Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective： To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c （HbA1c） was kept ≤6.0%. Methods： Totally 36 cases with type 2 diabetes （T2DM） with HbA1c≤6.0% and 30 cases with normal glucose tolerance （NGT） from December 2005 to December 2007 in our department were subjected prospectively. Continuous glucose monitoring system （CGMS） was employed to record their continuous blood glucose level for 3 d. The blood glucose profiles including the mean blood glucose （MBG）, standard differentiation （SD）, mean amplitude of glycemic excursions （MAGE） and absolute means of daily differences （MODD） were analyzed. Results： T2DM group had obviously postprandial hyperglycemia, in about 2 h after meal, especially after breakfast. Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups, of which 73.1% （38 episodes） were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L. And 20 episodes took place during the day hours, while 32 episodes observed during the night hours. Compared with NGT groups, SD, MAGE and MODD were all significantly higher in T2DM groups. MBG was significantly correlated with HbA1c in T2DM groups, but SD, MAGE, NGE and MODD were all independent of HbA1c. MAGE was independent of MODD. Conclusion： The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups Thus ideally glycemic control is not only to make HbA1c reach standard, but also to lessen glycemic excursions and reduce hypoglycemia episodes.     

Dynamic expression of glucose transporters 1 and 3 in the brain of diabetic rats with cerebral ischemia reperfusion

Background Blood glucose control improves the outcome of diabetic patients with stroke, but the target range of blood glucose control remains controversial. The functional recruitment of ischemia penumbra is extremely important to the recovery after stroke. The present study aimed to explore the expression of brain-type glucose transporters （GLUT1 and GLUT3） in cerebral ischemic penumbra at different blood glucose levels and different ischemic-reperfusion time in diabetic hypoxia-ischemia rats. The results might provide an experimental basis for clinical treatment of diabetic patients with stroke. Methods The Wistar rats included in this study were randomly assigned to 4 groups （50 rats each）： normal control group （NC）, uncontrolled diabetic group （DM1）, poorly-controlled diabetic group （DM2）, and well-controlled diabetic group （DM3）. Diabetic rats were induced by single intraperitoneal injection of streptozotocin, and the focal ischemic rat model of middle artery occlusion （MCAO） was made by insertion of fishing thread in 6 weeks after the establishment of the diabetic model. Each group was divided into 5 subgroups （10 rats each）： four focal ischemic subgroups at different ischemic-reperfusion time （at 3,12, 24 and 72 hours after reperfusion, respectively） and one sham-operated subgroup. The mRNA and protein expression of GLUT1 and GLUT3 was assessed by RT-PCR and Western blotting, respectively. Results There was significant difference in the mRNA expression of GLUT1 and GLUT3 between the four focal ischemic subgroups and the sham-operated subgroup at different reperfusion time in each group. The mRNA expression of GLUT1 and GLUT3 in the 4 ischemic groups began to increase at 3 hours, peaked at 24 hours after reperfusion and maintained at a higher level even at 72 hours compared with that of the sham-operated subgroup. The mRNA expression of GLUT1 increased more significantly than that of GLUT3. The mRNA expression of GLUT1 and GLUT3 was significantly different between the diabetic groups and normal control group. The mRNA expression of GLUT1 and GLUT3 was increased more significantty in the diabetic groups than that in the normal control group. There was a significant difference in the mRNA expression in the groups with different blood glucose levels. The mRNA expression tended to decrease with increased blood glucose levels. The expression trend of GLUT1 and GLUT3 protein was similar to that of GLUT1 and GLUT3 mRNA. Conclusions GLUT1 and GLUT3 expression was notably up-regulated in the penumbra region after cerebral ischemia in this study. But the up-regulated amplitude of GLUT1 and GLUT3 in the diabetic rats with cerebral ischemic injury became smaller than that of the normal controls. In the treatment of diabetic patients with cerebral embolism, blood glucose control should not be too strict, otherwise the up-regulation of GLUT1 and GLUT3 induced by cerebral ischemic injury might not be able to meet the needs of energy metabolism in cells. Chin Med J 2009; 122（ 17）： 1996-2001     

Changes in expression of adrenomedullin in the myocardium of streptozotocin-induced diabetic rats

