住院1型糖尿病糖代谢状况调查及血糖波动研究

Cross-sectional study of current situation of glucose metabolism with in-hospital type l diabetic patients

目的分析住院1型糖尿病（T1DM）患者糖代谢状况及血糖波动特点。方法回顾性分析2012年11月至2016年11月住院的T1DM患者143例（女67例，男76例），其中成年后起病T1DM的比例为76.22%（109/143），成年前起病23.78%（34/143），收集一般资料、测定糖代谢、胰岛功能等指标，对其中40例进行72 h的连续动态血糖监测（CGM）。结果患者年龄（40.29 ± 16.79）岁；发病年龄（33.57 ± 17.18）岁；病程为4.0（1.0，10.0）年；体质量指数（BMI）为（20.68 ± 2.95）kg/m2。空腹血糖（FBG）为（12.02 ± 5.40）mmol/L；糖化血红蛋白（HbA1c）为（9.80 ± 2.65）%，空腹血清C肽为0.08（0.01，0.38）nmol/L，餐后2 h血清C肽为0.12（0.01，0.70）nmol/L；谷氨酸脱羧酶自身抗体12.08（8.16，20.56）μg/L，胰岛素抗体4.85（2.66，12.07）μg/L，多元回归提示HbA1c与病程、BMI呈负相关；CGM结果提示24 h平均血糖为（10.34 ± 2.97）mmol/L，血糖标准差为（2.89 ± 1.07）mmol/L、日内平均血糖漂移幅度为（7.10 ± 3.09）mmol/L，低血糖发生率分别为10.00%（血糖≤ 2.8 mmol/L）和32.50%（血糖≤ 3.9 mmol/L）。结论住院1型糖尿病成年后起病占2/3以上，且血糖控制不佳，血糖波动大，低血糖发生率高。

ObjectiveTo analyze the present situation of glucose metabolism and the characteristics of blood glucose fluctuation in in-hospital type l diabetic patients （T1DM）.MethodsOne hundred and forty-three hospitalized cases of T1DM patients from November 2012 to November 2016 were retrospectively analyzed. The percentage of adult-onset T1DM patients was 76.22% （109/143） and none adult-onset was 23.78%（34/143）. The following data were collected： general information, the indexes of glucose metabolism and islet function. Seventy-two-hour continuous glucose monitoring （CGM） was carried on 40 patients as a subgroup.ResultsThe average age was （40.29 ± 16.79） years. The onset age of diabetes was （33.57 ± 17.18） years. The disease duration was 4.0（1.0, 10.0） years. The body mass index （BMI） was （20.68 ± 2.95） kg/m2. The fasting blood glucose （FBG） was （12.02 ± 5.40） mmol/L. The HbA1c was （9.80 ± 2.65）%. The fasting C-peptide was 0.08（0.01, 0.38） nmol/L. The 2-hour postprandial C-peptide （C-P 2 h） was 0.12（0.01, 0.70） nmol/L. The anti-glutamic acid decarboxylase antibody was 12.08（8.16, 20.56） μg/L. The islet-cell antibody was 4.85（2.66, 12.07） μg/L. By using multivariate linear regression analysis, HbA1c were negatively related to the duration and BMI of T1DM. CGM： the mean blood glucose was （10.34 ± 2.97） mmol/L. The standard deviation of blood glucose was （2.89 ± 1.07） mmol/L. The mean amplitude glycemic excursions was （7.10 ± 3.09） mmol/L. The incidence of hypoglycemia was 10.00% （≤ 2.8 mmol/L） and 32.50% （≤ 3.9 mmol/L）.ConclusionsAdult-onset T1DM patients account for more than two-thirds. In-hospital T1DM patients have poor control of blood glucose, and they show the clinical characteristics of high blood glucose fluctuation and more hypoglycemia.