糖化血红蛋白控制理想的2型糖尿病视网膜病变与血糖波动的关系

Relationship between glycosylated hemoglobin controlling ideal type 2 diabetic retinopathy and blood glucose fluctuation

目的动态血糖监测(CGM)评估血糖波动,探讨糖化血红蛋白(HbA1c)<7. 0%的2型糖尿病患者视网膜病变(DR)与血糖波动的关系。方法选择2014年5月至2018年1月在合肥市第二人民医院内分泌科住院的168例HbA1c <7. 0%的2型糖尿病患者为研究对象,根据DR病变程度,将108例无DR的患者纳为NDR组,60例DR患者纳为DR组。对受试者进行连续72 h的CGM,计算平均血糖(MBG)、血糖水平标准差(SDBG)、有效波动平均幅度(MAGE),同时检测Hb Alc、血压、体质指数,评估HbA1c控制理想的2型糖尿病视网膜病变与血糖波动之间的相关性。结果 DR组患者病程(8. 33±0. 82)年、收缩压(138. 20±11. 84) mm Hg、舒张压(86. 53±8. 57) mm Hg、SDBG(2. 73±0. 54)、MAGE(3. 98±0. 70) mmol/L,均高于NDR组,差异有统计学意义(P <0. 05)。logistic回归分析显示,病程、MAGE是2型糖尿病患者发生DR的危险因素(P <0. 05)。结论 Hb Alc <7. 0%的2型糖尿病患者DR与糖尿病病程、血糖波动及血压有关。

Objective To explore the relationship between retinopathy( DR) and the blood glucose fluctuations in patients with type2 diabetes who had glycosylated hemoglobin( HbA1c) < 7. 0% by using continuous glucose monitoring( CGM). Methods Altogether 168 patients with type 2 diabetes hospitalized in the Department of Endocrinology,the Second People’s Hospital of Hefei from May 2014 to Jan2018 were selected as the study subjects. According to the severity of DR,108 cases were divided into non-diabetic retinopathy group( NDR group) and 60 cases into retinopathy group( DR group). CGM was conducted for a continuous 72 h blood glucose monitoring of the subjects,then the average blood glucose( MBG),blood glucose standard deviation( SDBG),and the effective fluctuation average amplitude( MAGE)were calculated. Hb Alc was also tested and blood pressure and body mass index were measured. The correlation between HbA1 c controlled ideal type 2 diabetic retinopathy and blood glucose fluctuationwas evaluated. Results The duration( 8. 33 ± 0. 82) years,diastolic blood pressure( 86. 53 ± 8. 57) mm Hg,SDBG( 2. 73 ± 0. 54) and MAG( 3. 98 ± 0. 70) mmol/L of group DR were higher than those of group NDR( P < 0. 05). Logistic regression analysis showed that the course of disease,MAGE and type 2 diabetes were positively correlated with DR( P < 0. 05). Conclusion DR is associated with diabetic duration,blood glucose fluctuations and blood pressure in patients with type 2 diabetes who have Hb Alc < 7. 0%.