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背景:动态血糖监测以每5min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>7.8mmol/L及>11.1mmol/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。
Background: Dynamic blood glucose monitoring continuously monitors changes in subjects ’blood glucose levels every 5 minutes, helping to assess subjects’ glucose metabolism in a comprehensive and objective manner. Objective: To investigate the differences of blood glucose level drifts between normal subjects and newly diagnosed type 2 diabetic patients. Design: Patients and normal subjects, case-control confirmatory experiments. Unit: Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University Hospital. PARTICIPANTS: Forty-seven patients with newly diagnosed type 2 diabetes mellitus admitted to the Department of Endocrinology and Metabolism of the Sixth People’s Hospital affiliated to Shanghai Jiaotong University from December 2002 to July 2004 were selected. No interventions (diet, exercise and drugs) were taken. Exclude acute complications of diabetes such as ketoacidosis, hyperosmolar coma. In the normal group, there were 43 healthy voluntary volunteers in our hospital in the same period. The members of this group had no family history of diabetes except impaired fasting glucose and impaired glucose tolerance. No abnormalities in blood lipids, liver and renal function tests were found. Blood pressure was in the normal range. Two groups of participants were informed consent. Methods: A total of 43 normal subjects and 47 type 2 diabetic patients underwent continuous glucose monitoring (71 ± 10) h with a dynamic glucose monitoring system (846 ± 122). MAIN OUTCOME MEASURES: The average blood glucose level, the highest and lowest intra-day blood glucose levels, the blood glucose level, the mean pre-meal and post-prandial blood glucose levels and the percentage of intra-day blood glucose excursions were dynamically monitored. Results: According to the intention treatment, two groups of subjects completed the test, all included in the analysis of the results. (1) The average blood glucose level in type 2 diabetic patients [(12.2 ± 2.6) mmol / L], the highest intra-day blood glucose [(18.5 ± 2.7) mmol / L] The maximal amplitude was (11.2 ± 2.8) mmol / L], which were significantly higher than those in normal controls [(5.3 ± 0.5), (7.8 ± 1.4) and (7.8 ± 1.4) mmol / L, respectively (t = 16.68,23.04,15.14; P <0.001). (2) The percentage of intraday time covered by blood glucose drifts: the percentage of intraday blood glucose excursion at 2.8 ~ 7.8mmol / L was 99% (87% -100%) in normal subjects; the blood glucose was> 7.8mmol / L in patients with type 2 diabetes mellitus > 11.1 mmol / L were 95% (28% -100%) and 62% (6% -100%), respectively. Conclusion: The blood glucose level of type 2 diabetic patients drifts to a higher level and the drift amplitude increases than that of normal people. The dynamic blood glucose monitoring may help to evaluate the trend and characteristics of blood glucose drift in normal people and diabetic patients in more detail.