Background Adrenomedullin is a potent vasodilating peptide and involved in many cardiovascular diseases. However, whether adrenomedullin is involved in the pathogenesis of diabetic cardiomyopathy is still unknown. Our aim was to characterize the expression pattern of adrenomedullin in the myocardium of streptozotocin-induced diabetic rats. Methods The weight, blood glucose, and urine glucose of 20 streptozotocin-induced diabetic rats were measured before and after model induction in the diabetic and control groups. The alteration of the adrenomedullin expression was explored in the left ventricular myocardium in both groups by immunohistochemistry. Changes in heart ultrastructure were also analyzed by using hemotoxylin and eosin staining and transmission electron microscopy. All data were analyzed by the independent samples ttest. Results The data of weight, blood glucose, and urine glucose had no significant difference between the control and the diabetic groups before animal model induction. Four weeks after the induction of diabetes, the differences between the two groups in weight, blood glucose, and urine glucose were distinct. When compared with the control group, the diabetic group showed ultrastructural changes including hypertrophy, fibrosis, myofibrillar disarrangements, mitochondrial disruption, and increase in nuclear membrane invaginations. A significant decrease of adrenomedullin expression was also observed in cardiac myocytes of the diabetic rats （P〈0.01）. Conclusions Our study provides experimental evidence that hyperglycemia could damage cardiac myocytes. Down-regulation of cardioprotective peptide adrenomedullin in the myocardium of streptozotocin-induced diabetic rats may contribute to the diabetic cardiomyopathy and left ventricular dysfunction.     

Features analysis on Traditional Chinese Medicine syndromes in patients with diabetic peripheral neuropathy

OBJECTIVE:To study the features of the distribution and differentiation ofTraditional Chinese Medicine(TCM)syndromes in patients with diabetic peripheral neuropathy(DPN).METHODS:We collected clinical data on illness course,age,fasting blood glucose,saccharogenic hemoglobin,TCM syndromes,tongue,and pulse of238 DPN patients.Differentiated main syndromes(Yin deficiency and exuberant heat,invasion of spleen by damp-heat,deficiency of both Qi and Yins,and deficiency of both Yin and Yang)and accompanying syndromes(blood stasis and phlegm-dampness)of diabetes were also recorded.The features of DPN syndromes were then analyzed.RESULTS:Among the four main syndromes of diabetes,deficiency of both Yin and Yang was the most common in the 238 DPN patients,of which89%-96%had blood stasis.CONCLUSION:The method of differentiating syndromes of diabetes can be applied to DPN patients.Deficiency of both Yin and Yang,often accompanied by blood stasis,is commonly seen.     

Effect of short term intensive multitherapy on carotid intima- media thickness in patients with newly diagnosed type 2 diabetes mellitus

Background Controlling plasma glucose levels, blood pressure and lipid levels is proven to reduce the risk of vascular complications in patients with type 2 diabetes mellitus. This has prompted intensive multitherapy targeted at several macrovascular risk factors. Carotid intima-media thickness （cIMT） is a reliable measure of early atherosclerosis. We sought to determine whether a 6-month intensive mutiltherapy program resulted in better goal attainment than usual care and its effect on the development of cIMT among patients with newly diagnosed type 2 diabetes mellitus.
Methods The study randomly assigned 220 patients with newly diagnosed type 2 diabetes mellitus to intensive or traditional therapy groups. The clinical parameters, such as fasting plasma glucose, total cholesterol, triglyceride, blood pressure, body weight and insulin were assessed at the baseline and after the 6-month therapy, cIMT of the patients was also obtained.
Results The average levels of fasting plasma glucose, hemoglobin Alc, total cholesterol （TC） and low-density lipoprotein cholesterol （LDL-C） in the intensive group were significantly lower than those in the control group at the end of 6-month treatment. By 6 months, a higher proportion of patients in the intensive therapy group than in the control group attained goals for fasting plasma glucose （FPG）, TC, LDL-C and hemoglobin Alc. With intensive multherapy the level of carotid intima-media thickness in the intensive therapy group was lower than that in the control group （（0.88±0.26） mm vs （0.96±0.22） mm, P 〈0.01）.
Conclusions The evidence from this clinical trial demonstrates that intensive glucose, lipid and blood pressure control in patients with newly diagnosed type 2 diabetes is associated with diabetic macrovascular benefits. Intensive multitherapy allows more patients to achieve aims of control and may reduce macrovascular complications and delay disease progression.     

