老年2型糖尿病患者动态血糖监测分析

目的 探讨老年2型糖尿病患者的动态血糖波动特点.方法 对老年2型糖尿病患者(老年组)92例和中青年2型糖尿病患者(中青年组)58例进行动态血糖监测,对比分析两组患者血糖谱特征及老年不同糖化血红蛋白(HbA1c)水平糖尿病患者的血糖谱特征.结果 (1)老年组与中青年组比较,血糖波动系数(BGFC)增大[(2.68±1.00)mmol/L对(2.12±0.74) mmol/L,t=-3.691,P＜0.001];餐后血糖漂移幅度(PPGE)增大,早餐后分别为 ( 5.96±2.47) mmol/L对(5.11±2.44) mmol/L(t=-2.058,P＜0.05),晚餐后分别为(5.17±2.15) mmol/L对 (4.16±2.28) mmol/L(t=-2.730,P＜0.01);餐后血糖达峰时间延长,早餐后(112.5±29.7) min对(97.0±27.2) min(t=-3.225,P＜0.01),中餐后(140.0±39.7)min对 (118.1±42.6) min(t=-3.195,P＜0.01);低血糖发生频率增加(26.3%对5.5%,P＜0.05);最大血糖漂移幅度(LAGE)增大,分别为(9.66±2.48) mmol/L对(8.40±3.13) mmol/L(t=-2.720,P＜0.01);(2)老年组患者随HbA1c下降,低血糖发生率增加(P＜0.05);随 HbA1c升高,血糖波动幅度增大;(3)HbA1c与空腹血糖(FBG)、日平均血糖(MBG)、高血糖时间比(PT7.8、PT11.1)、最低血糖(LBG)、最高血糖(HBG)、BGFC、PPGE、LAGE均正相关(r=0.899～0.289,均P＜0.001);逐步回归分析显示,MBG、FBG、PT7.8与HbA1c独立相关(校正的R2=0.807,P＜0.05).结论 老年2型糖尿病患者血糖波动幅度大,易发生餐后高血糖和夜间低血糖,动态血糖监测能较详细地显示患者的血糖水平及波动特征.

Abstract：

Objective To investigate the characteristics of the blood glucose fluctuation in elderly patients with type 2 diabetes mellitus (T2DM). Methods The 92 elderly patients with T2DM (the elderly group) and 58 young and middle-aged patients with T2DM (the non-elderly group) were monitored using the continuous glucose monitoring system(CGMS). The characteristics of glucose profiles of the two different age groups, and of the different glycosylated hemoglobin (HbA1c) level groups in the elderly were comparatively analyzed. Results (1)There was no significant difference in HbA1c level between the elderly group and the non-elderly group. Compared with the non-elderly group, the elderly group showed the increases in blood glucose fluctuant coefficient [BGFC, (2.68±1.00) mmol/L vs. (2.12±0.74) mmol/L, t=-3.691, P＜0.001], in postprandial glucose excursion (PPGE) of breakfast and supper [(5.96±2.47) mmol/L vs. (5.11±2.44) mmol/L, t=-2.058, P＜0.05; (5.17±2.15) mmol/L vs. (4.16±2.28) mmol/L, t=-2.730, P＜0.01], in the time to postprandial glucose peak of breakfast and lunch [(112.5±29.7) min vs. (97.0±27.2) min, t=-3.225, P＜0.01; (140.0±39.7) min vs. (118.1±42.6) min, t=-3.195, P＜0.01], in the frequency of hypoglycemia (26.3% vs. 5.5%, P＜0.05), and showed the largest amplitude of glycemic excursions [LAGE, (9.66±2.48) mmol/L vs.(8.40±3.13) mmol/L, t=-2.720, P＜0.01]. (2)In the elderly, along with decreased HbA1c, the incidence of hypoglycaemia increased (P＜0.05); And along with increased HbA1c, the amplitude of blood glucose fluctuation increased. There were significant differences in BGFC, PPGE of breakfast and lunch, and LAGE among different HbA1c level groups (P＜0.01, P＜0.05, P＜0.05, P＜0.001). (3)HbA1c was positively correlated with FBG, mean blood glucose (MBG), percentage of time at glycemia (PT7.8, PT11.1), the lowest blood glucose (LBG), the highest blood glucose (HBG), BGFC, PPGE and LAGE (r=0.899-0.289, all P＜0.001). Multiple stepwise regression analysis indicated that MBG, FBG and PT7.8 was the independent influential factor of HbA1c (adjusted R2=0.807, P＜0.05). Conclusions The elderly patients with T2DM are at a particularly high risk for postprandial hyperglycemia and nocturnal hypoglycemic episodes, CGMS could show glucose fluctuation characters of T2DM patients diurnally, and provide a clinical basis for reasonable therapy.     

