老年2型糖尿病患者血糖漂移与糖化血红蛋白相关性分析

目的 动态监测老年2型糖尿病患者日内血糖波动情况,探讨血糖漂移与糖化血红蛋白（HbA1c）及糖尿病慢性并发症的关系.方法 以70例老年2型糖尿病患者作为研究对象,其中35例伴糖尿病肾病,30例伴糖尿病视网膜病变.采用动态血糖监测系统（CGMS）进行连续72 h血糖监测,考察日内不同时点血糖水平、不同时段血糖漂移、餐后血糖漂移（PPGE）、平均血糖漂移幅度（MAGE）和24 h平均血糖水平（24h MBG）.Pearson法分析患者HbA1c与血糖漂移的相关性,多元Logjstic回归分析与糖尿病肾病和糖尿病视网膜病变发生相关的影响因素.结果 HbA1c与日内7个时点血糖水平、24 h MBG及3：00～6：00、19：00～20：00时段血糖漂移呈显著正相关（P＜0.05或P＜0.01）,与PPGE无明显相关（P＞0.05）;MAGE与13：00、19：00时点血糖水平和PPGE均呈显著正相关（P＜0.05）.0：00～3：00时段血糖漂移是糖尿病视网膜病变发生的影响因素（P＜0.05）.结论 CGMS能较详细地显示日内血糖波动情况.HbA1c能反映日内整体血糖水平.日内血糖波动主要归因于PPGE和夜间血糖漂移.糖尿病视网膜病变的发生可能与血糖漂移有关.

Correlation of glycemic excursion with glycated hemoglobin Alc in elder patients with type 2 diabetes mellitus

Objective To continuously monitor the blood glucose fluctuation of elder patients with type 2 diabetes mellitus, and explore the relationship among glycemic excursion, glycated hemoglobin A1c (HbA1c) and chronic diabetic complications. Methods Seventy elder patients with type 2 diabetes mellitus were enrolled, among whom 35 were complicated with diabetic nephropathy and 30 with diabetic retinopathy. Blood glucose was monitored for 72 h with continuous glucose monitoring system (CGMS), and blood glucose levels of different time points, glycemic excursion of different time stages, postprandial glycemic excursion (PPGE) of different time stages, mean amplitude of glycemic excursion (MAGE) and 24 h mean blood glucose (24 h MBG) levels were obtained. The relationship between HbA1c and glycemic excursion with CGMS was investigated by Pearson analysis, and the influencing factors of diabetic nephropathy and diabetic retinopathy were explored by multivariate Logistic regression analysis. Results HbA1c was positively correlated with blood glucose levels of seven time points, 24 h MBG and glycemic excursion of 3:00 to 6:00 and 19:00 to 20:00 (r>0, P<0.05 or P<0.01), while was not significantly correlated with PPGE (P>0.05). MAGE was significantly positively correlated with blood glucose levels of 13:00 and 19:00 and PPGE (r>0, P<0.05). Glycemic excursion of 0:00 to 3:00 was influencing factors of diabetic retinopathy (P<0.05). Conclusion CGMS can display blood glucose fluctuation in details, and HbA1c may comprehensively reveal blood glucose levels. Blood glucose fluctuation is mainly attributed to PPGE and nighttime glycemic excursion. Diabetic retinopathy may correlate with glycemic excursion.