Determination of blood flow in the lower leg of patients with diabetes mellitus and the effects of treatment with the principle of vitalizing blood and solubilizing thrombus

Blood flow in the lower leg was determined in 50 cases of non-insulin dependent diabetes mellitus using an XLJ-2 bipolar rheoencephalometry impedance rheogram. In patients with leg pain (85 legs) and diabetic foot (15 legs), the blood flow of the lower leg was decreased as compared with healthy legs (P<0.01～0.001). The group with diabetic foot showed a bigger decrease compared with the leg pain group (P<0.05). After treatment with the principle of vitalizing blood and solubilizing thrombus, 22 cases with leg pain (32 legs) showed a significant increase of blood flow in the lower leg (P<0.001). The group with diabetic foot failed to show any significant increase, indicating the importance of early treatment. This method of determining blood flow in the lower leg will help early discovery of abnormal changes of blood supply in the lower leg. Treatment with the principle of vitalizing blood and solubilizing thrombus can help improve the conditions of the patients.     

Influence of High Blood Glucose Fluctuation on Endothelial Function of Type 2 Diabetes Mellitus Rats and Effects of Panax Quinquefolius Saponin of Stem and Leaf

Objective: To observe the influence of high blood glucose fluctuation on the endothelial function of type 2 diabetes mellitus (T2DM) rats and the effects of Panax Quinquefolius Saponin (PQS) of stem and leaf. Methods: The T2DM model was induced by intraperitoneal injection of a small dose of streptozotocin (STZ, 35 mg/kg) plus high fat and high caloric laboratory chow. Then, diabetic rats were divided into steady high blood glucose (SHG) group and fluctuant high blood glucose (FHG) group according to fasting blood glucose coefficient of variation (FBG-CV), and then, the FHG group rats were divided into 4 groups according to the level of FBG-CV and fasting blood glucose: PQS 30 mg/(kg?d) group, PQS 60 mg/(kg?d) group, metformin hydrochloride control (MHC) group, and FHG control group, 10 in each group. Meanwhile, 10 rats without any treatment were used as normal control (NOR) group. Eight weeks later, the aortic arteries histology, plasma hepatocyte growth factor (HGF), and serum nitric oxide (NO), endothelin-1 (ET-1), tumor necrosis factor α (TNF-α), and soluble intercellular adhesion molecule 1 (sICAM-1) were measured. Results: In comparison with the NOR group, the level of plasma HGF and serum NO, ET-1 and TNF-α, and sICAM-1 in SHG and FHG control groups were all significantly increased (P<0.01); in comparison with the SHG group, plasma HGF and serum NO, ET-1, TNF-α, and sICAM-1 in FHG group were all significantly increased further (P<0.01 or P<0.05); meanwhile, in comparison with the FHG control group, the level of plasma HGF and serum NO, ET-1, TNF-α, and sICAM-1 in PQS and MHC groups were all decreased significantly (P<0.01). However, comparison of the aortic arteries histology among groups showed no significant differences either before or after treatment. Conclusion: Blood glucose fluctuation could facilitate the development of vascular endothelial dysfunction in T2DM rats, while PQS could improve the endothelial function of T2DM rats with high blood glucose fluctuation, which may be related to its effects of relieving vessel stress, decreasing vasoconstrictor ET-1 production, preventing compensated increase of NO, and reducing inflammatory reaction.     

Sixty-one patients with diabetic peripheral neuropathy treated by Tongluo Yangyin Recipe (通络养阴方)

Objective:To observe the therapeutic effect of Tongluo Yangyin Recipe (通络养阴方,TLYYR) in patients with diabetic peripheral neuropathy (DPN).Methods:Ninety-nine patients with diabetes mellitus type 2 were assigned,according to the order of their visit,to two groups:61 in the treated group and 38 in the control group.They were given the same information about diabetes mellitus and treated with the same therapy:strict diet control and Western drugs for hypoglycemia.In addition,the treated group received one dose (200 mL) of TLYYR in water decoction every day in two portions,while the control group had vitamin B_1 100 mg and vitamin B_(12) 250μg administered daily via intramuscular injection.The course for all patients was 28 days.Results:The treated group experienced a therapeutic effect superior to that of the control group,with the difference between the total effective rates and the markedly effective rates (P<0.05,P<0.01).The blood levels of total cholesterol (TC) and triglyceride (TG) fell,the hemorrheological manner improved,the transmission velocity of the median nerve and common peroneal nerve significantly increased in the treated group after treatment (P<0.05), although the treatment showed no significant influence on blood glucose level (P>0.05).Conclusion: TLYYR could promote blood microcirculation,improve nutritional metabolism of peripheral nerve,and thus accelerating DPN repair.     

