动态血糖监测新发2型糖尿病患者糖耐量试验时的血糖变化

Blood glucose excursions during oral glucose tolerance test in newly diagnosed type 2 diabetes mellitus patients

目的探讨2型糖尿病患者口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)时的血糖变化特点。方法采用动态血糖监测系统(continuous glucose monitoring system,CGMS)对35例新诊断的2型糖尿病患者和24例糖代谢正常者进行动态血糖监测,同时进行75g葡萄糖的OGTT,比较两组在不同糖代谢状态下糖负荷后3小时内平均血糖值(MBG)、血糖峰值(PPG)、血糖达峰时间(△t)、血糖波动幅度(PGE)和血糖的曲线下面积增值(IAUC)变化。结果 2型糖尿病组OGTT 3小时的MBG、PPG、△t、PGE和IAUC显著高于对照组,分别为(11.6±13.16)mmol/L vs(7.66±0.80)mmol/L、(14.21±3.79)mmol/L vs(9.09±1.09)mmol/L、(117.09±36.84)min vs(84.04±34.17)min、(6.30±2.87)mmol/L vs(2.96±0.87)mmol/L、(3.22±1.97)mmol·L-1·d vs(1.69±0.71)mmol·L-1·d(均P<0.01)。2型糖尿病患者OGTT 2小时血糖达到诊断标准的占68.6%(24/35),与未达该标准的31.4%(11/35)相比,MBG、PPG、PGE和IAUC均明显增高(均P<0.01),分别为(12.99±2.70)mmol/L vs(8.46±0.82)mmol/L、(15.97±3.24)mmol/L vs(10.41±1.15)mmol/L、(7.49±2.44)mmol/L vs(3.70±1.89)mmol/L、(4.02±1.73)mmol·L-1·d vs(1.47±1.21)mmol·L-1·d;△t的差异无统计学意义(P>0.05)。2型糖尿病组在不同糖化血红蛋白水平时,OGTT时除MBG有显著差异外(P<0.05),PPG、PGE和IAUC的差异均无统计学意义(均P>0.05);而在不同空腹血糖状态时,OGTT的血糖波动指标差异均无统计学意义(P>0.05)。结论新发2型糖尿病患者在糖负荷状态下血糖波动加剧,达峰时间延迟;筛查2型糖尿病时,对OGTT 2小时血糖接近标准值上限或糖耐量异常者应复查OGTT以减少漏诊。

Objective To assess the characteristics of dynamic blood glucose during oral glucose tolerance test（OGTT） in type 2 diabetic（T2DM） patients.Methods 24 normal glucose tolerance individuals and 35 newly diagnosed T2DM patients who received OGTT when measured by continuous glucose monitoring system（CGMS）.The mean blood glucose（MBG）,peak post-load glucose（PPG）,time to PPG（△t）,post-load glucose excursion（PGE） and incremental area under the curve of post-load glucose（IAUC） were calculated in each individual within OGTT 3 hours.Results The levels of MBG,PPG,△t,PGE and IAUC in T2DM group were significantly higher than those of the NGT group,（11.6±13.16） mmol/L vs （7.66±0.80） mmol/L,（14.21±3.79） mmol/L vs （9.09±1.09） mmol/L,（117.09±36.84） min vs （84.04±34.17） min,（6.30±2.87） mmol/L vs （2.96±0.87） mmol/L,（3.22±1.97） had glucose concentration more than 11.1 mmol/L at 2 hPG during OGTT,and the levels of MBG,PPG,PGE and IAUC in these patients were all significantly higher than other 31.4%（11/35） of T2DM patients,（12.99±2.70） mmol/L vs （8.46±0.82） mmol/L,（15.97±3.24） mmol/L vs （10.41±1.15） mmol/L,（7.49±2.44） mmol/L vs P〈0.01）,except △t （112.50±30.44） min vs （125.64±40.74） min（all P〉0.05）.There were no significant disparity in post-load glucose excursion between different degrees of HbA1c,except the level of MBG. There were no significant differences in post-load glucose excursion when in different status of fasting plasma glucose （P〉0.05）.Conclusion The features of post-load glucose state in T2DM are representative in the delay of PPG and excessive glucose excursion.In order to prevent missing the diagnosis of T2DM,OGTT should be repeated when the 2 hour plasma glucose of OGTT is near the upper criteria or when the impaired glucose tolerance appears.