2型糖尿病全天血糖水平与糖化血红蛋白血糖漂移幅度的相关性分析

目的探讨2型糖尿病(T2DM)患者日内不同时间的血糖水平与糖化血红蛋白(HbA1c)及血糖漂移幅度的关系。方法选取2002年12月至2005年10月上海交通大学附属第六人民医院内分泌代谢科新诊断T2DM患者60例,采用动态血糖监测系统(CGMS)进行持续3d的血糖监测并分析日内不同时点、时段的血糖水平、HbA1c、餐后血糖漂移幅度(PPGE)及平均血糖漂移幅度(MAGE)之间的关系。结果(1)T2DM患者HbA1c与全天8次血糖水平均呈显著正相关(r=0.62~0.70,P均<0.01),与PPGE不相关(P>0.05),逐步回归分析显示空腹及中、晚餐后2h血糖进入最后的方程(校正R2=0.566,P<0.01)。(2)HbA1c与全天不同时段的平均血糖水平均呈显著正相关(r=0.57~0.74,P均<0.01),晚餐前1h、晚餐后2~3h及晨300~600时间段的平均血糖水平是其独立影响因素。(3)CGMS所示的日内平均血糖水平与HbA1c相关性最强(r=0.81,P<0.01)。(4)MAGE与HbA1c不相关(P>0.05),三餐PPGE及晨300的血糖水平为影响MAGE的独立参与因素(校正R2=0.427,P<0.01)。结论T2DM患者HbA1c与全天平均血糖水平的关系最密切,而日内血糖的漂移变化主要归因于餐后及夜间血糖的漂移。因此,T2DM的血糖监测及干预治疗应针对全天血糖谱。

Correlation analysis of blood glucose levels throughout the day, HbA1c and amplitude of glycemic excursions in type 2 diabetes

Objective To study the interrelationship of blood glucose levels throughout the day,HbA_1c and amplitude of glycemic excursions in type 2 diabetic patients.Methods From Dec.2002 to Oct.2005,in the Department of Sixth People's Hospital,Jiaotong University,60 newly diagnosed type 2 diabetic patients without previous management were measured by continuous glucose monitoring system(CGMS)for 3 days.The mean amplitude of glycemic excursions(MAGE),postprandial glycemic excursions(PPGE),mean levels of 288 CGMS values(MBG),the 8-point blood glucose profiles and mean blood glucose levels of different period for 24 hours were calculated in each individual.Results (1)8-point blood glucose profiles were all significantly correlated with HbA_1c(r= 0.62~0.70,all P<0.01).Stepwise regression analysis indicated that the blood glucose of fasting,2 h after lunch and dinner were the major independent contributing factors.However,the correlation of PPGE and HbA_1c was not significant.(2)Mean blood glucose levels of different periods during the whole day were all significantly correlated with HbA_1c(r= 0.62~0.70,all P<0.01),and blood glucose levels measured 1h before dinner,2~3 h after dinner and during 3am-6am were independent contributing factors.(3)MBG had the most significant correlation with HbA_1c(r= 0.81,P<0.01).(4)The MAGE,independent of HbA_1c,was largely attributed to the glycemic excursions of post-meal and nighttime.Conclusion It is the mean daily glycemia that highly correlates with HbA_1c and glucose variability is largely attributed to the glycemic excursions of post-meal and nighttime in type 2 diabetes.Thus,it is important that blood glucose monitoring and glycemic control should aim at the entire daily glucose profile.