动态评估2型糖尿病患者与正常人血糖水平漂移变化的差异

背景动态血糖监测以每5 min的间隔连续检测受试者血糖水平的漂移变化,有助于全面、客观地评估受试者的糖代谢状况.目的探讨正常人及新诊断2型糖尿病患者血糖水平漂移变化的差异.设计以患者和正常人为观察对象,病例-对照的验证性实验.单位上海交通大学医院附属第六人民医院内分泌代谢科病房及门诊.对象选择2002-12/2004-07上海交通大学附属第六人民医院内分泌代谢科住院及门诊新诊断的2型糖尿病患者47例,均未接受干预(饮食、运动及药物等)治疗.排除糖尿病急性并发症如酮症酸中毒、高渗性昏迷.正常人组为同期本院健康志愿体检者43例,本组成员无糖尿病家族史,除外空腹血糖受损及糖耐量受损;血脂及肝、肾功能检测无异常;血压均在正常范围内.两组参与者均知情同意.方法采用动态血糖监测系统对43例正常人及47例2型糖尿病患者进行连续(71±10)h的血糖监测,动态血糖监测数值(846±122)个.主要观察指标动态监测两组受试者的平均血糖水平、日内血糖最高值及最低值、血糖漂移幅度、餐前及餐后的平均血糖值,血糖漂移所占的日内时间百分比.结果按意向处理,两组受试对象均完成测试,全部纳入结果分析.①正常人及2型糖尿病患者血糖水平的漂移趋势2型糖尿病组平均血糖水平[(12.2±2.6)mmol/L]、日内血糖最高值[(18.5±2.7)mmol/L]、日内血糖漂移最大幅度[(11.2±2.8)mmol/L]均高于正常人组[上述指标分别为(5.3±0.5),(7.8±1.4),(7.8±1.4)mmol/L],差异均有显著性(t=16.68,23.04,15.14;P均＜0.001).②血糖漂移所占的日内时间百分比正常人组血糖漂移于2.8～7.8mmol/L所占的日内时间百分比为99%(87%～100%);2型糖尿病组血糖＞7.8 mmol/L及＞11.1 mmol/L的时间百分比分别为95%(28%～100%)和62%(6%～100%).结论2型糖尿病患者血糖较正常人漂移于较高水平,漂移幅度增大,动态血糖监测有助于更为详细地评估正常人及糖尿病患者血糖漂移变化的趋势及特征.

Dynamic evaluation of blood glucose fluctuations in type 2 diabetic and normal subjects

BACKGROUND: Dynamic glucose monitoring can reflect the fluctuation of blood glucose by successive examination at the interval of 5 minutes,which contributes to the overall and objective evaluation of glucose metabolism.OBJECTIVE: To investigate the tendency and characteritics of blood glucose fluctuation in type 2 diabetic and normal subjects.DESIGN: A case-controlled retrospective experiment based on patients and healthy controls.SETTING: Endocrine Metabolism Ward and Clinic of Sixth People's Hospital Affiliated to Shanghai Jiaotong University.PARTICIPANTS: Totally 47 patients were newly diagnosed as having type 2 diabetes mellitus at Endocrine Metabolism Ward and Clinic, Sixth People's Hospital Affiliated to Shanghai Jiaotong University, between December 2002 and July 2004. They had not received intervention (diet, exercise or medicine) before. Those with acute complications such as ketoacidosis and hyperosmolar coma were excluded. Meanwhile, 43 healthy controls were selected from those coming for routine health examinations, and they had no family history of diabetes, and impaired fasting glucose and impaired glucose tolerance were excluded. Their lipid and liver and kidney indexes as well as blood pressure were within normal range. They all signed informed consent.METHODS: Totally 43 normals and 47 patients with type 2 diabetes mellitus were subjected to dynamic glucose monitoring for consecutive (71±10) hours, and (846±122) results of glucose level were obtained.MAIN OUTCOME MEASURES: The average glucose level, diurnal maximum and minimum, fluctuation amplitude, the average preprandial and postprandial glucose values and the time percentage of diurnal glycemic fluctuations.RESULTS: According to the objective of this study, all subjects went through the experiment without loss. ① The fluctuation tendency of blood glucose in two groups: The average glucose, diurnal maximum and maximum fluctuation amplitude in type 2 diabetes mellitus group were [(12.2±2.6) mmol/L], [(18.5±2.7) mmol/L] and [(11.2±2.8) mmol/L,respectively], which were significantly higher than those in control group [(5.3±0.5), (7.8±1.4) and (3.9±1.6) mmol/L](t=16.68, 23.04, 15.14;P ＜ 0.001). ② The percentage of diurnal glycemic fluctuations time: The time percentage of glycemic fluctuations within 2.8-7.8 mmol/L was 99％ (87％-100％) in control group, 95％ (28％-100％) and 62％ (6％-100％) when blood glucose.was increased to ＞ 7.8 mmol/L or ＞ 11.1 mmol/L in type 2 diabetes mellitus group.CONCLUSION: Blood glucose in type 2 diabetes mellitus has been proved to fluctuate at a relatively higher level than that of normals, with greater fluctuation amplitude.Dynamic glucose monitoring is benefical to evaluating the tendency and characteritics of blood glucose fluctuations in type 2 diabetic and normal subjects.