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目的探讨2型糖尿病(T2DM)患者日内不同时间的血糖水平与糖化血红蛋白(HbA1c)及血糖漂移幅度的关系。方法选取2002年12月至2005年10月上海交通大学附属第六人民医院内分泌代谢科新诊断T2DM患者60例,采用动态血糖监测系统(CGMS)进行持续3d的血糖监测并分析日内不同时点、时段的血糖水平、HbA1c、餐后血糖漂移幅度(PPGE)及平均血糖漂移幅度(MAGE)之间的关系。结果(1)T2DM患者HbA1c与全天8次血糖水平均呈显著正相关(r=0.62~0.70,P均<0.01),与PPGE不相关(P>0.05),逐步回归分析显示空腹及中、晚餐后2h血糖进入最后的方程(校正R2=0.566,P<0.01)。(2)HbA1c与全天不同时段的平均血糖水平均呈显著正相关(r=0.57~0.74,P均<0.01),晚餐前1h、晚餐后2~3h及晨300~600时间段的平均血糖水平是其独立影响因素。(3)CGMS所示的日内平均血糖水平与HbA1c相关性最强(r=0.81,P<0.01)。(4)MAGE与HbA1c不相关(P>0.05),三餐PPGE及晨300的血糖水平为影响MAGE的独立参与因素(校正R2=0.427,P<0.01)。结论T2DM患者HbA1c与全天平均血糖水平的关系最密切,而日内血糖的漂移变化主要归因于餐后及夜间血糖的漂移。因此,T2DM的血糖监测及干预治疗应针对全天血糖谱。
Objective To investigate the relationship between blood glucose and hemoglobin A1c (HbA1c) and glycemic excursion in patients with type 2 diabetes mellitus (T2DM) at different times of the day. Methods Sixty patients with newly diagnosed T2DM were selected from the Department of Endocrinology and Metabolism of the Sixth People’s Hospital, Shanghai Jiao Tong University from December 2002 to October 2005. The blood glucose was monitored by the continuous glucose monitoring system (CGMS) for 3 days and the intragastric time was analyzed. Period of blood glucose, HbA1c, postprandial glycemic excursion (PPGE) and mean glycemic excursion (MAGE). Results (1) There was a significant positive correlation between HbA1c and 8 times of blood glucose level in T2DM patients (r = 0.62-0.70, P <0.01), but no correlation with PPGE (P> 0.05). Stepwise regression analysis showed that fasting and moderate, 2h after dinner blood glucose into the final equation (corrected R2 = 0.566, P <0.01). (2) There was a significant positive correlation between HbA1c and average blood glucose level in different periods of time (r = 0.57-0.74, P <0.01), 1h before dinner, 2 ~ 3h after dinner and 300 ~ 600d during morning Level is its independent influence factor. (3) The intraday average blood glucose level indicated by CGMS was the strongest correlated with HbA1c (r = 0.81, P <0.01). (4) MAGE was not related to HbA1c (P> 0.05). The blood glucose levels of PPGE and morning 300 were the independent factors influencing MAGE (R2 = 0.427, P <0.01). Conclusions HbA1c in T2DM patients is most closely related to the mean daily blood glucose level, while the changes in intraday blood glucose excursions are mainly attributed to postprandial blood glucose excursions. Therefore, T2DM blood glucose monitoring and intervention should be targeted at the whole blood glucose spectrum.