2型糖尿病患者血糖水平及血糖变异性与糖化血红蛋白水平的相关性研究

目的探讨2型糖尿病患者血糖水平及血糖变异性与糖化血红蛋白(HbA1_c)的相关性。 方法选取2019年3月至2020年4月在克拉玛依市人民医院内分泌科就诊的240例2型糖尿病患者,根据HbA1_c水平,分为Q1组(5.5%～6.8%)(n＝60)、Q2组(6.9%～7.9%)(n＝55)、Q3组(8.0%～9.0%)(n＝62)和Q4组(9.1%～14.0%)(n＝63);采用动态持续血糖监测系统(CGMS)进行连续72 h动态血糖监测,以HbA1_c为因变量,以与HbA1_c具有相关性的参数为自变量,采用多元线性回归方法进行回归分析。 结果Q1、Q2、Q3和Q4组的空腹及餐后2 h血糖分别为5.92(4.81,6.64)mmol/L和10.27(8.79,12.34)mmol/L,6.37(5.49,8.49)mmol/L和12.02(9.98,15.27)mmol/L,8.45(6.78,9.97)mmol/L和14.45(11.51,18.12)mmol/L,10.16(8.09,11.52)mmol/L和16.08(12.47,19.27)mmol/L,4组患者72 h动态血糖平均值分别为7.41(6.71,8.14)mmol/L,8.20(7.40,9.30)mmol/L,8.91(7.93,10.35)mmol/L和10.36(9.12,11.79)mmol/L,4组间的平均空腹血糖、餐后2 h血糖随HbA1_c的增高而增高,组间比较均差异有统计学意义(H＝81.35,37.26,均P<0.05);空腹及餐后2 h血糖、72 h动态血糖平均值、血糖>10.0 mmol/L时间百分率、血糖>7.8 mmol/L时间百分率以及血糖平均标准差(SDBG)与HbA1_c具有相关性(r＝0.68,0.46,0.63,0.59,0.42,0.36,均P<0.05);多元线性回归分析结果显示72 h动态血糖平均值和空腹血糖为HbA1_c的独立影响因素(B＝0.23,0.53;均P<0.05)。 结论血糖变异对HbA1_c无影响,空腹血糖和平均血糖为影响HbA1_c的主要因素。     

老年2型糖尿病患者血糖变异性与糖尿病肾病的关系

目的:研究老年2型糖尿病患者血糖变异性与糖尿病肾病的关系.方法:对114例老年2型糖尿病患者按照24 h尿微量白蛋白量分为:单纯糖尿病组(DM组)36例,早期糖尿病肾病组(EDN组)44例,临床糖尿病肾病组(DN组)34例.检测收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血肌酐(sCr)、半胱氨酸蛋白酶抑制剂C(Cys C),并采用动态血糖监测系统(CGMS)计算日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、全天血糖值标准差(SDBG)、曲线下面积(AUC)和日间血糖平均绝对差(MODD)来评价血糖变异性.结果:DN组SBP、DBP、HbA1C、sCr和Cys C显著高于EDN组和DM组(P＜0.05).EDN组Cys C显著高于DM组(P＜0.05).DN组SDBG、MAGE、LAGE、AUC、MODD显著高于EDN组和DM组(P＜0.05),日内及日间血糖波动幅度显著增加,EDN组的CGMS各项指标均显著高于DM组(P＜0.05).结论:老年2型糖尿病患者血糖变异性与DN的发生、发展及严重程度有着密切关系.     

2型糖尿病伴轻度认知功能障碍患者脑静息态功能MRI研究

目的探讨2型糖尿病(T2DM)伴轻度认知功能障碍(MCI)患者脑静息态脑功能局部一致性(Re Ho)及分数低频波动振幅(f ALFF)的改变特点。材料与方法共纳入21名T2DM伴MCI患者(D-MCI组)及25名年龄、性别、受教育水平相匹配的对照组志愿者(HC组),通过3.0 T MR仪采集T2WI、FLAIR、三维T1WI结构数据和静息态功能数据,分别计算静息态Re Ho值和f ALFF值并进行组内和组间比较,然后提取组间存在显著差异脑区的Re Ho/f ALFF值与临床数据做相关分析。结果 D-MCI组存在多个右侧额上回亚区、部分小脑Re Ho值显著增高,双侧内侧眶额部额上回、右侧额中回、右侧颞下回、左侧枕中回及右侧舌回Re Ho值显著减低;而左侧颞下回、双侧扣带回前部f ALFF值显著增高,右侧舌回f ALFF值显著减低。D-MCI组Hb A1c与扣带回前部f ALFF值(r=-0.482,P=0.027)、Mo CA评分与左侧颞下回f ALFF值(r=-0.547,P=0.010)呈显著负相关。结论 T2DM伴MCI患者存在认知控制网络、视觉信息处理、语义认知等多个相关脑区的异常活动,这些异常活动可部分阐释T2DM患者伴发MCI的神经生理基础。     