2型糖尿病血糖控制未达标患者现状调查报告

目的 调查2型糖尿病血糖未达标患者的现状,为制定应对策略提供理论依据.方法 201.年8至10月,收集全国26个城市181家医院血糖未达标的2型糖尿病患者进行问卷调查,调查未达标患者的血糖水平、生活方式干预、血糖监测、药物使用情况等,得到资料比较完整的问卷3 861份,分析患者未达标原因.结果 在统计的未达标患者中,HbA1c均值7.9%,空腹血糖均值8.2 mmol/L,餐后血糖均值11.5 mmol/L.生活方式干预方面,仅25.6%的患者能按医嘱严格进行饮食控制,44.5%的患者基本不进行体育锻炼.分别有35.8%和47.8%的患者不进行空腹和餐后血糖的监测.60岁以上的患者,血糖控制水平与其他年龄组并无差别,但其低血糖发生率高达35.5%,较其他两组(分别为20.8%和21.4%)明显为高(均P＜0.05).药物治疗方面,单药治疗及联合治疗患者比例分别为46.1%和51.7%.＞60岁的老年组联合用药比例更高(58.7%,与其他年龄组比,P＜0.05).75%的患者进行了治疗方案的调整.结论 药物治疗方案不够强化或不适当是患者血糖未达标的主要原因;另外,生活方式不佳,血糖监测不够,患者依从性差也是血糖未达标的重要原因.对于未达标患者,需要进一步强化患者教育,加强生活方式干预,选择更加强化,同时安全、依从性好的降糖治疗方案.对于老年患者降糖的目标值应适当放宽.

Abstract：

Objective To investigate the current status of type 2 diabetic patients who failed to achieve the glycemic control target, and provide theoretic evidences for making corresponding strategies. Methods The 2 diabetic patients who failed to reach the glycemic target were recruited from 181 hospitals in 26 cities and received a standard questionnaire, the conditions of their blood glucose level, lifestyle intervention, blood sugar monitoring, and drug therapy were recorded. Totally 3 861 questionnaires with complete information were collected. And the causes which account for glycemic control status were analyzed. Results Among these patients, the mean HbA1c was 7.9%, the mean fasting plasma glucose was 8.2 mmol/L, and the mean postprandial plasma glucose was 11.5 mmol/L. Only 25.6% of patients take their diet control strictly as prescribed and 44. 5% of patients have little exercise. 35. 8% and 47.8% of patients did not monitor their fasting and postprandial plasma glucose,respectively. Glycemic control in the patients aged ＞ 60 years was similar to the younger patients, but the hypoglycemia incidence in the elder group reached 35.5%, which was higher than those in the other 2 groups (20.8% and 21.4%, both P＜0. 05 ). The proportion of patients with mono-therapy and combination therapy was 46. 1% and 51.7%, while the proportion with combination therapy rose in the patients aged ＞60 years (58.7%;Compared with the other age-groups, all P＜0.05 ). 75 % of patients have adjusted their drug administration regimen since initial treatment. Conclusions Inadequate or inappropriate drug therapy regimen is a major cause responsible for this poor glycemic control status. In addition, the unhealthy life styles, insufficient blood sugar monitoring, and poor compliance were also important causes. Thus, for these patients, it is necessary to further enhance patients' education, to improve life style intervention, as well as to select more effective, safer, and compliant drug therapy regimens. Finally, the glycemic control target for the elder patients should be more flexible.     

老年人血镁水平降低与血糖代谢异常的关系

目的 探讨老年人血镁水平降低与血糖代谢异常的关系.方法 收集我院门诊126例老年人的查体资料,其中2型糖尿病患者50例,糖调节异常者35例,血糖正常者41例,对3组老年人临床资料进行比较分析.结果 (1)3组的年龄、体质指数、血脂水平差异均无统计学意义,糖尿病组和糖调节异常组血清镁明显低于血糖正常组,分别为(0.75±0.11)mmol/L和(0.78±0.12)mmol/L对(0.84±0.1)mmol/L,差异有统计学意义(P＜0.01、＜0.05);(2)低血镁发病率在2型糖尿病和糖调节异常组明显高于血糖正常组,分别为24.0%和28.6%对7.3%(均为P＜0.01);(3)相关分析结果显示,血镁水平与空腹血糖及糖化血红蛋白水平呈明显负相关(r=-0.343、-0.271,均为P＜0.01),与年龄及体质指数无相关.结论 老年人血清镁水平降低与血糖代谢异常有关.

