al.Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes[J].JAMA,2006,295(14):1681-1687.
[5]Brownlee M,Hirsch IB.Glycemic variability:a hemoglobin A1c-independent risk factor for diabetic complications[J].JAMA,2006,295(14):1707-1708.
[6]Bergenstal RM.Glycemic Variability and Diabetes Complications:Does It Matter?Simply Put,There Are Better Glycemic Markers![J].Diabetes Care,2015,38(8):1615-1621.
[7]del Prato S,Marchetti P,Bonadonna RC.Phasic insulin release and metabolic regulation in type 2 diabetes[J].Diabetes,2002,51(Suppl 1):S109-S116.
[8]Service FJ,Nelson RL.Characteristics of glycemic stability[J].Diabetes Care,1980,3(1):58-62.
[9]Kohnert KD,Augstein P,Zander E,et al.Glycemic variability correlates strongly with postprandial beta-cell dysfunction in a segment of type 2 diabetic patients using oral hypoglycemic agents[J].Diabetes Care,2009,32(6):1058-1062.
[10]Jin SM,Kim TH,Bae JC,et al.Clinical factors associated with absolute and relative measures of glycemic variability determined by continuous glucose monitoring:an analysis of 480 subjects[J].Diabetes Res Clin Pract,2014,104(2):266-272.
[11]周健,贾伟平.血糖稳定性的意义及临床评估[J].中华医学杂志,2006,92(30):2154-2157.
[12]刘晓峰,刘纯.当前几种动态血糖监测系统的比较[J].国际内分泌代谢杂志,2009,29(3):197-200.
[13]Service FJ.Glucose variability[J].Diabetes,2013,62(5):1398-1404.
[14]de Vries JH.Glucose variability:where it is important and how to measure it[J].Diabetes,2013,62(5):1405-1408.
[15]Service FJ,Molnar GD,Rosevear JW,et al.Mean amplitude of glycemic excursions,a measure of diabetic instability[J].Diabetes,1970,19(9):644-655.
[16]Greven WL,Beulens JW,Biesma DH,et al.Glycemic variability in inadequately controlled type 1 diabetes and type 2 diabetes on intensive insulin therapy:a cross-sectional,observational study[J].Diabetes Technol Ther,2010,12(9):695-699.
[17]Murata GH,Duckworth WC,Shah JH,et al.Sources of glucose variability in insulin-treated type 2 diabetes:the Diabetes Outcomes in Veterans Study(DOVES)[J].Clin Endocrinol(Oxf),2004,60(4):451-456.
[18]Gjesing AP,Pedersen O.'Omics'-driven discoveries in prevention and treatment of type 2 diabetes[J].Eur J Clin Invest,2012,42(6):579-588.
[19]Xu M,Huang Y,Xie L,et al.Diabetes and Risk of Arterial Stiffness:A Mendelian Randomization Analysis[J].Diabetes,2016,65(6):1731-1740.
[20]Chen J,Wildman RP,Hamm LL,et al.Association between inflammation and insulin resistance in U.S.nondiabetic adults:results from the Third National Health and Nutrition Examination Survey[J].Diabetes Care,2004,27(12):2960-2965.
[21]Avula NR,Shenoy D.Evaluation of Association of Hyperuricaemia with Metabolic Syndrome and Insulin Resistance[J].J Clin Diagn Res,2016,10(12):OC32-OC34.
[22]王天怡,敖虎山.非体外循环冠状动脉旁路移植术术中血糖波动与术后高血糖的关系[J].安徽医学,2017,38(7):877-880.
[23]Zhang Y,Lee ET,Howard BV,et al.Insulin resistance,incident cardiovascular diseases,and decreased kidney function among nondiabetic American Indians:the Strong Heart Study[J].Diabetes Care,2013,36(10):3195-3200.