初诊2型糖尿病平均血糖波动幅度影响因素分析

Identification of Factors Influencing Mean Amplitude of Glycemic Excuisions in Newly Diagnosed Type 2 Diabetic Patients

探讨初诊2型糖尿病患者平均血糖波动幅度(mean amplitude of glycemic excuisions,MAGE)影响因素。方法:横断面研究100例未经治疗的初诊2型糖尿病患者临床资料。行连续72h 动态血糖监测(continuous glucose monitoring system,CGMS),计算MAGE;收集患者一般资料,外周血检测血脂、糖化血红蛋白(hemoglobin A1c,HbA1c)、空腹血糖(fasting blood glucose,FBG);行馒头餐糖耐量试验(OGTT)加胰岛素释放试验,采用稳态模式评估法的胰岛素抵抗指数(homeostasis model assessment,HOMA-IR)、胰岛β细胞功能指数(homeostasis model assessment,HOMA-β)及糖负荷后120min净增胰岛素/120min净增葡萄糖(△I 120 /△G 120 )评价胰岛功能。多元线性逐步回归分析MAGE影响因素。结果:HOMA-β、△I 120 /△G 120 与MAGE呈负相关( P <0.01)。HbA1c 、FBG是MAGE独立影响因素( P <0.01),其中FBG与MAGE相关系数最大;FBG<8.0mmol/L组,腰围与MAGE负相关( P <0.01),体重指数(body mass index,BMI)、HbA1c与MAGE呈正相关( P <0.01),其中HbA1c与MAGE相关系数最大;8.0mmol/L≤FBG≤11.0mmol/L组,总甘油三酯(total triglyceride,TG)与MAGE呈负相关( P <0.01),年龄与MAGE呈正相关( P <0.01),其中TG与MAGE相关系数最大;FBG>11.0mmol/L组,FBG、低密度脂蛋白-胆固醇(low density lipoprotein cholesterol,LDL-C)与MAGE呈正相关( P <0.01),其中FBG与MAGE相关系数最大。(3)TG、HbA1c与FBG呈正相关( P < 0.01),其中TG与FBG相关系数最大;LDL-C、FBG与HbA1c呈正相关( P <0.01),其中FBG与HbA1c相关系数最大。结论:MAGE 随HOMA-β、△I 120 /△G 120 下降而增大;HbA1c 、FBG是MAGE独立影响因素,其中FBG对MAGE影响最大,并且仅在FBG<8.0mmol/L时,MAGE随HbA1c增高而增大。

To identify the factors influencing mean amplitude of glycemic excuisions in patients newly diagnosed with type 2 diabetic patients. Methods We analyzed the clinical data of 100 patients with type 2 diabetes without treatment by cross-sectional study. The MAGE was calculated using 72h continuous glucose monitoring system (CGMS). Baseline data of patients were collected,and blood lipid profiles,serum hemoglobin A1c (HbA1c),fasting blood glucose (FBG). Everybody made a steamed bread glucose tolerance test (OGTT) plus an insulin release test, Homeostasis model assessment insulin resistance (HOMA-IR) and Homeostasis model assessment βcell secretion index (HOMA-β)were adopted, islets insulin secretion index was assessed by adopting the ratio of the increase in insulin to the increase in glucose 120 min after oral glucose loading (△I 120 /△G 120 ). Multiple linear stepwise regression analysis was used to analyze the influence factors of MAGE. Results HOMA-β、△I 120 /△G 120 were negatively correlated with MAGE ( P <0.01). HbA1c and FBG were the independent factors of MAGE ( P <0.01), while the correlation coefficient of FBG and MAGE was the largest. In patients with FBG<8.0mmol/L group, the waist circumference was negatively correlated with MAGE ( P <0.01), BMI and HbA1c were positively correlated with MAGE ( P <0.01), while the correlation coefficient of HbA1c and MAGE was the largest. In patients with 8.0mmol/L≤FBG≤11.0mmol/L group, TG was negatively correlated with MAGE ( P <0.01), the age was positively correlated with MAGE ( P <0.01), while the correlation coefficient of TG and MAGE was the largest. In patients with FBG>11.0mmol/L group, FBG, LDL-C were positively correlated with MAGE ( P <0.01), and the correlation coefficient of FBG and MAGE was the largest.(3) TG and HbA1c were positively correlated with FBG ( P <0.01), while the correlation coefficient of TG and FBG was the largest;LDL-C, FBG and HbA1c were positively correlated ( P <0.01), and the correlation coefficient of FBG and HbA1c was the largest. Conclusion MAGE increases with the decrease of HOMA-β,△I 120 /△G 120 in patients newly diagnosed with type 2 diabetes. HbA1c and FBG are independent factors of MAGE, while FBG has the greatest influence on MAGE. And MAGE increases with the increase of HbA1c only in patients with FBG<8.0mmol/L.