Abstract：

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

老年人血镁水平降低与血糖代谢异常的关系

Objective To explore the relationship between serum magnesium (Mg) levels and glucose metabolism disorders in the elderly.Methods The data of health examination of 126 elderly people were collected in our hospital.There were 50 patients with type 2 diabetes,35 patients with impaired glucose regulation (IGR) and 41 people with normal glucose.The clinical data of the three groups were compared and analyzed.Results (1)There were no significant differences in age,body mass index (BMI) and blood lipid level among the three groups.The mean serum Mg level was lower in normal glucose group [(0.84±0.1) mmol/L] than in diabetic group [(0.75±0.11) mmol/L,P＜0.01] and IGR group [(0.78±0.12) mmol/L,P＜0.05].(2)The prevalence of hypomagnesemia was higher in diabetic group and IGR group than in normal glucose group (24%,28.6% vs.7.3%,P＜ 0.01 ).(3)The correlation study showed that the serum magnesium level was negatively associated with fasting plasma glucose and HbA1c (r= - 0.343,- 0.271,P＜0.01 ),but not associated with age and BMI.Conclusions The low serum magnesium level is associated with glucose metabolism disorders in the elderly.     

那格列奈单药或序贯二甲双胍治疗对初诊2型糖尿病患者血糖稳定性的影响

观察那格列奈单药或序贯二甲双胍治疗对初诊2型糖尿病患者血糖稳定性的影响.对34例初诊2型糖尿病患者予口服那格列奈治疗,血糖不达标者再序贯加用二甲双胍,患者分为那格列奈单药组(单药组,14例)和那格列奈序贯二甲双胍组(双药组,20例).以HbA1C及动态血糖谱中日内平均血糖波动幅度(MAGE)联合反映患者血糖稳定性.患者治疗前及治疗3个月后检测血糖稳定性指标.经过治疗后两组MAGE、HbA1C均较治疗前明显改善(P＜0.05).使用那格列奈单药或序贯二甲双胍治疗能有效改善初诊2型糖尿病患者的血糖稳定性.

Abstract：

The effect of nateglinide or sequential treatment with metformin on glycemic stability in newly diagnosed type 2 diabetes was investigated. Thirty-four cases of newly diagnosed type 2 diabetes received nateglinide therapy, or sequential treatment with metformin according to fasting and postprandial blood glucose, and were classified into isolated nateglinide therapy group(n=14) and sequentially treated with metformin group(n=20). Glycemic stability, reflected by mean amplitude of glycemic excursions(MAGE) and HbA1C, was determined in all patients before and after therapy for three months. HbA1C and MAGE in two groups were all improved after treatment(P＜0.05). The therapy of nateglinide alone or combined with metformin can significantly improve glycemic stability in newly diagnosed type 2 diabetes.     

南昌社区中老年人群糖尿病流行病学调查中HbA1C对诊断2型糖尿病的价值

选择南昌1 415例中老年人作为研究对象,分为正常糖耐量组、糖调节受损组及糖尿病组.结果 显示,HbA1C与空腹血糖(FPG)及餐后2 h血糖呈显著相关,HbA1C 6.3%诊断糖尿病的敏感度为85.19%,特异度为99.45%,HbA1C 6.5%诊断糖尿病的敏感度为75.56%,特异度为99.61%.在本研究的人群中,HbA1C 6.3%诊断糖尿病较HbA1C 6.5%及FPG 7.0 mmol/L具有更高的敏感性.

Abstract：

A total of1415 elderly individuals in Nanchang were included in the study and were divided into normal glucose tolerance group, impaired glucose regulation group, and diabetes mellitus group.The results showed that HbA1C was significantly correlated with fasting plasma glucose (FPG) and 2 h postprandial plasma glucose.When HbA1C 6.3% was applied as the cut point of diabetes, the sensitivity was 85.19% and the specifity was 99.45%.When HbA1C 6.5% was applied, the sensitivity was 75.56% and specifity was 99.61%.It seems that HbA1C 6.3% had higher specifity and sensitivity for diagnosing diabetes than HbA1C 6.5% and FPG 7.0mmol/L in studied population.     

