应用动态血糖监测系统评估胰岛素泵治疗初期发生低血糖的特点

目的 应用动态血糖监测系统(CGMS)评估短期胰岛素泵(CSII)快速控制2型糖尿病病人高血糖状态时低血糖的发生特点及其影响因素.方法 61例住院的2型糖尿病病人,男35例,女26例,年龄(60±15)岁,病程8(0.5～12)年,糖化血红蛋白(11.1±1.6)%,糖化血清蛋白(32±6)%,人院后予胰岛素泵治疗同时进行CGMS监测;分析胰岛素泵治疗第3、4天CGMS监测的24 h平均血糖水平(MBG)及其标准差(SDBG)以及低血糖事件的发生情况,根据低血糖事件分为低血糖组和无低血糖组.结果 (1)胰岛素泵治疗期间每日胰岛素总量为(0.8±0.2)U·kg-1·d-1,餐前大剂量与基础量比例为(1.30±0.36):1.(2)CGMS监测显示胰岛素泵治疗初期有18例病人共发生31次低血糖事件,其中20次发生于夜间.CGMS的低血糖检出率较指端血糖监测(SMBG)显著增多(P＜0.01).(3)两组间空腹C肽、血总胆固醇和胰岛素泵基础量差异有统计学意义(P＜0.05).低血糖组的MBG低于无低血糖组(7.88±1.24)mmol/L vs(8.92±1.83)mmol/L,P＜0.05],而SDBG和胰岛素泵基础率高于无低血糖组(2.95±0.73)mmol/L vs(2.37±0.99)mmol/L;(0.37±0.09)U·kg-1·d-1 vs (0.33±0.08)U·kg-1·d-1,均P＜0.05].多元回归分析显示SDBG及胰岛素泵基础量与低血糖的发生呈独立正相关.结论 (1)动态血糖监测显示胰岛素泵强化治疗2型糖尿病初期约1/3病人可发生低血糖.(2)除了血糖控制水平及胰岛素泵基础量外,血糖波动过大与低血糖的发生也密切相关.

Evaluating the feature of hypoglycemia detected by continuous glucose monitoring system during temporary continuous subcutaneous insulin infusion in type 2 diabetes patients

Objective To use continuous glucose monitoring system(CGMS)to investigate the features of hypoglycemia in control of hyperglycemia in T2DM patients by continuous subcutaneous insulin infusion(CSⅡ)and to study the influencing factors of hypoglycemia.Methods Sixty-one T2DM patients,35 males and 26 females,age 23-88,with the disease duration of 0.5-12 years,HbA1c level of(11.1±1.6)％,and glycosylated serum prorein of(32±6)％.Underwent.CSⅡ and finger blood sugar test.On the second day CGMS was used for 72 hours.Logistic regression WaS used to analyze the correlation among different factors.Results CGMS discovered 31 hypoglycemia events in 18 patients in tlle early stage of CSⅡ treatment.20 events occurring at night.A number significantly higher than that by self-monitoring of blood sugar.The C-peptide and mean blood glucose(BMG)of the patients with hypoglycemia were significantly lower than those of the patients without hypoglycemia.And the total cholesterol,standard deflation of blood glucose(SDBG),and insulin pump basal rate of the patients with hypoglycemia were significantly higher than those of the patients witllout hypoglycemia(all P<0.05).Multiple regression indicated that MBG was negatively correlated with hypoglycemia but SDBG and basal rate wore positively correlated with hypoglycemia.Conclusion①Hypoglycemia detected by CGMS occurs in about 1/3 of the type 2 diabetes patients at the early stage of CSⅡ therapy.②In addition of MBG and insulin pump basal rate,glycemic excursion is related closely to hypoglycemia.