老年人群的动态血糖谱特点及正常参考值范围的初步探讨

A preliminary investigation on the characteristics of continuous glucose profiles and the ranges of normal reference values in elderly people

目的探讨70岁以上正常糖耐量者的动态血糖谱特点及正常参考值范围。方法对102例70岁以上正常糖耐量者进行动态血糖监测,分析动态血糖谱特点,探讨正常参考值范围,对比日内存在血糖≥7.8mmol/L者与全天血糖<7.8 mmol/L者的临床特征及血糖波动特点。结果血糖最高峰值集中在午餐后,最低谷值集中在夜间2:00~5:00。不同性别之间、70~84岁组与≥85岁组之间动态血糖参数的差异均无统计学意义(P>0.05)。动态血糖参数的正常参考值上限为:24 h平均血糖值<7.65 mmol/L,血糖水平的标准差<1.61 mmol/L,最大血糖波动幅度<6.78 mmol/L,平均血糖波动幅度<4.27 mmol/L,日间血糖平均绝对差<1.62 mmol/L,血糖≤3.9 mmol/L及≥7.8 mmol/L的时间百分比分别为<22%和<21%。与全天血糖<7.8 mmol/L者比较,日内存在血糖≥7.8 mmol/L者的血糖水平的标准差、最大血糖波动幅度、平均血糖波动幅度、日间血糖平均绝对差均显著升高(P<0.05)。结论 70岁以上正常糖耐量老年人群的整体血糖波动较大,血糖较高者的血糖波动比血糖正常者更大;该人群有独特的动态血糖参数的正常参考值范围。

Objective To investigate the characteristics of continuous glucose profiles and the normal reference values ranges in elderly people with normal glucose tolerance. Methods Continuous glucose monitoring system （CGMS） was used to monitor the blood glucose of 102 subjects with normal glucose tolerance over 70 years old. The characteristics of continuous glucose profiles were analyzed. The normal reference values range of glycemic parameters were investigated. The differences of characteristics of blood glucose fluctuations between the subjects with daily glucose 〉 = 7.8 mmol/L partly and those 〈 7.8 mmol/L all day were analyzed. Results The glucose peak mostly occurred after lunch, while the nadir at 2：00 to 5：00 before dawn. Differences of CGM parameters between different genders were not statistically signifi- cant, nor between 70 - 84 year group and 〉 = 85 year group. The upper limits of normal reference values for continuous glucose monitoring were as follow ： 24 h mean blood glucose （ 24 h MBG） 〈 7. 65 mmoL/L, standard deviation of mean blood glucose （SDBG） 〈 1.61 retool/L, largest amplitude of blood glucose excursions （LAGE） 〈6. 78 mmol/L, mean amplitude of blood glucose excursions （MAGE） 〈 4. 27 mmol/L, and absolute means of daily differences （MODD） 〈 1.62 mmol/L. The percentages of time spent on blood glucose 〈 =3.9 mmol/L and 〉 =7.8 mmol/L were 〈22% and 〈21%, respectively. Compared to the subjects with daily glucose 〈 7.8 mmol/L all day, SDBG, LAGE, MAGE and MODD were significantly higher in the subjects with daily glucose 〉 = 7.8 mmol/L partly. Conclusion The elderly population over 70 years old with normal glucose tolerance have large fluctuation of holistic blood glucose. The subjects with higher blood glucose have larger fluctuation of blood glucose than those with normal blood glucose. The population have unique normal reference values ranges for continuous glucose monitoring.