2型糖尿病大鼠胰腺微区血液灌流量与空腹血糖的相关性研究

Objective To observe the dynamic change of microcirculatory hemoperfusion in pancreatic head,body and tail of type 2 diabetic rats and its relationship with fasting blood glucose.Method All Wistar rats were randomly divided into control group(n=130)and experimental group(n=150).The rat model of type 2 diabetes mellitus was established by high-fat,high-sugar feeding combined with low-dose streptozotocin(30 mg/kg).At the 0,4,8,12,16 weeks after the occurrence of diabetes,twenty rats were picked up randomly and respectively from two groups,and microcirculatory hemoperfusion in pancreatic head,body and tail and fasting blood slucose were measured in vivo.Results At the 0,4,8,12,16 weeks after the occurrence of diabetes,fasting blood glucose in experimental group were(10.25±7.98),(14.72±7.51),(19.23±6.09),(22.44±7.45),(26.03±4.96)mmol/L respectively,while microcirculatory hemoperfusion in pancreatic body and tail were(2.46±0.90),(2.79±1.34),(3.15 ±1.24),(3.76±0.99),(4.28±0.23)V respectively.They both increased progressively(P<0.05).No significant changes were found in pancreatic head compared with control group(P>0.05). Microcirculatory hemoperfusion in pancreatic body and tail was positively associated with fasting blood glucose(r=0.3786,P<0.05).Conclusion Microcirculatory hemoperfusion in pancreatic body and tail increased with the increase of fasting blood glu cose in type 2 diabetic rats.     

社区2型糖尿病患者HbA1c水平与营养状况的关系研究

Objective To explore the possible correlation between HbA1c level and nutritional status in community.based patients with type 2 diabetes.Methods A totaI of 219 type 2 diabetes patients were assigned into 2 groups:one with HbAIc<6.5%(n:108)and HbA1f≥6.5%(n=111).Metabolic parameters,food components.and nutritional status were compared between 2 groups.Results (1)49.32% of the participants attained HbA1c<6.5%.(2)HbA1c level was positively correlated with fasting plasma glucose,postprandial plasma glucose,and homeostasis assessment for insulin resistance(HOMA-IR)(r were 0.56,0.49,and 0.20,respectively,P<0.05 or P<0.01),but negatively correlated with high-density lipoprotein-cholesterol(HDL-C)(r=0.16,P<0.05).(3)Linear regression analysis showed that energy,carbohydrate,protein,and fat were the independent risk factors of HbA1c(all P<0.05).(4)Patients with HbA1c<6.5%consumed more fruits.The intake of pure energy-providing foods and protein-,fat-,or saturated fatty acid-rich foods were more frequent in patients with HbA1c≥6.5%(P<0.05).(5)The linear regression revealed that HbA1c level were decreased 0.36%(P<0.10)or 0.46%(P<0.01)by intake of more fruits,roughage and beans,and HbA1c levels were also decreased 0.42%(P<0.05)or 0.37%(P<0.10)by intake of less meat or oils.Conclusions In communitybased patients with type 2 diabetes mellitus,the incidence of HbA1c<6.5% remains low,There exists great difference in nutritional status between the groups with high and low HbA1c levels.The impact of diet OB HbA1c level is great.It's necessary to emphasize the importance of diet therapy far better diabetes control.     

Left ventricular remodeling in patients with stress hyperglycemia after acute myocardial infarction

Background To investigate the association between left ventricular remodeling and stress hyperglycemia (SH) inpatients with acute anterior wall myocardial Infarction. Methods Patients with acute anterior myocardial infarction and a successful primary percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to the presence or absence of SH. Patients with diabetes mellitus were excluded. Echocardiographic studies were performed on discharge and at 6 month follow-up. Left ventricular (LV) ejection fractions (EF), LV end-diastolic volume (EDV) and LV end-systolic volume (ESV) were obtained at baseline and at 6 month. Differences between changes of ESV (ΔESV) and changes of EDV (ΔEDV) in the two groups as well as EF improvement rate (ΔEF %) over six month were obtained. Correlation between SH and LV remodeling was investigated. Results (1) At baseline, the level of hemoglobin A1c was significantly higher in SH group (6.9±1.4 vs 6.2±0.8 P=0.04). Other baseline characteristics, including peak serum creatine kinase MB and LV function, were similar between two groups; (2) EF increased significantly over 6 months in both group with SH((41.1±7.2)% vs (52.7±8.4)%, P=0.02) and group without SH. ((43.6±8.7)% vs (54.5±9.3)%, P=0.03) (3) Only in SH group, EDV increased significantly at 6 month (139.6±26.7 vs 126.1±26.7 P=0.04); (4) There was a weak correlation between ΔEDV and the level of fasting plasma glucose on admission.(Pearson's r=0.35, P0.01). Conclusions (1) Previous glucose metabolism disorder is at least partially responsible for hyperglycemia on admission; (2) Given successful primary PCI within recommended time interval, left ventricular function improved regardless of whether SH is present or not; (3) The degree of glucose metabolic dysfunction on admission is weakly associated with the remodeling process in 6 months     

