血糖控制不佳的2型糖尿病患者动态血糖波动的观察

摘要

目的 观察血糖控制不佳的T2DM患者全天动态血糖波动特点. 方法 以动态血糖监测系统(CGMS)对28例磺脲类药物继发失效(SFS)患者(观察组)进行72 h血糖监测,以17例伴高血糖的新诊断T2DM患者作为对照组. 结果 两组间BMI差异无统计学意义,病程、年龄、HbA1c、血糖下降百分数(DBG)、胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)差异有统计学意义(P＜0.01).与对照组比较,观察组最高血糖值(Max-BG)、血糖波动系数(SDBG)较大,差异有统计学意义(P＜0.05)；血糖峰值集中出现在午餐后(165±9)min,血糖谷值集中出现在0∶00～5∶00时间段；午、晚餐后血糖峰值延迟,持续时间更长(P＜0.05).对照组日内血糖随进食而规律升高并逐渐下降,不进食不升高；观察组进食后血糖持续升高且不降,不进食也升高. 结论 对照组具有一日三餐血糖变化规律；观察组存在波动性高血糖状态,一日三餐血糖变化规律消失,提示对SFS患者应以控制早餐后血糖及午、晚餐前血糖为主.%Objective To observe the characteristic of dynamic glycemic excursion throughout the day in the T2DM patients suffering from poor glucose control. Methods Twenty-eight patients with secondary failures of sulfonylurea (SFS) were measured by continuous glucose monitoring system (CGMS) for 72 hours, and the result was compared with that of the control group in newly diagnosed T2DM patients with 17 hyperglycemia. Results There was no difference in body mass index between the two groups (P>0.05), while the significantly statistical differences were shown in the age, course of disease, HbAiC, the percentage of blood glucose descend (DBG), HOMA-IR, and HOMA-β between the two groups (P<0. 01). Compared with the control group, the maximum blood glucose (Max-BG) and standard deviation of blood glucose (SDBG) of the observed group were higher. There existed a statistical difference between the two groups (P<0. 05). The peak of blood glucose in the observed group appeared mainly at (165±9)min after lunch, while the glucose nadir of the whole day was in the duration of 0 : 00~5:00. The peaks of postprandial glucose after lunch and dinner were delayed significantly, and lasted longer (P<0. 05). The daily glucose of the newly diagnosed T2DM patients with hyperglycemia increased regularly after meals and then decreased gradually, no increasing if no eating; while the glucose of SFS patients increased continuously without decreasing, even without a meal. Conclusion The regularity of the daily glucose variation after three meals still existed in the newly diagnosed T2DM patients with hyperglycemia, while such a regularity disappeared in the SFS patients in the state of fluctuated hyperglycemia. As a guide of treatment, it could be focused on controlling the postprandial glucose after breakfast and the preprandial glucose before lunch and dinner.