Remission of hyperglycemia following intensive insulin therapy in newly diagnosed type 2 diabetic patients: a long-term follow-up study

Background Early intensive insulin therapies in newly diagnosed type 2 diabetic patients may improve β-cell function and yield prolonged glycemic remissions. This study was performed to evaluate the relationship between the glycemic remission and 13-cell function and assess the variables predictive of long-term near-normoglycemic remission. Methods Eighty-four newly diagnosed type 2 diabetic patients were treated with 2-week continuous subcutaneous insulin infusion （CSII） and followed up longitudinally. Intravenous glucose tolerance tests （IVGTTs） were performed, and blood glucose, hemoglobin Alc （HbAlc） and insulin were measured at baseline, after CSII and at 2-year visit. The patients who maintained glycemic control for two years were defined as the remission group and those who relapsed before the 2-year visit were the non-remission group. Results The duration to be diagnosed of the patients （from the time that patients began to have diabetic symptoms until diagnosis） in the remission group was shorter than that in the non-remission group （1.00 month vs 4.38 months, P=0.040）. The increase of the acute insulin response （AIR） was maintained after 2 years in the remission group compared with AIR measured immediately after intervention （413.05 pmol·L^-1·min^-1 vs 408.99 pmol·L^-1·min^-1, P=0.820）. While AIR in the non-remission group significantly declined （74.71 pmol·L^-1·min^-1 vs 335.64 pmol·L^-1·min^-1, P=0.030）. Cox model showed that a shorter duration to be diagnosed positively affected the duration of near-nomoglycemic remission with an odds ratio （OR） 1.019, P=0.038, while fasting plasma glucose （FPG） and post-breakfast plasma glucose （PPG） after CSII were the risk factors （OR 1.397, P=0.024 and OR 1.187, P=0.035, respectively）. Conclusion The near-normoglycemic remission is closely associated with long-term maintenance of β-cell function and occurs more commonly in patients with shorter duration to be diagnosed and better glycemic control during CSII.     

Influence of peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients on continuous ambulatory peritoneal dialysis

Background Extra glucose load in peritoneal dialysis is an important cause of newly-occurred diabetic mellitus, which initiates insulin treatment in some of the dialytic patients. The purpose of this study was to discuss the influence of the peritoneal transfer status on fasting blood glucose in non-diabetic nephropathy patients who are on continuous ambulatory peritoneal dialysis （CAPD）. Methods One hundred and forty-five patients with total KTN per week over 2.0 were recruited, including 60 males and 85 females. Fasting blood glucose （FBG）, creatinine, blood urea nitrogen （BUN）, blood albumin, blood lipid profile and blood C-reactive protein （CRP） were analyzed at the beginning of the peritoneal dialysis and after 12 months. A peritoneal equilibration test （PET） was carried out at the 3rd month of CAPD, and meantime residual renal function, peritoneal solute clearance rate, ultrafiltration volume and urine volume were also evaluated. Results Twenty-one cases were identified as a low transfer group （L）, 32 cases as a low average transfer group （LA）, 58 cases as a high average transfer group （HA） and 34 cases as a high transfer group （H）. At the end of the 12th month, 83 cases had elevated FBG. Through stepwise multiple regression analysis we found the FBG level in these patients was positively related to glucose load and CRP, and negatively related to glucose absorption in the peritoneum （D/D0） and blood albumin （P 〈0.05）. Kaplan-Meier analysis during a 48-month follow-up found the morbidity of hyperglycemia to be 17/34 cases （50.1%） in the high transfer group, 20/58 cases （34.5%） in the high average transfer group, 11/32 cases （34.3%） in the low average transfer group, and 1/21 cases （5.4%） in the low transfer group. Conclusions Patients with high peritoneal transfer capacity might have the highest morbidity from hyperglycemia among patients with these four different peritoneal transfer status. Glucose load, baseline CRP and FBG level before peritoneal dialysis, and D/D0 can efficiently predict hyperglycemia in CAPD patients.     

