波动性高血糖、代谢记忆与糖尿病慢性并发症

糖尿病治疗的核心是防治糖尿病慢性并发症,波动性高血糖通过刺激氧化应激,会增加患者产生代谢记忆及诱发糖尿病并发症的机率.代谢记忆已逐渐成为糖尿病治疗中新的挑战.一、波动性高血糖和糖尿病并发症血糖紊乱分为持续性高血糖和血糖波动为特征的波动性高血糖[1].波动性高血糖是指间歇性或阵发性高血糖状态,亦称血糖飘移.早期的研究多关注于长期慢性高血糖与并发症的关系,随着血糖监测手段的发展,糖尿病患者血糖波动逐渐为人们所重视.近年来的研究表明,波动性高血糖相对于持续性高血糖更能增加糖尿病患者发生并发症的危险性.糖尿病慢性并发症的发生、发展不仅与整体血糖水平相关,而且与血糖的波动性密切相关[2].血糖波动通过活化氧化应激、炎症反应损失内皮细胞参与糖尿病并发症的进展,因此,对血糖波动的正确认识、评价和积极控制将有助于减缓糖尿病并发症的发生.波动性高血糖导致糖尿病慢性并发症,可能与血糖波动产生氧化应激产物激活血管损伤的4条途径有关[3].     

波动性高血糖与糖尿病大血管并发症

高血糖是糖尿病的标志 ,也是导致糖尿病慢性血管并发症的主要因素。最近研究发现 ,波动性高血糖也是糖尿病患者血糖表现的一种常见形式 ,相对于持续性高血糖更能增加糖尿病患者发生慢性血管并发症的危险性。控制波动性高血糖 ,可以降低或延缓糖尿病慢性血管并发症的发生、发展。     

糖尿病患者的四大“杀手”

随着生活水平的提高,人们的健康亮起了"红灯",出现了"四高"的症状:高血糖、高血压、高血脂、高血粘。而"四高"的出现,让糖尿病患者雪上加霜,它们是严重危害糖尿病患者的杀手。高血糖高血糖是糖尿病的主要特征,其危害主要分为急性危害(急性并发症)和慢性危害(慢性并发症)。急性危害主要有酮症酸中毒、高渗性昏迷,主要是由于血糖过高及代谢紊乱所致,病情较急,需要急性抢救才能解除急性危害,如果抢救不及时则可导致死亡。慢性危害主要是由于长期高血糖引起的慢性并发症。长期高血糖对健康威胁更大,糖尿病患者     

波动性高血糖危害大

高血糖是糖尿病的标志，也是导致糖尿病慢性血管并发症的主要因素。最近研究发现。波动性高血糖相对于持续性高血糖来说，更会增加糖尿病患者发生慢性血管并发症的危险性。控制波动性高血糖。可以降低或延缓糖尿病慢性血管并发症的发生、发展。     

波动性高血糖与糖尿病大血管并发症

高血糖是糖尿病的标志，也是导致糖尿病慢性血管并发症的主要因素。最近研究发现，波动性高血糖也是糖尿病患者血糖表现的一种常见形式，相对于持续性高血糖更能增加糖尿病患者发生慢性血管并发症的危险性。控制波动性高血糖，可以降低或延缓糖尿病慢性血管并发症的发生、发展。     

餐后高血糖与糖尿病慢性并发症

高血糖与糖尿病慢性并发症的关系多年来一直存在着争议。1993年美国和加拿大29个医疗中心发表的DCCT（糖尿病控制和并发症试验DiabetesControlandComplicationTrial）结果表明，高血糖在糖尿病慢性并发症的发生和发展中虽不是唯一的因素，但确是主要因素。在临床工作中，部分病人空腹血糖控制较为满意，但仍还会出现各种各样慢性并发症，究其原因是一些医生往往只注意空腹血糖，而忽视了餐后高血糖的出现，致使病人经常处于高血糖状态中，即所谓"葡萄糖毒性（Glucoset。X...ty），于是不可避免地会发生各种各样的慢性并发症。平文就近年…     

动态血糖监测系统的临床应用及护理

<正>高血糖是糖尿病的标志,也是导致慢性并发症的主要原因,其不良作用主要通过慢性持续高血糖和血糖水平波动两种方式体现。(1)目前认为,波动性高血糖相对于持续性高血糖更能增加糖尿病患者发生慢性并发症的危险。     

血糖波动的评价指标——平均血糖波动幅度的I临床意义及研究进展

高血糖是糖尿病的标志以及导致慢性并发症的主要原因,其不良作用主要体现在慢性持续的高血糖和血糖波动两方面。长期持续的高血糖对糖尿病慢性并发症的危害已经明确,而近年来的研究表明血糖波动亦可能与糖尿病并发症的发生、发展有关。因此,在制定治疗方案时可能需要兼顾减轻血糖波动以更理想地控制血糖。     

