应用瞬感扫描式血糖监测系统分析1型糖尿病患者血糖波动相关因素的研究

Clinical factors associated with glycemic variability analyzed by flash glucose monitoring in type 1 diabetes mellitus

目的采用瞬感扫描式血糖监测系统(FGM)收集T1DM患者血糖数据,计算血糖波动相关指标,确定与血糖波动相关的临床因素。方法连续收集2019年1~10月于北京大学人民医院内分泌科住院的T1DM患者37例,均佩戴FGM进行血糖数据的采集,分析与血糖波动相关的指标。Spearman相关分析临床因素与血糖波动指标之间相关性。根据不同FC-P水平及混合餐耐量试验(MMNT)刺激后2 hC-P水平进行分组,观察两组血糖波动差异。结果本研究共纳入男性患者18例(48.6%),女性患者19例(51.4%),年龄(46.1±19.9)岁,病程(11.8±9.9)年。Spearman相关性分析显示,胰岛素日剂量及单位体重胰岛素日剂量均与平均血糖浓度(MEAN)、血糖标准差(SD)、血糖在正常范围内时间(TIR)及平均血糖波动幅度(MAGE)呈正相关(P<0.01)。FC-P及MMNT后2 hC-P与上述指标呈负相关(P<0.01)。FC-P>0.05 ng/ml组MEAN和SD低于FC-P≤0.05 ng/ml组[8.52(7.13,9.68)vs 9.66(8.84,11.32)mmol/L,3.14(2.86,3.48)vs 3.63(3.19,4.66)mmol/L,P<0.05或P<0.01],TIR高于FC-P≤0.05 ng/ml组(P<0.05)。19例(51.4%)对MMNT刺激有反应且SD低于无反应患者(P<0.05)。结论胰岛素用量较高、C-P水平较低的T1DM患者血糖波动较大,为临床识别并个体化降糖治疗提供依据。

Objective To identify clinical factors related to glucose variability in type 1 diabetes by collecting glucose data and calculating metrics related to glucose variability based on flash glucose monitoring(FGM).ously from the Endocrinology Department of Peking University People’s Hospital from January to October2019.All subjects wore FGM to collect glucose data,and metrics related to glucose variability were calculated.The relationship between clinical factors and the metrics representing glucose variability was identified by Spearman correlation analysis.Meanwhile,differences between groups according to fasting C-peptide levels and C-peptide levels two hours after the stimulation of mixed meal tolerance test(MMNT)were compared.Results A total of 18 male subjects(48.6%)and 19 female subjects(51.4%)were enrolled,with an average age of(46.1±19.9)years and an average diabetic duration of(11.8±9.9)years.Spearman correlation analysis shows both daily insulin dosage and daily insulin dosage per weight had a significant positive linear correlation relationship with mean glucose(MEAN),standard deviation(SD),time in range(TIR)and mean amplitude of glycemic excursions(MAGE)(P<0.01).There were significant negative linear correlation relationships between both fasting and stimulated C-peptide and glycemic variability metrics(P<0.01).Detectable fasting C-peptide was identified in 21 subjects(56.7%).MEAN and SD for individuals with detectable C-peptide were lower[8.52(7.13,9.68)vs 9.66(8.84,11.32)mmol/L,3.14(2.86,3.48)vs 3.63(3.19,4.66)mmol/L,P<0.05 or P<0.01]and TIR was higher(P<0.05).19 subjects(51.4%)responded to MMNT stimulation with double increase in C-peptide,and SD for these responders was significantly lower than non-responders(P<0.05).Conclusion T1DM patients with higher insulin dosage and lower C-peptide level were associated with greater glycemic variability,which reminds us the importance of identifying these individuals and providing personalized treatment.