老年2型糖尿病患者血糖波动性别差异的病例对照研究

A case-control study on gender difference of glycemic variability in elderly patients with type 2 diabetes

目的：探讨老年2型糖尿病患者血糖波动的性别差异。方法：采用病例对照研究设计,以行动态血糖监测的老年2型糖尿病住院患者为研究对象,病例组纳入40例女性患者,对照组按照同民族、年龄相差±3岁、糖尿病病程相差±3年做1∶1配比,纳入40例男性患者。应用平均血糖波动幅度（MAGE）和血糖标准差（SDBG）评估血糖波动,以2011年中国血糖监测临床应用指南作为血糖波动正常参考值的判定标准。利用单因素和多因素非条件Logistic回归模型分析老年2型糖尿病患者血糖波动的性别差异。结果：老年女性2型糖尿病患者的MAGE（[4.88±1.90）vs.（3.71±1.72）mmol.L-1,P〈0.01]和SDBG（[1.97±0.68）vs.（1.52±0.73）mmol.L-1,P〈0.01]显著高于男性。单因素非条件Logistic回归分析显示,性别与MAGE、SDBG均显著相关（P〈0.05）。在调整年龄、BMI、糖尿病病程、胰岛素治疗、总胆固醇、HbA1c后,多因素非条件Logistic回归分析显示,性别是老年2型糖尿病血糖波动（MAGE或SDBG）的重要影响因素,其OR值和95%CI为MAGE3.76（1.301~10.868,P=0.014）、SDBG 5.86（1.769~19.415,P=0.004）。结论：老年2型糖尿病患者的血糖波动存在性别差异,女性患者的血糖波动水平高于男性患者。

Objective： To investigate the gender difference of glycemic variability in elderly patients with type 2 diabetes. Methods： A case-control study was conducted among elderly type 2 diabetic inpatients who received continuous glucose monitoring （CGM）. Forty female patients were recruited as case group, and 40 male patients who were matched in 1 ： 1 with similar race, age （± 3 years） and diabetes duration （± 3 years） were recruited as control group. The mean amplitude of glycaemic excursion （MAGE） and standard deviation of blood glucose （SDBG） were adopted to evaluate glycemic variability. The diagnosis criteria of Chinese Diabetes Society Guideline in 2011 was used as normal reference value of glycemic variability. The data were analyzed by univariate and multivariate unconditional Logistic regression models to discriminate the gender difference of glycemic variability in elderly patients with type 2 diabetes. Results： MAGE [（4.88± 1.90 ） vs. （ 3.71 ± 1.72 ） mmol-L1, P 〈 0.01] and SDBG [（1.97 ± 0.68 ） vs. （ 1.52 ±0.73 ） mmol·L-1, P 〈 0.01] were both higher in female patients than in male patients. Univariate unconditional Logistic regression analysis showed that gender was associated with selected variables of glycemic variability including MAGE and SDBG. After adjustment for age, BMI, diabetes duration, insulin therapy, total cholesterol and HbAlc, multivariate unconditional Logistic regression analysis demonstrated that gender was a significant influential factor of glycemic variability, with OR （95%CI） of MAGE 3.76 （1.301 - 10.868, P = 0.014） and SDBG 5.86 （1.769 - 19.415, P = 0.004）. Conclusion： Gender difference was found in glycemic variablity in elderly patients with type 2 diabetes. The level of glycemic variability was higher in female patients than in male patients.