波动性高血糖与糖尿病慢性并发症相关性研究进展

正随着糖尿病患病率的逐年增长,其导致的各种慢性并发症严重影响了患病人群的生活质量,乃至威胁生命。近年来多项研究表明,相对于持续性高血糖,波动性高血糖更能加剧糖尿病慢性并发症的发生和发展。血糖波动越大,氧化应激、炎症反应越明显,对血管内皮的损害越大。随着动态血糖监测系统(CGMS)的广泛应用,波动性高血糖对血管并发症带来的危害也渐渐受到重视。本文将围绕波动性高血糖与糖尿病慢性并发症的相关性展开综述。     

早期强化降糖的“记忆效应”

糖尿病慢性并发症侵犯人体各种组织器官,主要包括大血管（心血管、脑血管、四肢大动脉,尤其是下肢）、微血管（肾小球、眼底及心肌等）、神经、皮肤及骨关节等。糖尿病慢性并发症的病因尚不十分明确,常有多种因素参与,如代谢紊乱、遗传易感性、血流动力学改变和血液流变学异常等。其中,长期高血糖是糖尿病慢性并发症发生的最主要原因。在糖尿病慢性并发症中,微血管并发症（如糖尿病肾病和糖尿病视网膜病变）和神经病变与高血糖的关系更加密切,     

Implantable continuous glucose sensors

Because of the limits of wearable needle-type or microdialysis-based enzymatic sensors in clinical use, fully implantable glucose monitoring systems (IGMS) represent a promising alternative. Long-term use reducing impact of invasiveness due to implantation, less frequent calibration needs because of a more stable tissue environment around the sensor and potential easier inclusion in a closed-loop insulin delivery system are the expected benefits of IGMS. First experiences with subcutaneous and intravenous IGMS have been recently collected in pilot studies. While no severe adverse events have been reported, biointerface issues have been responsible for the failures of IGMS. Tissue reactions around implanted subcutaneous devices and damages of intravenous sensors due to shearing forces of blood flow impaired IGMS function and longevity. In functioning systems, accuracy of glucose measurement reached satisfactory levels for average durations of about 120 days with subcutaneous IGMS and 259 days with intravenous sensors. Moreover, sensor information could help to improve time spent in normal glucose range when provided to patients wearing subcutaneous IGMS and allowed safe and effective closed-loop glucose control when intravenous sensors were connected to implanted pumps using intra-peritoneal insulin delivery. These data could open a favourable perspective for IGMS after improvement of biointerface conditions and if compatible with an affordable cost.     

Clinical use of real-time continuous glucose monitoring

Maintaining near-normal glycaemia in all patients with diabetes mellitus (DM) has become a standard and a well accepted recommendation. Unfortunately, most people with DM do not achieve this clinical goal because of marked glycaemic fluctuations and hypoglycaemia. Real-time continuous glucose monitoring (RT-CGM) has been introduced recently into clinical practice offering more knowledge about current glucose concentration and trend and enabling people with DM to intervene and prevent unwanted glucose excursions by acting upon real-time and predictive alarms. Several RT-CGM devices proved to be sufficiently accurate and feasible for routine use. Observational reports with The Guardian and Paradigm RT by Medtronic, the STS by DexCom, FreeStyle Navigator by Abbott and GlucoDay by Menarini established initial clinical benefit. Five randomised controlled trials (RCT) demonstrated significantly improved glucose variability or metabolic control, one of them showing a statistically significant and clinically meaningful decrease of HbA1c with a 3 months use of the Guardian RT (Medtronic, Northridge, CA). The great potential of RT-CGM devices to improve daily glucose control and quality of life in people with DM can only be developed further through RCTs, clarifying in more details the optimal clinical use and the most beneficial indications for this novel technique.     

动态血糖监测系统的准确性评估

良好的血糖控制能延缓和（或）阻止糖尿病慢性并发症的发生。但是,不管是对1型还是2型糖尿病患者,良好的血糖控制是以严重的低血糖发生增加为前提条件,低血糖成为血糖控制达标的最大障碍。在糖化血红蛋白（HbA1c）控制良好的患者,常出现血糖波动,即出现不可预料的低血糖和高血糖;而且,低血糖尤其是无症状性低血糖,     

The next generation: continuous glucose monitors

These "real-time" monitors promise to change the way we chart ups and downs, by delivering readings every few minutes around the clock. But don't toss your old monitors just yet!