类固醇糖尿病患者动态血糖谱的特点及意义

Characteristics and clinical significance of daily blood glucose profiles of glucocorticoid-related diabetes by continuous glucose monitoring system

目的探讨类固醇糖尿病患者动态血糖谱的特点,为临床治疗提供依据。方法分析3例类固醇糖尿病患者动态血糖监测系统(CGMS)显示的血糖特点,探讨其临床意义。结果1例新诊断未干预治疗及1例预混胰岛素2次皮下注射治疗的类固醇糖尿病患者均以中餐后-睡前血糖升高为主,其日内血糖峰值分别为15.6 mmol/L及15.4 mmol/L,均出现于中餐后。1例3餐前短效胰岛素治疗的类固醇糖尿病患者清晨及上午出现无症状性低血糖(血糖≤3.9 mmol/L),持续115 m in;将强的松改为每日3次口服后低血糖消失,血糖波动改善。结论类固醇糖尿病患者的血糖变化具有自身的特点,其中部分患者表现午后严重高血糖及空腹低血糖的特点值得关注。

Objective To investigate the characteristics of the daily blood glucose profiles of glucocorticoid-related diabetes by continuous glucose monitoring system （ CGMS ） so as to guide the clinical treatment. Methods The characteristics of the daily blood glucose detected by CGMS in three cases of glucocorticoid-related diabetes were reported, and the related clinical significance was explored by literature review. Results It was revealed by CGMS that the climax of glucose level tended to appear during the period from post-lunch to bedtime in one newly-diagnosed patient and one patient treated with premixed insulin, and the peak value （ 15.6 mmol/L and 15.4 mmol/L, respectively） throughout the day occurred at post-lunch. One glucocorticoid-related diabetic patient treated with pre-meal regular insulin experienced fasting asymptomatic hypoglycemia （blood glucose ≤3.9 mmol/L） which lasted 115 min, while the hypoglycemia disappeared and glycemic fluctuations were improved when the prednisolone was adjusted to oral administration three times per day. Conclusion The glycemic excursions in glucocorticoid-related diabetic patients may exhibit distinct characteristics, and the feature of post-lunch hyperglycemia and fasting hypoglycemia in some patients shall be taken into account in the protocol design.