7点末梢血糖值预测老年2型糖尿病患者夜间无症状低血糖的价值

目的基于动态血糖监测系统(CGMS)探讨7点末梢血糖谱中不同时间点血糖值预测老年2型糖尿病(T2DM)患者夜间无症状低血糖的价值。方法采用便利抽样法,选取2019年1—10月于新乡市中心医院住院的老年T2DM患者225例,入院后监测7点末梢血糖,同步进行72 h动态血糖监测(CGM),调查患者夜间低血糖发生状况,根据结果分为夜间有症状低血糖组和夜间无症状低血糖组,比较两组低血糖相关指标,绘制ROC曲线,计算曲线下面积(AUC)判定各指标与夜间无症状低血糖发生相关的最佳切点值。结果225例患者在CGM监测中,74例出现夜间低血糖,发生率为32.89%;其中,34例为夜间无症状低血糖,占45.95%(34/74)。夜间无症状低血糖组患者空腹、晚餐后、睡前血糖均低于夜间有症状低血糖组。睡前血糖和空腹血糖预测夜间无症状低血糖的最佳切点值分别为6.9 mmol/L和6.0 mmol/L,AUC分别为0.822和0.651。结论应警惕老年T2DM患者夜间无症状低血糖的发生,睡前血糖<6.9 mmol/L或空腹血糖<6.0 mmol/L提示夜间无症状低血糖的发生风险增加。

The value of 7-point peripheral blood glucose in predicting asymptomatic hypoglycemia at night in elderly patients with type 2 diabetes mellitus

Objective To explore the value of blood glucose at different time points in the 7-point peripheral blood glucose spectrum in predicting asymptomatic hypoglycemia at night in elderly patients with type 2 diabetes mellitus(T2DM)based on continuous glucose monitoring system(CGMS).Methods From January to October 2019,convenience sampling was used to select 225 elderly T2DM patients who were hospitalized in Xinxiang Central Hospital.We monitored the peripheral blood glucose at 7 time points after admission,and performed 72-hour continuous glucose monitoring(CGM)simultaneously.We investigated the occurrence of night hypoglycemia of patients,and divided patients into night symptomatic hypoglycemia group and night asymptomatic hypoglycemia group according to the results.We compared the hypoglycemia related indicators of two groups,drew the receiver operating characteristic(ROC)curve,calculated the area under the curve(AUC)to determine the best cut-point value of each indicator and the occurrence of asymptomatic hypoglycemia at night.Results In the CGM of 225 patients,74 cases had hypoglycemia at night,and the incidence was 32.89%,and 34 cases of them had asymptomatic hypoglycemia at night,accounting for 45.95%(34/74).The fasting blood glucose,blood glucose after dinner and before bedtime of patients in night asymptomatic hypoglycemia group were lower than those of night symptomatic hypoglycemia group.The best cut-off points of blood glucose before bedtime and fasting blood glucose for predicting asymptomatic hypoglycemia at night were 6.9 mmol/L and 6.0 mmol/L respectively,and the AUC were 0.822 and 0.651 respectively.Conclusions We should be alert to the occurrence of asymptomatic hypoglycemia at night in elderly patients with T2DM.Blood glucose before bedtime<6.9 mmol/L or fasting blood glucose<6.0 mmol/L indicates an increased risk of asymptomatic hypoglycemia at night.