动态监测1型及2型糖尿病患者血糖漂移变化

目的 通过动态血糖监测系统(CGMS)监测1型及2型糖尿病患者的血糖漂移变化,并分别探讨糖化血红蛋白及C肽水平与血糖漂移参数的关系.方法 对30例1型糖尿病(T1DM)患者、50例2型糖尿病(T2DM)患者以及30例糖调节正常(NGR)者进行连续72 h动态血糖监测,分析其血糖谱参数,包括日内平均血糖水平(24h MBG)及标准差(SDBG)、三餐前后平均血糖水平、日内最大血糖漂移幅度(LAGE)、日内平均血糖漂移幅度(MAGE)及漂移次数(NGE)、不同血糖水平所占日内时间百分比(PT)及日间血糖平均绝对差(MODD).结果 ①T1DM组和T2DM组的24 h MBG及三餐前后平均血糖明显高于NGR组(P＜0.05).②在昼夜24 h中,T1DM组处于理想血糖控制水平(＞4.4且＜8.0 mmol/L)所占日内时间百分比为(27.03±15.71)％,T2DM组为(37.77±25.40)％,均明显少于NGR组(89.20±10.34)％,P＜0.05.③与NGR组相比,T1DM组及T2DM组日内血糖漂移参数(SDBG、LAGE、MAGE、晚餐PPGE)及日间血糖漂移参数(MODD)显著升高(P＜0.05),且多数指标T1DM组显著高于T2DM组(P＜0.05).④T1DM组及T2DM组的HbAlc与日内及日间血糖漂移参数无明显相关,而其空腹C肽、餐后1h及2hC肽均与LAGE、SDBG、MODD呈负相关(P＜0.05),且T1DM组相关程度多高于T2DM组.结论 糖尿病患者存在慢性持续性高血糖及血糖漂移增加,在血糖漂移方面,T1DM较T2DM更显著.胰岛功能与血糖漂移密切相关.日内及日间血糖漂移参数是全面而精细反映血糖全方位变化的重要指标.

Glycemic excursion variation in type 1 and type 2 diabetic patients by continuous glucose monitoring system

【Objective】 To evaluate the glycemic excursion(GE) variation in type 1 and type 2 diabetic patients,and investigate the relationship between glycosylated hemoglobin(HbA1c),C-peptide and parameters of GE,respectively.【Methods】 30 patients with type 1 diabetes mellitus(T1DM),50 patients with type 2 diabetes mellitus(T2DM) and 30 controls with normal glucose regulation(NGR) were recruited for 72 h continuous glucose monitoring.Parameters of the glucose profiles were analyzed,including mean level(24 h MBG) and standard deviation(SDBG) of 24 h blood glucose values,mean blood glucose levels before or after meals,the largest amplitude of glycemic excursions(LAGE),mean amplitude of glycemic excursions(MAGE),number of glycemic excursions(NGE),the percentage of time for different glucose levels in 24 hours(PT),absolute means of daily differences(MODD).【Results】 ①24 h MBG and mean blood glucose levels before or after meals in T1DM and T2DM groups were both significantly higher than NGR group(P <0.05).②The percentage of time considered as well-controlled blood glucose(blood glucose between 4.4 mmol/L and 8.0 mmol/L) was only(27.03±15.71)% in 24 hours for T1DM group,while(37.77±25.40)% for T2DM group,which were significantly less than NGR group(89.20±10.34)%,P <0.05.③Compared with NGR group,the parameters of circadian GE(SDBG,LAGE,MAGE,supper PPGE) and daily GE(MODD) in T1DM and T2DM groups were significantly higher(P <0.05).And they seemed to be higher in T1DM group than those in T2DM group(P <0.05).④HbAlc of T1DM and T2DM groups had no obvious relationship with parameters of circadian and daily GE.Fasting serum C-peptide,1 hour postprandial C-peptide and 2 hours postprandial C-peptide in DM groups all had a negative relationship with LAGE,SDBG and MODD respectively(P <0.05),while in T1DM most of the correlation coefficients were increased.【Conclusion】 There exists both chronic sustained hyperglycemia and increased glycemic excursions in DM patients.Blood glucose fluctuates severely in T1DM patients.β-cell dysfunction correlates strongly with glucose excursion.Besides HbAlc,parameters of the circadian and daily GE are important markers which can reflect glycemic variation comprehensively and accurately.