血糖波动与糖尿病大血管病变的相关研究

目的:探讨血糖波动与糖尿病动脉粥样硬化(AS)大血管病变的关系。方法:对3组不同糖耐量者进行连续3d的动态血糖监测,分析平均血糖水平(MBG)、日内平均血糖波动幅度(MAGE)以及日间血糖平均绝对差(MODD);并用B型超声观察双侧颈动脉内膜中层厚度(IMT)、内膜连续性及AS积分等指标。结果:(1)与糖耐量正常(NGT)组比较,糖耐量受损(IGT)组和新诊断2型糖尿病(T2DM)组高血压、冠心病、中风的发生率逐渐增高,且后2组间有显著差异。(2)从NGT组到IGT组再到T2DM组,IMT、AS积分等动脉粥样硬化指标逐渐增加,差异显著。(3)动态血糖监测结果显示:IGT组和T2DM组血糖波动幅度比NGT组明显增大,以T2DM组最明显。(4)多元分析发现平均IMT和AS积分与MAGE正相关。结论:波动性高血糖与AS密切相关,血糖波动幅度大的患者发生糖尿病大血管并发症的危险性高。血糖稳态受损可能是糖尿病大血管并发症的危险因素之一。

Study of the relationship between blood glucose fluctuation and type 2 diabetes mellitus with macroangiopathy

AIM: To investigate the relationship between the fluctuation of blood glucose and the macrovascular complication of atherosclerosis (AS) in diabetic patients. METHODS: The individuals with different glucose tolerance were observed by continuous glucose monitoring for 3 days including the mean blood glucose (MBG) and its standard deviation (SD), mean amplitude of glycemic excursions (MAGE) and absolute means of daily differences (MODD). In addition, the intima-media thickness (IMT), intima smoothness as well as AS scores were measured respectively in bilateral common carotid arteries by means of high resolution B mode ultrasonography. RESULTS: The incidence of macrovascular complications in the subjects with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes (T2DM) was significantly higher than those in the subjects with normal glucose tolerance (NGT), and a significantly difference between group IGT and T2DM was observed. The indexes detected by B mode ultrasonography were all increased gradually from NGT to IGT, then to newly diagnosed T2DM. The values of glycemic excursion were higher in IGT and T2DM group, especially in the subjects with diabetes than those in NGT group. In addition, multiple regression analysis showed that MAGE was significantly correlated with mean IMT and AS scores. CONCLUSION: Blood glucose fluctuation is associated with atherosclerosis. The patients with a larger range of blood glucose excursion have higher risks for developing atherosclerotic complications. The impaired glucose stability is a possible risk factor for atherosclerotic macroangiopathy in diabetes.