妊娠糖尿病患者动态血糖谱的特点及其意义

目的探讨妊娠糖尿病（GDM）患者动态血糖谱的特点,为临床治疗提供依据。方法采用动态血糖监测系统（CGMS）对7例GDM患者及20名糖耐量正常者（NGT）进行连续3d的皮下组织葡萄糖监测。GDM组和NGT组平均年龄分别为28岁与41岁,体质指数分别为24、25kg／m^2。计算比较2组平均血糖水平（MBG）、血糖标准差（SDBG）、平均血糖波动幅度（MAGE）、三餐餐后血糖漂移幅度（PPGE）、日间血糖平均绝对差（MODD）及日内最大血糖波动幅度（DMMG）,并统计血糖达标后胰岛素的使用情况。组间及组内参数比较采用t检验。结果GDM组MAGE、PPGE及DMMG均较NGT者升高,分别为MAGE（4．3±0．2）比（1．6±0．3）mmol／L,早餐餐后血糖漂移幅度（BPPGE）（5．5±1．1）比（1．8±0．4）mmol／L,中餐餐后血糖漂移幅度（LPPGE）（3．1±0．3）比（1．3±0．2）mmol／L,晚餐餐后血糖漂移幅度（DPPGE）（3．4±0．4）比（1．5±0．2）mmot／L,DMMG（6．0±2．7）比（2．9±0．2）mmol／L,2组差异均有统计学意义（t=4．4、5．6、2．3、2．8、6．1,均P〈0．05）。2组MBG、SDBG、MODD差异均无统计学意义（t=0．9、1．4、0．3,均P〉0．05）。GDM患者BPPGE较LPPGE和DPPGE大,差异均有统计学意义（t=3．1、2．6,均P〈0．05）。GDM患者基础胰岛素用量占一天胰岛素总量15．0％,早餐的餐时胰岛素用量最大,占一天胰岛素总量的33．5％。结论CGMS是GDM监测血糖波动的有效手段,GDM患者以三餐后高血糖及餐后血糖波动为主,早餐血糖波动最为显著,餐时胰岛素用量为主,早餐餐时胰岛素用量最大。胰岛素用量与血糖波动的情况一致。     

实时动态血糖监测对住院2型糖尿病患者血糖波动的控制

目的 评估实时动态血糖监测对血糖波动的影响.方法 2010年1月至2012年12月,选取住院胰岛素治疗的2型糖尿病患者122例,按随机数字表法分组为传统动态血糖监测（传统组,n=61）和实时动态血糖监测（实时组,n=61）.进行72 h持续血糖监测,安装当天为设备调试日（d0）,其后第1天（d1）和第2天（d2）为观察时限.传统组每日3次根据指尖末梢血糖调整血糖;实时组每日3次根据实时显示血糖曲线,调整降糖,并设定高低血糖报警界限.统计分析组内（d1和d2）和组间平均血糖波动幅度（MAGE）、平均血糖（MBG）、血糖标准差（SDBG）、日间血糖平均绝对差（MODD）、日内最大血糖波动幅度（LAGE）和低血糖情况.组间比较采用两独立样本均数比较t检验,计数资料采用x2检验.结果 （1）组内比较：实时组d1与d2的MAGE、MBG、SDBG、LAGE分别为（5.3±3.2）比（4.2±2.1）、（8.6±1.7）比（8.2±1.5）、（2.1±0.9）比（1.8±0.7）、（8.6±3.3）比（7.5±2.8）mmol/L（F=9.797、5.852、20.625、11.057,均P＜0.05）,低血糖持续时间为40（32.5 ～135） min比25（15 ～ 40） min（Z=2.456,P＜0.05）.传统组d1与d2的MAGE、MBG、LAGE差异均无统计学意义（F=0.229、0.246、0.635,均P＞0.05）;SDBG为（2.4±1.1）比（2.2±1.0） mmol/L（F=5.615,P＜0.05）.（2）组间比较：实时组和传统组d1、d2MAGE、LAGE差值之间的比较分别为0.7（-0.3 ～2.0）比0（-1.0～1.5）、0.9（-0.7～2.1）比0.1（-2.5 ～1.9）（Z值分别为2.002、2.023,均P＜0.05）;组间MODD比较1.8（1.3 ～2.6）比2.1（1.4～2.9） mmol/L（Z=1.572,P＞0.05）.结论 依据实时动态血糖监测,及时调整降糖策略,能减少血糖波动,使血糖更稳、更快达标.     