血糖波动与2型糖尿病患者周围神经病变的相关性研究

目的：：探讨血糖波动与2型糖尿病患者周围神经病变的关系。方法：回顾性分析112例2型糖尿病患者的临床资料,根据周围神经传导速度,将112例2型糖尿病患者分为神经传导正常组(非DM)组和异常组(DNP 组),两组患者均应用动态血糖监测系统(CGMS)进行血糖监测,监测连续进行3d,最后比较CGMS监测中平均血糖( MBG)及标准差( SD),血糖波动系数( CV),日内平均血糖波动幅度(MAGE),日间血糖平均绝对差(MODD),并测 HbA1C、血脂、血压、血糖等。结果：两组间病程、HbA1C、血脂、收缩压、日内平均血糖波动幅度( MAGE),平均血糖( MBG)及标准差( SD)比较差异有统计学意义( P<0.05)。多元线性回归分析发现,病程、CV、MAGE是影响周围神经传导速度的独立危险因素(P<0.05)。结论：血糖波动是2型糖尿病患者周围神经病变的危险因素,糖尿病患者不仅要做好血糖的控制,同时还应避免血糖波动。     

血糖漂移与2型糖尿病视网膜病变发生的相关性

目的探讨血糖漂移与2型糖尿病视网膜病变(DR)发生的关系。方法对138例2型糖尿病患者根据眼底摄片结果分为无视网膜病变组(NDR)和糖尿病视网膜病变组(DR)。比较两组年龄、糖尿病病程、血压、空腹血糖、餐后血糖、糖化血红蛋白、尿白蛋白/肌酐、甘油三酯、胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹C肽的水平。同时对两组患者进行连续72 h的动态血糖监测,观察两组间血糖波动指标的差异。最后采用Logistic回归分析DR与各因素的相关性。结果两组间患者的年龄、病程、平均血糖水平、日内平均血糖漂移幅度的差异均有统计学意义(P<0.01),Logistic分析结果显糖尿病病程、日内平均血糖漂移幅度是DR的独立危险因素(P<0.01),但平均血糖水平是否为其独立危险因素尚不能确定(P=0.05)。结论糖尿病病程、日内平均血糖漂移幅度是2型糖尿病患者发生DR的独立危险因素,血糖波动可加剧DR病变进展,应及早干预。     

新诊断2型糖尿病患者肾损伤的影响因素分析

目的 观察新诊断的2型糖尿病患者肾损伤特点,并分析相关影响因素.方法 120例新诊断2型糖尿病患者根据肾小球率过滤(glomerular filtration rate,GFR)分为G1组[GFR≥90 mL/(min·1.73 m2)]、G2组[GFR 60~89 mL/(min·1.73 m2)]、G3组[GFR 45~ 59 mL/(min·1.73 m2)],比较各组生化指标、血糖波动指标及炎症因子CRP水平.结果 G3组三酰甘油(TG)、空腹血糖(FPG)、糖化血红蛋白(HbA1c%)、平均血糖漂移幅度(MAGE)、24 h平均血糖水平(24hMBG)、胰岛素抵抗指数(HOMA-IR)及GFR较G1组、G2组均升高(P<0.05);G2、G3组年龄较G1组高(P<0.05);年龄、TG、FPG、HbA1c%、MAGE、24hMBG、HOMA-IR及CRP与GFR呈负相关(P<0.05或P<0.01). 结论 新诊断2型糖尿病患者存在早期肾损伤,高龄、高血糖、高血脂、血糖波动、炎症是新诊断2型糖尿病患者肾损伤的影响因素.     

