动态监测糖耐量正常者血糖水平的漂移变化

The glycemic excursions in normal glucose tolerance individuals revealed by continuous glucose monitoring system

目的 探查糖耐量正常 (NGT)者日内血糖水平漂移变化的细节。方法 采用动态血糖监测系统 (CGMS)对 4 3例NGT进行连续 (72± 7)h血糖监测。结果 本组受试者的血糖水平呈波动性变化 ,夜间及 3餐前是血糖较低的时间段 ,日内血糖高峰多于餐后 1～ 2h显现 ,尤以晚餐后为甚。本组NGT的平均血糖值 (5 3± 0 5 )mmol/L。日内血糖的峰、谷值分别为 (7 8± 1 4 )mmol/L、(3 9± 0 7)mmol/L ;日内血糖漂移最大幅度 (3 9± 1 6 )mmol/L。 4 3例受试者中血糖漂移 >7 8mmol/L者占 6 3% (2 7例 ) ;血糖漂移 <2 8mmol/L者占 2 1% (9例 )。血糖漂移于 3 3～ 7 0mmol/L所占的日内时间百分比为 95 (74～ 10 0 ) % ;血糖漂移于 2 8～ 7 8mmol/L的百分比达 99(87～10 0 ) %。结论 本研究结果有助于较为详细地认识正常人的血糖漂移变化 ,并对探讨糖尿病诊断的血糖分割点及血糖控制目标具有重要意义。

Objective To probe more details about the daily glycemic excursions in normal glucose tolerance (NGT) individuals Methods The fluctuations of glucose levels in 43 NGT individuals were measured by continuous glucose monitoring system (CGMS) for (72 ±7) hours Results The number of glucose values detected by CGMS amounted to 858±77 with a mean absolute difference (MAD) of 8 9 %± 3 0% The CGMS values in this study were significantly correlated with the plasma glucose and capillary glucose measurements ( n =204, r =0 93; n =804, r = 0 95; both P <0 001) The glycemic excursions revealed that the daily glycemic levels were lower at night and before meals, the climax of daily glycemic level tended to appear 1～2 hours after meals, particularly after dinner The average glycemic value was 5 3 mmol/L The daily glycemic peak and nadir levels were (7 8 ± 1 4) mmol/L and (3 9 ± 0 7) mmol/L respectively; the difference between maximal and minimal glucose levels was (3 9 ± 1 6) mmol/L Twenty seven of the 43 individuals (63%) showed glycemic excursion above 7 8 mmol/L, and 9 individuals (21%) showed brief glycemic excursion below 2 8 mmol/L During 95% (74% ～ 100%) of the daytime the glycemic level drifted to and fro between 3 3 mmol/L and 7 0 mmol/L; and during 99% (87% ～ 100%) of the daytime the glycemic level drifted to and fro between 2 8 mmol/L and 7 8 mmol/L Conclusion The profile of glycemic excursion in NGT individuals may have an important significance in defining the diagnostic cut points and targets for glycemic control on diabetes mellitus