糖尿病合并急性心肌梗死患者住院期间血糖波动的变化及其临床意义

目的探讨糖尿病合并急性心肌梗死（AMI）患者住院期间血糖波动的变化及意义。方法以性别、年龄及HbA1c水平进行1：1配对的糖尿病合并AMI患者（AMI组）和糖尿病合并稳定性冠心病患者（CAD组）各30例,通过动态血糖监测技术获得患者住院期间血糖波动参数并比较。结果（1）AMI组与CAD组比,日内平均血糖波动幅度MAGE,（3．83±1．38）vs（3．17±1．14）mmol／L]、日间血糖平均绝对差[MODD,（2．62±1．08）vs（2．00±0．90）mmol／L]、餐后血糖波动幅度[PPGE,（3．43±1．70）vs（2．34±1．64）mmol／L]和餐后3h平均血糖水平[3hMPBG,（10．49±2．44）vs（8．95±2．45）mmol／L]均升高（P〈0．05）,平均血糖标准差有升高趋势[SDBG,（2．53±1．02）vs（2．16±0．85）mmol／L,P=0．051]。（2）多因素逐步回归分析显示AMI组中MAGE是独立于射血分数和年龄影响全球急性冠状动脉事件（GRACE）积分的危险因子。结论糖尿病合并冠心病患者发生AMI时,其住院期间的日内、日间和餐后血糖波动幅度均明显增大,MAGE还可能有助于评估患者的预后。     

Comparison of daily glucose excursion by continuous glucose monitoring between type 2 diabetic patients receiving biphasic insulin aspart 30 or biphasic human insulin 30

Aims/Introduction: Biphasic insulin aspart 30 (BIAsp 30) has an earlier and stronger peak effect with a similar duration of action to biphasic human insulin 30 (BHI 30). However, direct comparison of daily glucose excursion during treatment with these two types of insulin has not been carried out. Materials and Methods: We carried out continuous glucose monitoring (CGM) and evaluated the 48‐h glucose profile during twice‐daily injections of BIAsp 30 or BHI 30 at the same dosage in 12 hospitalized patients with type 2 diabetes who participated in a randomized cross‐over trial. Results: The 48‐h average glucose level and mean amplitude of glucose excursion (MAGE) were lower during BIAsp 30 treatment than with BHI 30. The average glucose level during 2–3 h after breakfast and 2–4 h after dinner, and the incremental postprandial glucose from just before to 4 h after dinner were lower with BIAsp 30 treatment than with BHI 30. Furthermore, BIAsp 30 treatment reduced the SD from 30 min before to 4 h after breakfast and lunch compared with BHI 30. The average glucose level and SD during the 30 min before each meal and during the night were not different between the two insulin preparations, and hypoglycemia was not observed with either treatment. Conclusions: Twice‐daily BIAsp 30 reduced the 48‐h average glucose and MAGE, the postprandial glucose (after breakfast and dinner), and the SD of glucose excursion (after breakfast and lunch) compared with the same dosage of BHI 30, without causing hypoglycemia or deterioration of glycemic control before meals and at night. This trial was registered with UMIN (no. UMIN000005129). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00123.x, 2011)     

老年2型糖尿病患者血糖控制全面评估

目的对老年2型糖尿病患者血糖控制情况进行全面评估,并探讨糖化血红蛋白（HbAlc）与血糖波动的相关性;方法选取老年糖尿病患者共284名,测定空腹血糖（FPG）、餐后2h血糖（PPG）、HbAlc水平,进一步采用动态血糖监测系统（CGMS）评估血糖波动情况。按照HbAlc水平分为两组（HbAlc≤7％组和HbAlc〈7％组）,比较两组间血糖控制水平及血糖波动情况。结果本研究中老年糖尿病患者FPG达标率为67．6％,PPG为34．9％,HbAlc为42．9％,血糖波动正常范围内的患者占28．6％,血糖波动大的患者占71．4％。两组间比较,FPG、PPG、MBG差异有统计学意义（P〈0．01）;但两组间代表血糖波动的各参数平均血糖标准差（SDBG）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）、日间血糖波动幅度（MODD）相比,差异无统计学意义（P〉0．05）。相关性分析表明,MAGE及MODD均与HbAlc水平无关（P〉0．05）。结论大多数老年糖尿病患者的血糖控制未达标,且约70％的老年糖尿病患者血糖波动大。HbAlc与血糖波动无关,HbAlc和血糖波动是评价血糖控制的独立指标。     