血糖变异对老年T2DM合并ACS患者内皮功能和MACE的影响

目的探讨血糖变异对老年2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者内皮功能和主要不良心血管事件(MACE)的影响。方法选择109例老年ACS患者,按是否合并T2DM分为T2DM组与非T2DM组,按有无MACE分为MACE组与无MACE组。记录空腹血糖(FBG)、糖化血红蛋白(HbA1c)和入院后MACE。辅理善瞬感扫描式血糖监测系统检测最大血糖波动幅度(LAGE)、日内血糖波动幅度(MAGE)、日内血糖绝对差(MODD)、餐后血糖波动幅度(PPGE)。ELISA法检测血清内皮型一氧化氮合酶(eNOS),冠状动脉造影(CAG)检查血管病变特点,进行冠状动脉Gensini评分。结果与非T2DM组比较,T2DM组MODD、PPGE、LAGE、MAGE、FBG、HbA1c增高,eNOS水平降低,血管单、双支病变和轻中度病变较少,多支病变及重度病变较多,Gensini评分较高。与无MACE组比较,MACE组Gensini评分、LAGE、MAGE、MODD、PPGE升高,eNOS水平降低。Logistic回归显示,LAGE、MAGE、eNOS和Gensini评分是老年T2DM合并ACS患者MACE的独立危险因素;ROC曲线分析显示,LAGE和MAGE对该类患者MACE有预测价值。 结论LAGE和MAGE是老年T2DM合并ACS患者MACE的危险因素,减少血糖变异可能通过改善内皮功能降低其MACE的发生。     

老年2型糖尿病患者血糖漂移与糖化血红蛋白相关性分析

目的 动态监测老年2型糖尿病患者日内血糖波动情况,探讨血糖漂移与糖化血红蛋白（HbA1c）及糖尿病慢性并发症的关系.方法 以70例老年2型糖尿病患者作为研究对象,其中35例伴糖尿病肾病,30例伴糖尿病视网膜病变.采用动态血糖监测系统（CGMS）进行连续72 h血糖监测,考察日内不同时点血糖水平、不同时段血糖漂移、餐后血糖漂移（PPGE）、平均血糖漂移幅度（MAGE）和24 h平均血糖水平（24h MBG）.Pearson法分析患者HbA1c与血糖漂移的相关性,多元Logjstic回归分析与糖尿病肾病和糖尿病视网膜病变发生相关的影响因素.结果 HbA1c与日内7个时点血糖水平、24 h MBG及3：00～6：00、19：00～20：00时段血糖漂移呈显著正相关（P＜0.05或P＜0.01）,与PPGE无明显相关（P＞0.05）;MAGE与13：00、19：00时点血糖水平和PPGE均呈显著正相关（P＜0.05）.0：00～3：00时段血糖漂移是糖尿病视网膜病变发生的影响因素（P＜0.05）.结论 CGMS能较详细地显示日内血糖波动情况.HbA1c能反映日内整体血糖水平.日内血糖波动主要归因于PPGE和夜间血糖漂移.糖尿病视网膜病变的发生可能与血糖漂移有关.     

老年2型糖尿病患者血糖漂移与糖化血红蛋白相关性分析

目的 动态监测老年2型糖尿病患者日内血糖波动情况,探讨血糖漂移与糖化血红蛋白(HbA1c)及糖尿病慢性并发症的关系.方法 以70例老年2型糖尿病患者作为研究对象,其中35例伴糖尿病肾病,30例伴糖尿病视网膜病变.采用动态血糖监测系统(CGMS)进行连续72 h血糖监测,考察日内不同时点血糖水平、不同时段血糖漂移、餐后血糖漂移(PPGE)、平均血糖漂移幅度(MAGE)和24 h平均血糖水平(24h MBG).Pearson法分析患者HbA1c与血糖漂移的相关性,多元Logjstic回归分析与糖尿病肾病和糖尿病视网膜病变发生相关的影响因素.结果 HbA1c与日内7个时点血糖水平、24 h MBG及3:00～6:00、19:00～20:00时段血糖漂移呈显著正相关(P＜0.05或P＜0.01),与PPGE无明显相关(P＞0.05);MAGE与13:00、19:00时点血糖水平和PPGE均呈显著正相关(P＜0.05).0:00～3:00时段血糖漂移是糖尿病视网膜病变发生的影响因素(P＜0.05).结论 CGMS能较详细地显示日内血糖波动情况.HbA1c能反映日内整体血糖水平.日内血糖波动主要归因于PPGE和夜间血糖漂移.糖尿病视网膜病变的发生可能与血糖漂移有关.     