2型糖尿病患者丘脑损伤及其与认知功能及肠道菌群的相关性

目的 观察2型糖尿病(T2DM)患者丘脑微结构改变及其与认知功能及肠道菌群的相关性。方法 前瞻性纳入63例T2DM患者和33名健康志愿者(HC组),根据蒙特利尔认知评估量表(MoCA)将T2DM患者分为伴轻度认知障碍(MCI)组(MCI组,n=32)和不伴MCI组(nonMCI组,n=31)。对各组采集颅脑平均表观传播子MRI(MAP-MRI),测量丘脑q-space逆方差(QIV)、均方位移(MSD)、返回原点概率(RTOP)、返回轴概率(RTAP)及返回平面概率(RTPP);行认知量表评估并检测肠道菌群;对比观察3组间MAP-MRI参数差异及其与认知量表评分及肠道菌群α、β多样性指数的相关性。结果 3组右侧丘脑RTOP、RTAP及左侧丘脑RTPP差异均有统计学意义(P均＜0.05);两两比较,MCI组与nonMCI组间差异亦有统计学意义(P均＜0.05)。部分肠道菌群丰度及多样性指数3组间差异有统计学意义(P均＜0.05)。T2DM患者右侧丘脑RTOP及RTPP均与MoCA评分呈正相关(r=0.332、0.284,P=0.010、0.028);左侧丘脑RTAP与Chao1及Unweighted_MDS2呈负相关(r=-0.255、-0.257,P=0.049、0.047),左侧丘脑RTOP与Unweighted_MDS2呈负相关(r=-0.279,P=0.031)。结论 T2DM患者右侧丘脑RTOP、RTAP及左侧丘脑RTPP发生改变并与认知功能及肠道菌群多样性相关。     

2型糖尿病与认知功能

2型糖尿病是以胰岛素抵抗和内分泌功能不足为特征的代谢性疾病。越来越多的证据表明,2型糖尿病与记忆功能受损二者之间存在着紧密联系。本文对近10年与2型糖尿病对中枢系统损伤相关的文献进行综述,结果显示:(1)2型糖尿病主要影响与记忆有关的海马体的结构和代谢,致海马、额叶及丘脑出现能量代谢异常改变。(2)2型糖尿病的认知损伤主要表现为学习和记忆能力下降,其中中枢神经系统中胰     

2型糖尿病认知功能障碍研究

2型糖尿病作为目前临床常见病、多发病已受到重视,2型糖尿病中大部分合并轻度认知功能障碍,早期发现、早期干预可延缓病情的发展,提高患者的生活质量.该文就其病因、发病机制、临床表现及其防治等方面作一综述.     

中年2型糖尿病患者认知功能损害特征及影响因素调查

目的探讨中年2型糖尿病(T2DM)患者认知功能损害(MCI)特征及影响因素。方法采用长沙版蒙特利尔认知评估量表对合肥市某2所医院内分泌科216例中年T2DM患者进行调查。结果中年T2DM患者MCI患病率为43.1%,其中受损最严重为延迟回忆,其次为视空间与执行功能和抽象功能。注意、语言和定向功能轻微受损,命名功能未见受损。多因素Logistic回归分析结果显示,女性是T2DM患者MCI的独立危险因素。高文化程度是T2DM患者MCT发生的保护因素。结论中年T2DM患者MCI的发生率较高,延迟回忆受损最为突出。其次为视空间与执行功能和抽象功能。临床医务人员可根据中年T2DM患者的认知功能损害特征及影响因素,制定特异性的认知干预方案,延缓认知功能下降。     

强化降糖护理指导对2型糖尿病患者血糖变异性的影响

目的：研究强化降糖护理指导对2型糖尿病患者血糖变异性的影响。方法选取我院2014年1月~12月按照常规护理要求及医嘱实施护理的62例2型糖尿病患者为对照组,2015年1月~12月给予强化降糖护理指导的62例患者为观察组。比较两组患者入院时及强化降糖护理指导1个月后空腹血糖( FPG)、餐后2 h血糖(2hPG)和糖化血红蛋白(HbA1c),健康知识认识水平及满意度。结果经过强化降糖护理指导后,观察组FPG、2 hPG和HbA1 c均显著低于对照组( P<0.05),健康知识认知水平显著优于对照组( P<0.05)。观察组满意度为93.6%(58/62),对照组为79.0%(49/62),观察组显著高于对照组(字2=5.522,P<0.05)。结论强化降糖护理指导有助于控制T2 DM患者血糖水平,提高患者健康知识认识水平及满意度,值得推广应用。     