Relationships between glucose excursion and the activation of oxidative stress in patients with newly diagnosed type 2 diabetes or impaired glucose regulation

The effect of glucose excursions on oxidative stress is an important topic in diabetes research. We investigated this relationship by analyzing markers of oxidative stress and glycemic data from a continuous glucose monitoring system (CGMS) in 30 individuals with normal glucose regulation (NGR), 27 subjects with impaired glucose regulation (IGR), and 27 patients with newly diagnosed type 2 diabetes (T2DM). We compared the mean amplitude of glycemic excursion (MAGE), mean postprandial glucose excursion (MPPGE), and mean postprandial incremental area under the curve (IAUC) with plasma levels of oxidative stress markers 8-iso-PGF2α, 8-OH-dG, and protein carbonyl content in the study subjects. Patients with T2DM or IGR had significantly higher glucose excursions and plasma levels of oxidative stress markers compared to normal controls (P < 0.01 or 0.05). Multiple linear regression analyses showed significant relationships between MAGE and plasma 8-iso-PGF2α, and between MPPGE and plasma 8-OH-dG in patients with IGR or T2DM (P < 0.01 or 0.05). Furthermore, 2h-postprandial glucose level and IAUC were related to plasma protein carbonyl content in the study cohort including T2DM and IGR (P < 0.01). We demonstrate that glucose excursions in subjects with IGR and T2DM trigger the activation of oxidative stress.     

2型糖尿病合并急性冠状动脉综合征患者早期血糖波动观察

目的探讨2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者早期血糖波动情况及意义。方法采用动态血糖监测系统对60例T2DM合并ACS患者(观察组),45例T2DM不伴ACS患者(对照组)进行3 d血糖检测,全球急性冠状动脉事件(GRACE)评分评价ACS患者危险度。比较两组血糖波动参数差异,并与不同GRACE评分组进行相关性分析。结果 (1)观察组餐后血糖波动幅度(PPGE)、日内平均血糖波动幅度(MAGE)、日内血糖平均绝对差(MODD)均明显高于对照组[(3.53±1.43)mmol/L比(2.35±0.95)mmol/L;(3.46±1.23)mmol/L比(2.97±0.94)mmol/L;(2.54±0.92)mmol/L比(2.01±0.64)mmol/L,均为P<0.05];(2)GRACE评分为低危组、中危组和高危组ACS患者的PPGE、MAGE和MODD值比较差异有统计学意义(均为P<0.05);PPGE、MAGE、MODD和24 h平均血糖值与GRACE评分值呈正相关(r=0.604,0.504,0.492和0.581,均为P<0.05),多元线性回归分析显示MAGE是独立于射血分数及年龄的影响GRACE评分的危险因子。结论 T2DM患者合并ACS时,其早期血糖波动幅度明显增大,并且MAGE和GRACE评分相关。     

糖尿病心肌病患者血糖波动与结缔组织生长因子的关系

目的观察糖化血红蛋白低于7％的糖尿病心肌病患者血糖波动与血清结缔组织生长因子水平的关系及其临床意义。方法选取2009年10月至2010年7月在黑龙江省医院内分泌科就诊的2型糖尿病患者50例,其中男25例,女25例,年龄30～50岁,根据是否合并糖尿病心肌病分为单纯2型糖尿病组[n=25,男13例,女12例,年龄（41±5）岁]和糖尿病心肌病组[n=25,男12例,女13例,年龄（43±6）岁]。另以同期于黑龙江省医院进行体检的20名健康志愿者为正常对照组[男11例,女9例,年龄（40±5）岁]。应用动态血糖监测系统连续监测血糖3d,计算平均血糖波动幅度及日间血糖绝对差值。采用酶联免疫吸附法检测血清结缔组织生长因子水平。采用方差分析和多元逐步回归分析进行数据统计。结果糖尿病心肌病组血清结缔组织生长因子水平明显高于单纯2型糖尿病组和正常对照组[分别为（311±32）、（211±29）、（181±38）ng／L,F=81．53,P〈0．05]。糖尿病心肌病组平均血糖波动幅度[分别为（7．1±1．0）、（6．0±1．0）mmol／L,F=25．46,P〈0．05]、日间血糖平均绝对差[分别为（2．56±0．38）、（1．37±0．26）mmol／L,F=66．13,P〈0．05]明显高于单纯2型糖尿病组。Pearson直线相关分析显示,血清结缔组织生长因子水平与餐后2h血糖、24h尿微量白蛋白、平均血糖波动幅度、日问血糖平均绝对差呈正相关（r值分别为0．759、0．655、0．491、0．617,均P〈0．05）。结论血糖波动可能通过影响血清结缔组织生长因子水平参与糖尿病心肌病的发展,结缔组织生长因子表达上调对糖尿病心肌病的诊断及预后有重要的临床意义。     

