糖耐量正常人群血糖波动初探

The preliminary research on glucose variability with normal glucose regulation

目的探讨糖耐量正常人群的血糖波动特征。方法对受试者进行了75g口服葡萄糖耐量试验(OGTT):36例正常糖耐量人群(NGR),其中20例1h PG<8.6mmol/L,16例1h PG≥8.6mmol/L;20例糖耐量异常患者(IGT);20例新诊断的2型糖尿病患者(T2DM)。胰岛素分泌指数(△I30/△G30),用来评估胰岛β细胞功能。HOMA-IR用来评估胰岛素敏感性。血糖波动的指标包括血糖标准差(SD),平均血糖水平(MBG),平均血糖波动幅度(MAGE)日间血糖平均绝对差(MODD)。结果从NGR(1h PG)<8.6组、NGR(1h PG)≥8.6组、IGT组到T2 DM组,血糖波动指标逐步升高(P<0.05)。NGR(1h PG)≥8.6组明显高于NGR(1h PG)<8.6组(P<0.05)。ΔI30/ΔG30从NGR(1h PG)<8.6组、NGR(1h PG)≥8.6组、IGT组到T2DM组是逐渐下降的(P<0.05),且NGR(1h PG)≥8.6组较NGR(1h PG)<8.6组下降。结论糖耐量正常人群中,尤其是1h PG升高的人群,存在血糖波动,并存在早期相胰岛素分泌的下降。

Objective To observe glucose variability in population with normal glucose regulation. Methods 75 g oral glucose tolerance test（OGTT） was performed in cnsubjects：36 with normal glucose regulation,and 20 with 1 h PG8.6 mmol/L（NGR8.6）,16 with 1 h PG≥8.6 mmol/L（NGR≥8.6）,20 with isolated impaired glucose tolerance（IGT）,20 newly diagnosed type 2 diabetes（T2 DM）.Insulin secretion index（ΔI30/ΔG30）,and β cell function measured by the insulin secretion index. Insulin resistance was estimated using the homeostasis assessment of IR（HOMA-IR）. The multiple parameters of glycemic variability included the standard deviation of blood glucose（SD）,mean of continuous 24 hours blood glucose（MBG）,mean of daily differences（MODD） and mean amplitude of glycemic excursions（MAGE）. Results From the NGR（1 h PG）8.6 to NGR（1 h PG）≥8.6 to IGT to T2 DM group,the respective values of SD,MBG,MODD and MAGE from CGMS were all increased progressively（P0.05）. SD,MBG,MODD and MAGE value of NGR 8.6 group were all higher than those of NGR 8.6 group（P 0.05）. After comparison of β cell function,ΔI30/ΔG30 decreased progressively from NGR（1 h PG）8.6 to NGR（1 h PG）≥8.6 to IGT to T2 DM group（P0.05）. ΔI30/ΔG30 value of NGR（1 h PG）≥8.6 group was lower than NGR8.6 group. Conclusion Normal glucose regulation subjects have glucose variability. The glucose variability in 1 h PG≥8.6 mmol/L group higher than 1 h PG8.6 mmol/L group,and the NGR≥8.6 mmol/L group has decreased earlyphase insulin secretion.