黎明现象对2型糖尿病患者血糖水平及血糖波动的影响

Infuence of dawn phenomenon on overall glucose level and glucose variability in patients with type 2 diabetes

目的研究黎明现象(DP)对T2DM患者血糖水平及血糖波动的影响,提高临床对DP的认知。方法回顾性分析具有完整CGMS数据的T2DM患者114例。早餐前最高血糖值-夜间最低血糖值(ΔGlu)≥1.11mmol/L诊断为DP。将患者分为DP组(n=59)和NDP组(n=55)。t检验、非参数检验比较血糖水平和血糖波动的差异;Spearman法和偏相关法分析DP与血糖波动指标相关性。结果T2DM患者DP发生率51.75%(59/114);两组全天平均血糖(MBG)和HbA1c比较,差异无统计学意义(P>0.05);DP组平均血糖波动幅度(MAGE)[5.03(3.69,6.36)vs 4.30(2.99,5.93)mmol/L,Z=2.200,P=0.028]、血糖标准差(SD)[1.99(1.51,2.48)vs 1.61(1.21,1.99)mmol/L,Z=2.399,P=0.016]高于NDP组。结论 DP使T2DM患者血糖水平增高,血糖波动程度加重,应加强对DP的干预。

Objective To investigate the effect of the Dawn Phenomenon（DP）on the overall glucose exposure and glucose variability in subjects with type 2 diabete mellitus（T2DM）,and to improve the clinical awareness of it. Methods A total of 114 patients with T2DM and complete data of continuous glucose monitoring system（CGMS）were retrospectively analyzed.TheΔGlu was quantified by absolute increment from nocturnal nadir to prebreakfast value.And ΔGlu≥1.11 mmol/L was used as the diagnostic threshold of DP.All the patients were divided into two groups：DP group（n=59）and NDP group（n=55）.The overall glucose level and glucose variability were compared by t test and nonparametric test.The correlations between DP and parameters of glucose variability were analyzed by spearman and partial correlation method. Results The overall incidence of DP was 51.75%（59/114）in all the patients with T2DM.The 24 h MBG and HbA1c were not significantly different in DP and NDP group（P〉0.05）.MAGE [5.03（3.69,6.36）vs 4.30（2.99,5.93）mmol/L,Z=2.200,P=0.028]and SD [1.99（1.51,2.48）vs 1.61（1.21,1.99）mmol/L,Z=2.399,P=0.016]were higher in DP group than in NDP group. Conclusion DP elevated blood glucose levels,and signifcantly increased the degree of glucose variability in patients with T2DM.The intervention with DP should be strengthened.