糖尿病Ⅰ型孕妇餐前及餐后血糖监测的临床随机对照研究

Comparison study on preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes

目的比较糖尿病Ⅰ型孕妇餐前及餐后末稍血糖结果。方法 61例糖尿病Ⅰ型孕妇自妊娠16周起监测餐前及餐后血糖及糖化血红蛋白。分娩后测脐血胰岛素、血糖、胰岛素样样生长因子(IGF-1),新生儿生后72小时之内进行人体测量。结果两组孕妇年龄、孕产次、糖尿病发病年龄、流产数、吸烟状态、孕期体重增加数、治疗结果相似,餐后血糖组子痫前期发病率明显减低(3%:21%,P<0.048),血糖控制满意(55%:30%,P<0.001),新生儿三头肌皮肤对折试验(4.5±0.9:5.1±1.3,P=0.05)。结论糖尿病Ⅰ型孕妇餐后末稍血糖测定与餐前血糖测定相比可明显降低子痫前期新生儿三头肌皮褶厚度。

Objective This study was undertaken to compare preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes. Methods Sixty--one women with type 1diabetes were randomly assigned at 16 weekggestation to preprandial or postprandial blood glucose monitoring throughout pregnancy. Serial measurements of hemoglobin Alc. Insulin, glucose, and insulin-like growth factor-1 （IGF-1） were measured in cord blood at delivery. Neonatal anthropometric measures were performed within 72 hours of delivery. Results Maternal age,parity,age of onset of diabetes, number of prior miscarriages, smoking status, social class, weight gain in pregnancy, and compliance with therapy were similar in the two groups. The postprandial monitoring group had a significantly reduced incidence of preeclampsia （3 %vs21%, P 〈 0. 048） , a greater success in achieving glycemic control targets （55 % vs30%, p 〈 0.001） and a smaller neomatal triceps skin fold thickness（4.5±0.9vs 5.1±1. 3, P = 0.05） . Conclusions Postprandial capillary blood glucose monitoring in type 1 diabetic pregnancy may significantly reduce the incidence of preeclampsia and neonatal triceps skin fold thickness compared with preprandial monitoring.