预混人胰岛素治疗的老年2型糖尿病患者动态血糖分析

Analysis on the Dynamics of Glucose in Elderly Type 2 Diabetic Patients Treated by Premixed Human Insulin Therapy

目的分析并比较以预混人胰岛素治疗血糖控制良好的高龄糖尿病患者与高龄正常糖调节（NGR）个体的动态血糖图谱特点。方法选取26例高龄（60~80岁）2型糖尿病（T2DM）患者,糖化血红蛋白（HbA1 c）〈7%,均以预混胰岛素治疗;同时入选24例年龄、性别、体质指数与T2DM组相匹配的NGR者。采用动态血糖仪行72h动态血糖监测。比较两组的高血糖（≥10 mmol/L）、低血糖（≤3.9 mmol/L）的时间百分比、24 h平均血糖（MBG）,三餐前1 h和三餐后3 h的血糖,日内平均血糖波动幅度（MAGE）及日间平均血糖波动幅度（MODD）。结果 T2DM组患者除0：00-3：00时段外,其余各时段血糖均显著高于NGR组,并以早餐后血糖升高最显著,其MAGE、MODD亦显著高于NGR组,差异有统计学意义（P〈0.05）。14例（53.8%）T2DM患者发生30次低血糖,且66.7%（20/30）发生于夜间,尤以0：00-3：00多见（60.0%）;NGR组未发生低血糖。HbA1 c与MBG、24 h内血糖≥5.6 mmol/L的曲线下面积（AUCPG≥5.6 mmol/L）成正相关〔r值分别为0.58（P=0.03）和0.60（P=0.02）〕,而与MAGE、MODD无相关性。结论 HbA1 c控制良好的老年T2DM患者仍有较高的餐后血糖,餐后的急性血糖升高主要发生在早餐后;HbA1 c虽能反映平均血糖水平,但并不能反映具体的血糖波动;即使在HbA1 c控制良好的情况下,仍可能有较大幅度的血糖波动,且常发生夜间无症状低血糖,故应通过调整生活方式及胰岛素剂量等方法更好地实现血糖的平稳控制。

Objective To Analyze and compare the characteristics of CGMS patterns of patients with well controlled plasma glucose that treated with premixed human insulin and elderly individuals with normal glucose regulation.Methods 26 elderly T2DM patients（aged 60~80 years） with HbA1c less than 7% were treated with premixed human insulin.Meanwhile 24 normal glucose regulation patients with matched age,sex and BMI were selected.Continuous glucose was monitored for 72 hours by CGMS.Duration of hyperglycemia（≥10 mol/L） and hypoglycemia（≤3.9 mol/L）,24-hour mean blood glucose level,blood glucose level 1-hour before and 3-hour after meal,MAGE and MODD were evaluated in the two group.Results Plasma glucose levels of T2DM patients were significantly higher than those of NGR except for 0：00-3：00 AM,and the plasma glucose level of T2DM patients was the highest after breakfast.MAGE and MODD of T2DM patients were also significantly higher than NRG（P〈0.05）.Hypoglycemia was found 30 times in 14 T2DM patients,66.7% of them happened at night,60.0% was during 0：00-3：00AM.While no hypoglycemia was found in NRG.HbA1c had a positive correlation with 24-hour MBG and AUCPG≥5.6 mmol/L,but disrelated to MAGE and MODD.Conclusion Elder T2DM patients with well controlled HbA1c still had high PBG,especially after breakfast;HbA1c could reflect MBG but not specific amplitude of glycemic excursions.Asymptomatic hypoglycemia during night and large amplitude of glycemic excursions still happened frequently even HbA1c was well controlled.So ways like management of lifestyle,regulation of insulin dose are still required to maintain stable plasma glucose.