应用动态血糖监测系统评价格列喹酮对新发2型糖尿病血糖波动的控制及其促泌作用

目的应用动态血糖监测技术评价不同磺脲类药物控制新发2型糖尿病餐后血糖波动的作用特征,对比其胰岛素促泌作用模式的差异,并分析二者的相关性。方法选取2008年3月至12月于解放军总医院门诊就诊病程小于1年的2型糖尿病患者40例,采用随机数字表法将所有研究对象分为3组,分别给予不同磺脲类药物干预1个月：格列喹酮组16例（60mg／早,30mg／晚）,格列齐特组13例（80mg／早,80mg／晚）,格列苯脲组11例（2．5mg／早,2．5mg／晚）。各组研究对象在干预前后均行动态血糖监测（CGMS）和葡萄糖耐量一胰岛素释放试验（OGTF-IRT,分别在服糖前30、0min、糖负荷后15、30、45、60、120和180rain留取静脉血标本）,同时采集空腹血送检各项代谢指标;对比干预前后血糖波动和胰岛素分泌特征的变化,组内治疗前后比较用配对t检验,组间比较采用方差分析。结果格列喹酮和格列奇特组干预后果糖胺较干预前分别下降了17．5％和14．8％[分别为（257±49）、（212±40）μmol／L;（2374-52）、（202±31）Ixmol／L;t=2．098、2．052,均P〈0．05];干预后3组糖化血红蛋白水平均有下降,但差异均无统计学意义（均P〉0．05）;干预后3组的平均血糖波动幅度（MAGE）、平均血糖（MBG）、平均血糖标准差（SDBG）、最大血糖波动幅度（LAGE）、空腹血糖变异系数（CV—FPG）均较干预前有不同程度的改善（均P〈0．05）,其中格列喹酮组和格列奇特组干预后MAGE降幅（分别为42．2％、36．6％）明显优于格列苯脲组的27．0％（分别为6．6±2．3,3．8±2．0;7．0±2．3,4．4±1．6;6．44-1．2,4．74-1．8;t=3．977、2．349、2．977,均P〈0．05）;干预后格列喹酮组和格列奇特组的血糖谱曲线相对平稳,血糖波动特征类似;格列苯脲组清晨空腹血糖偏低,而早餐后、晚餐后血糖升高明显强于其他2组,血糖曲线显著分离;格列喹酮干预后胰岛素分泌速率分别在30和60min达峰,120min降至基线水平;格列奇特与之非常类似;格列苯脲组胰岛素分泌速率达峰时间延迟,峰值更高,高胰岛素血症持续时间相对较长;MAGE与糖负荷后45、60min胰岛素分泌速率显著相关（r=-0．342、-0．386,均P〈0．05）。结论格列喹酮和格列奇特显著降低餐后血糖波动,改善平均血糖控制水平,与其刺激胰岛β细胞快速双峰分泌胰岛素的拟生理促泌模式有关;格列苯脲低血糖发生风险相对较大,与其强而持久的促泌作用有关。     

老年2型糖尿病患者1,5-脱水葡萄糖醇与平均血糖及漂移幅度的相关性

目的研究老年2型糖尿病患者1,5-脱水葡萄糖醇（1,5-AG）与平均血糖（MBG）及漂移幅度的关系,探讨1,5-AG是否可作为糖尿病临床观察及治疗监控的指标之一。方法选取95例老年2型糖尿病住院患者,男性65例,女性30例,年龄70～88（80.1±4.3）岁,连续进行3d的动态血糖监测,统一进餐时间,期间记录每日参比血糖、饮食、服药及锻炼等活动事件。在第3天禁食8h以上,抽取空腹静脉血分别测定1,5-AG、糖化血红蛋白（HbA1c）、糖化血清蛋白（GSP）等数值。结果1,5-AG与空腹血糖、餐后2h血糖、HbAlc、GSP、3d MBG及平均血糖漂移幅度呈负相关（均P＜0.05）,将1,5-AG与日内不同时段的MBG进行Pearson相关分析,显示其与早餐前1h、早餐后2h、早餐后3h、晚餐后2h、晚餐后3h及2∶00～4∶00的MBG呈负相关（均P＜0.05）,与其他时段MBG相关性不明显。结论1,5-AG能较好地反映短时间内的MBG水平和血糖漂移,可作为糖尿病筛查和治疗监控的指标之一。