2型糖尿病患者早期认知功能障碍弥散峰度成像研究

目的:采用弥散峰度成像技术分析2型糖尿病(T2DM)患者早期认知功能障碍的全脑弥散结构改变,并分析其与认知行为学及临床实验室指标的相关性,为T2DM患者早期认知功能障碍的诊断与治疗提供有力的影像学依据.方法:对18例早期无其它并发症的T2DM患者组及19例种族、性别、年龄、受教育年限相匹配的正常对照组(HC)进行DKI...     

2型糖尿病患者血糖与血脂的相关性调查分析

糖尿病在世界各地发病率比较高,并且发病年龄逐渐年轻化。糖尿病已成为疾病死亡原因。局势促使着卫生工作者迫不及待地寻找更多的诊断手段来早期发现糖尿病,减少糖尿病的发病,控制并发症,降低死亡率。1资料与方法1.1对象60例2型糖尿病组选取2004年6月至2006年3月中旬我院门诊、     

Relationship between glycemic variability and cognitive function in lacune patients with type 2 diabetes

BACKGROUND Lacunes are the manifestations of lacunar infarction which can lead many patients to the clinical outcome of disability or dementia. However, the relationship between lacune burden, cognitive function and blood glucose fluctuation in patients with type 2 diabetes mellitus(T2DM) complicated with lacunes is not very clear.AIM To explore the correlation between glucose variability, lacune burden and cognitive function in patients with lacunes complicated with T2DM.METHODS The clinical an...     

血糖波动与老年2型糖尿病周围神经病变的相关性研究

目的探讨血糖波动与老年2型糖尿病周围神经病变的关系。方法应用动态血糖监测系统(CGMS)对24例老年2型糖尿病周围神经病变和28例单纯老年2型糖尿病患者进行连续3 d的血糖监测,比较CGMS监测中平均血糖(MBG)及其标准差(s)、日内最大血糖波动幅度(LAGE)、日内平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD),并测HbA1c、血糖、血脂、血压等。结果 DPN组SD、MAGE、MODD均显著高于DM组(t=-4.31、-9.85、-10.45,均P<0.01),其中MAGE与s显著相关(r=0.82,P<0.01),与HbA1c、MBG均不相关(P>0.05)。结论血糖波动是老年2型糖尿病周围神经病变的危险因素,血糖控制同时应避免血糖波动。     

Impact of glycemic and blood pressure variability on surrogate measures of cardiovascular outcomes in type 2 diabetic patients

OBJECTIVE

The effect of glycemic variability (GV) on cardiovascular risk has not been fully clarified in type 2 diabetes. We evaluated the effect of GV, blood pressure (BP), and oxidative stress on intima-media thickness (IMT), left ventricular mass index (LVMI), flow-mediated dilation (FMD), and sympathovagal balance (low frequency [LF]/high frequency [HF] ratio) in 26 type 2 diabetic patients (diabetes duration 4.41 ± 4.81 years; HbA_1c 6.70 ± 1.25%) receiving diet and/or metformin treatment, with no hypotensive treatment or complications.

RESEARCH DESIGN AND METHODS

Continuous glucose monitoring (CGM) data were used to calculate mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA)-2, mean blood glucose (MBG), mean postprandial glucose excursion (MPPGE), and incremental area under the curve (IAUC). Blood pressure (BP), circadian rhythm, and urinary 15-F2t-isoprostane (8-iso-prostaglandin F_2α [PGF_2α]) were also evaluated. Subjects were divided into dipper (D) and nondipper (ND) groups according to ΔBP.

RESULTS

IMT and LVMI were increased in ND versus D (0.77 ± 0.08 vs. 0.68 ± 0.13 [P = 0.04] and 67 ± 14 vs. 55 ± 11 [P = 0.03], respectively). MBG, MAGE, and IAUC were significantly associated with LF/HF ratio at night (r = 0.50, P = 0.01; r = 0.40, P = 0.04; r = 0.41, P = 0.04, respectively), MPPGE was negatively associated with FMD (r = −0.45, P = 0.02), and CONGA-2 was positively associated with LVMI (r = 0.55, P = 0.006). The Δsystolic BP was negatively associated with IMT (r = −0.43, P = 0.03) and with LVMI (r = −0.52, P = 0.01). Urinary 8-iso-PGF_2α was positively associated with LVMI (r = 0.68 P < 0.001).

