2型糖尿病患者血糖波动水平及影响因素分析

Analysis of blood glucose fluctuation and its influencing factors in patients with type 2 diabetes

目的了解2型糖尿病患者血糖波动的现状并探讨其影响因素。 方法采用一般资料调查表、糖尿病自我管理活动问卷、匹兹堡睡眠质量指数量表、正性负性情绪量表、医学应对问卷、社会支持问卷和美敦力动态血糖监测仪对105例2型糖尿病患者进行问卷调查和动态血糖监测。 结果2型糖尿病患者经动态血糖监测得出的血糖波动各参数结果中，105例2型糖尿病患者血糖标准差（SDBG）为（2.41 ± 0.91）mmol/L，日内平均血糖波动幅度（MAGE）为（4.01 ± 1.86）mmol/L，最大血糖波动幅度（LAGE）中位数为5.3 mmol/L，M-值中位数为5.13 mmol/L，日间血糖平均绝对差（MODD）中位数为1.84 mmol/L，低血糖指数（LBMI）中位数为1.08 mmol/L。以血糖波动各参数为因变量的多元逐步回归分析显示，家庭人均年收入、糖化血红蛋白（HbA1c）、自我管理行为可以解释SDBG总变异的51.5%；HbA1c、自我管理行为、家庭人均年收入、社会支持总分、屈服可以解释MAGE总变异的76.3%；HbA1c、负性情绪、家庭人均年收入可以解释LAGE总变异的63.8%；HbA1c、家庭人均年收入、自我管理行为、文化程度可以解释M-值总变异的52.3%；HbA1c、负性情绪、自我管理行为、家庭人均年收入、有无睡眠障碍可以解释MODD总变异的48.0%；HbA1c、家庭人均年收入、性别可以解释LBMI总变异的20.4%。 结论2型糖尿病患者血糖波动较大，其中HbA1c、家庭人均年收入、糖尿病自我管理行为、睡眠质量、负性情绪、屈服是主要影响因素。

To figure out the status of blood glucose fluctuations in patients with type 2 diabetes mellitus （T2DM） and explore its influencing factors. MethodsA total of 105 T2DM cases were subjected to multiple surveys with questionnaires pertaining to general patient information, diabetes self-management, medical responses and social support as well as rating scales for the Pittsburg Sleep Quality Index and positive and negative emotions. Furthermore, the continuous glucose monitoring system （CGMS, Medtronic） was used to examine their blood sugar dynamics. ResultsThe outcome of dynamic blood sugar monitoring showed, the standard deviation of blood glucose （SDBG） concentration was （2.41±0.91） mmol/L, the mean amplitude of glycemic excursion （MAGE） per day was （4.01±1.86） mmol/L, the median of glycemic excursion （LAGE） was 5.3 mmol/L, the median of the M-value was 5.13 mmol/L, the median for the means of daily difference （MODD） was 1.84 mmol/L and the median for low blood glucose indexes（LBMI） was 1.08 mmol/L. According to the results derived from multiple stepwise regression analyses, which used blood sugar fluctuation parameters as the variances. The results showed that： annual family income, glycosylated hemoglobin A1c （HbA1c）, and diabetes self-management were shown to account for 51.5% of total SDBG variations; HbA1c, diabetes self-management, annual family income, social support and obedience could account for 76.3% of total MAGE variations; HbA1c, negative emotions and annual family income could account for 63.8% of total LAGE variations; HbA1c, annual family income, diabetes self-management and educational status could account for 52.3% of total M-value variations; HbA1c, negative emotions, diabetes self-management, annual family income and sleep quality could account for 48.0% of total MODD variations; HbA1c, annual family income and gender could account for 20.4% of total LBMI variation. ConclusionsThe T2DM patients, by contrast, demonstrated greater blood sugar fluctuations. HbA1c, annual family income, diabetes self-management, sleep quality, negative emotions and obedience were the main determinants that affect such fluctuations.