血糖波动与2型糖尿病亚临床周围神经病变的相关性

目的分析血糖波动与2型糖尿病(T2DM)亚临床周围神经病变(sDPN)的相关性。 方法纳入T2DM sDPN患者153例为sDPN组,无DPN T2DM患者186例为非DPN组,比较两组患者临床指标及血糖波动。多因素Logistic回归分析T2DM患者并发sDPN与血糖波动的关系,ROC分析血糖波动对T2DM患者合并sDPN的预测价值。 结果与非DPN组相比,sDPN组空腹血糖、平均血糖(MBG)、血糖标准差(SDBG)、血糖变异系数(CV)、平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)及葡萄糖高于目标范围(TAR)的时间更高,葡萄糖目标范围内时间(TIR)更低(P＜0.05)。多因素Logistic回归分析显示,MBG、SDBG、CV、MAGE、LAGE及TAR为T2DM并发sDPN的危险因素,TIR为其保护因素。ROC曲线显示危险因素MAGE曲线下面积最大。 结论血糖波动与T2DM患者合并sDPN密切相关,关注血糖波动有助于早期发现和治疗糖尿病神经病变。     

2型糖尿病目标范围内时间与糖化血红蛋白相关性分析

目的：分析2型糖尿病病人目标范围内时间(TIR)与糖化血红蛋白(HbA1c)的相关性。方法：选取2型糖尿病(T2DM)病人142例,根据HbA1c分为A组(HbA1c<7.0%)、B组(7%≤HbA1c<9%)、C组(HbA1c≥9%)。对病人进行72 h持续血糖监测,观察各组TIR、血糖监测平均值(MBG)、预估糖化血红蛋白(eHbA1c)、标准差(SD)、变异系数(CV)、平均血糖波动幅度(MAGE)、空腹血糖(PG)的差异性,探究TIR对HbA1c的影响。结果：A、B、C组间性别、年龄、病程、BMI、SBP、DBP、CV差异均无统计学意义(P>0.05),HbA1c、eHbA1c、MBG、SD、MAGE、TIR、PG差异均有统计学意义(P<0.01)。HbA1c与TIR呈负相关关系(P<0.01),与PG、MBG、CV、eHbA1c呈正相关关系(P<0.01)。多元线性回归分析结果表明PG、TIR均是HbA1c影响因素。结论：TIR与HbA1c呈负相关,PG、TIR是HbA1c的影响因素。     

Correlation between 1,5-anhydroglucitol and glycemic excursions in type 2 diabetic patients

Background  The accurate and comprehensive assessment of glycemic control in patients with diabetes is important for optimizing glycemic management and for formulating personalized diabetic treatment schemes. This study aimed to analyze the correlation between 1,5-anhydroglucitol (1,5-AG) and glycemic excursions in type 2 diabetic patients.

Methods  Seventy-one outpatients with type 2 diabetes mellitus were randomly recruited from Chinese People’s Liberation Army General Hospital. Using a continuous glucose monitoring system (CGMS), these patients’ blood glucose levels were monitored for three consecutive days to obtain mean blood glucose (MBG) data. Intraday glycemic excursions were evaluated using the mean amplitude of glycemic excursions (MAGE), the largest amplitude of glycemic excursions (LAGE), standard deviation of blood glucose (SDBG) and the M-value. Interday glycemic excursion was assessed by absolute mean of daily difference (MODD). Postprandial glycemic fluctuations were evaluated using postprandial glucose excursions (PPGE) and postprandial incremental area under the curve (iAUC). Fasting venous blood samples were collected to measure serum 1,5-AG, whole-blood hemoglobin A1c (HbA1c) and serum glycated albumin (GA). Clinical markers of glycemia and parameters of glycemic excursions from CGMS were analyzed using the Pearson correlation coefficient and multivariate stepwise regression.

Results  Pearson correlation analysis revealed that 1,5-AG was significantly correlated with MAGE, SDBG, M-value, LAGE, PPGE and iAUC (r values were –0.509, –0.430, –0.530, –0.462, –0.416 and –0.435, respectively, P <0.01), especially in moderately and well-controlled patients, based on defined HbA1c levels. Multivariate stepwise regression analysis revealed a negative correlation between 1,5-AG and the above parameters, but not HbA1c and GA. Finally, HbA1c and GA were positively correlated with MBG and fasting blood glucose (FBG).

Conclusions  1,5-AG was much better than HbA1c and GA as a marker of glycemic excursions in type 2 diabetic patients. Based on these results 1,5-AG is the best metric for assessing postprandial glucose levels in moderately and well-controlled patients, while HbA1c and GA were superior to 1,5-AG for monitoring MBG and FBG.