CONCLUSIONS

An impaired GV and BP variability is associated with endothelial and cardiovascular damage in short-term diabetic patients with optimal metabolic control. Oxidative stress is the only independent predictor of increased LV mass and correlates with glucose and BP variability.The role of hyperglycemia in the pathogenesis of micro- and macrovascular complications is well known (1). However, glycemic variability (GV) may be important in the development of chronic diabetes complications, beyond the average blood glucose (BG) concentration (2). This issue has not been fully clarified, because no gold standard measure of GV is currently available, and HbA_1c, which is an undisputable index of overall glycemic control, only partially depicts glycemic excursions, in particular, postprandial spikes.A recent systematic review of the effect of GV on the development of diabetes complications suggested a correlation in type 2 diabetes but not in type 1 (3). The San Luigi Gonzaga Diabetes Study supports the theory of a predictive role of glucose spikes on the development of cardiovascular events, showing that BG levels after lunch better predict the occurrence of cardiovascular events than fasting BG and confirming previous observations that postprandial hyperglycemia—but not fasting BG—is an independent risk factor for cardiovascular disease (4).It is still unclear whether postprandial glucose excursions, rather than chronic hyperglycemia, are responsible for the activation of oxidative stress pathways and contribute to the development of cardiovascular disease (5,6). Although the influence of a sustained increase in blood pressure (BP) on cardiovascular disease is well known, less data are available on the role of altered circadian rhythm of BP. The aim of our study was to investigate the relative role of overall glycemic load, GV, abnormal BP circadian rhythm, and oxidative stress activation on organ damage in short-term, well controlled type 2 diabetic patients without overt complications.     

正常人与2型糖尿病患者血糖水平漂移的比较

目的:探讨正常人及新诊断2型糖尿病患者血糖水平漂移变化的差异,为糖尿病患者的一级康复预防提供理论依据。方法:采用动态血糖监测系统(continuousglucosemonitoringsystem,CGMS)对43例正常人及47例新诊断、未经干预治疗的2型糖尿病患者进行连续(71±10)h的血糖监测。结果:正常人组与2型糖尿病组在平均血糖水平犤(5.3±0.5)mmol/L比(12.2±2.6)mmol/L犦,日内血糖最高值犤(7.8±1.4)mmol/L比(18.5±2.7)mmol/L犦,日内血糖漂移最大幅度犤(3.9±1.6)mmol/L比(11.2±2.8)mmol/L犦,两组餐前及餐后的平均血糖值之间差异均具有显著性意义(P<0.001)。正常人组血糖漂移于2.8～7.8mmol/L所占的日内时间百分比为99%(87%～100%);而2型糖尿病组血糖>7.8mmol/L及11.1mmol/L的时间百分比分别为95%(28%～100%)和62%(6%～100%)。CGMS观测值与血浆葡萄糖值及指端毛细血管血糖值均呈显著正相关(r=0.93,r=0.95,P均<0.001)。结论:动态血糖监测能更为详细地显示正常人及2型糖尿病患者血糖水平的漂移变化,对糖尿病的防治及康复具有临床应用价值。     

食物血糖指数、血糖负荷对2型糖尿病病人代谢的影响

阐述食物血糖指数（GI ）、血糖负荷（GL）的概念,综述 GI 和 GL 对2型糖尿病病人代谢的影响,指出食物 GI、GL 概念的提出对2型糖尿病病人的饮食和健康有重要指导意义,深入了解以碳水化合物（CHO）为主的食物对人体机体代谢的影响,将会有助于预防和控制疾病的发生、发展。     

Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function

OBJECTIVE: To investigate whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission. RESEARCH DESIGN AND METHODS: Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose >11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA(1c), lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin. RESULTS: Optimal glycemic control was achieved within 6.3 +/- 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control >12 months (remission group) had greater recovery of beta-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of beta-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 +/- 89.6 vs. 78.5 +/- 68.5, P = 0.002, and 1,423.4 +/- 523.2 vs. 1,159.5 +/- 476.8 pmol x l(-1) x min(-1), P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 +/- 430.4 vs. 387.3 +/- 428.8 pmol x l(-1) x min(-1), P = 0.033). CONCLUSIONS: Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of beta-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.