新诊断2型糖尿病患者治疗前后血糖水平的动态变化

Dynamic changes of glycemic excursions before and after treatment in newly diagnosed patients with type 2 diabetes mellitus

目的探查2型糖尿病(T2DM)患者血糖漂移变化的特征.方法选取2002-11～ 2004-12上海交通大学附属第六人民医院22例新诊断T2DM患者采用动态血糖监测系统(CGMS)对其治疗前后均进行连续3 d的血糖监测,进行自身前后对照分析.结果本组患者经2～3周治疗后,糖代谢紊乱明显缓解.22例患者治疗前后平均血糖值[(12.7±2.4)mmol/L对(7.3±0.9)mmol/L];日内血糖最高值[19.5±2.3)mmol/L对(11.0±1.7)mmol/L];血糖漂移最大幅度[(12.1±3.1)mmol/L对(7.1±2.0)mmol/L].餐前及餐后的平均血糖水平及上述血糖参数之间差异均有显著性意义(P均<0.001).治疗后血糖>7.8 mmol/L及11.1 mmol/L的时间百分比与治疗前比较均显著降低[(29(6～64)% 对99(37～100)%,3(0～28)%对72 (13～100)%,P均<0.001)].结论动态血糖监测能评估T2DM血糖漂移变化的特征,有助于更有效地控制糖代谢紊乱.

Objective To investigate the characteristics of glycemic excursions in more detail in type 2 diabetes mellitus, Methods The glycemic excursions in 22 newly diagnosed type 2 diabetic patients before and after treatment were determined by continuous glucose monitoring system （CGMS） from Nov. 2002 to Dec. 2004. The system took a glucose measurement every 5 minutes for a total of 288 measurements every 24 hours [The number of glucose values detected by the CGMS achieved 1702 ± 196 with a mean absolute difference （MAD） of （ 10.2 ± 4. 5 ） % ]. Results After treatment for 2 ～ 3 weeks, the glycemic excursions and trends of 22 type 2 diabetic patients were markedly lowered. There were significant differences in average glycemic values [（12.7 ±2. 4） mmol/L vs （7.3 ±0. 9） mmol/L] , the daily glycemic peaks [ （ 19.5 ±2.3） mmol/L vs （ 11.0 ± 1.7） mmol/L] , the differences between maximal and minimal glycemic values [ （12. 1 ±3. 1） mmol/L vs （7. 1 ± 2. O） mmol/L] , and the average glycemic levels of pre -meal and lh, 2h and 3h post - meal before and after treatment in 22 diabetic patients （all P 〈 O. 001 ）. The percentage of time spent in hyperglycemia above 7. 8 and 11. 1 mmol/L were significantly decreased after treatment in the patients 129 （6 ～ 64）% vs99 （37～100）%, 3 （0～28）% vs72 （13～100）% respectively, both P〈 0.001]. Conclusion Our study indicates that the glycemic parameters obtained by the CGMS are beneficial to evaluating the characteristics of glycemic excursions and the quality of glycemic control in more detail in type 2 diabetes mellitus.