初诊2型糖尿病患者75g葡萄糖负荷后血糖升高速率的影响因素研究

Influencing Factors of Blood Glucose Elevation Rate after 75 g Glucose Load in Newly Diagnosed Type 2 Diabetic Patients

背景血糖的急剧变化会对机体组织器官造成损伤,但目前国内外学者对血糖变化速率的关注度仍待加强。研究血糖变化速率及其影响因素对糖尿病合并症的防治有重要意义。目的探讨初诊2型糖尿病(T2DM)患者75 g葡萄糖负荷后血糖升高速率的影响因素。方法回顾性分析2016年1月-2019年4月在武汉科技大学附属孝感医院内分泌科住院的337例初诊T2DM患者的临床资料。收集患者的一般信息、血常规、生化检查、糖化血红蛋白(HbA1c)、标准口服葡萄糖耐量试验(OGTT)及胰岛素释放试验(IRT)结果,记录OGTT葡萄糖负荷后血糖峰值(Gmax)、达峰时间(Tmax),计算糖负荷后血糖升高平均速率(Vmean)。记录早相胰岛素分泌指数(△I30/△G30)、胰岛β细胞功能指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR)。根据Vmean三分位数将研究对象分为低Vmean组(n=112)、中Vmean组(n=112)和高Vmean组(n=113),采用有序Logistic回归分析初诊T2DM患者糖负荷后血糖升高速率的影响因素。结果 Vmean不同水平组患者年龄、HbA1c、G120、I120、△I30/△G30、HOMA-β、中性粒细胞数、淋巴细胞数及血清尿酸水平比较,差异有统计学意义(P<0.05)。Spearman秩相关分析结果显示,Vmean与HbA1c、G120呈正相关,与年龄、I120、△I30/△G30、HOMA-β呈负相关(P<0.01)。有序Logistic回归分析结果显示,高△I30/△G30[OR=0.758,95%CI(0.662,0.867)]和增龄[OR=0.966,95%CI(0.949,0.984)]是Vmean延缓的保护因素;高HbA1c[OR=1.138,95%CI(1.011,1.280)]是Vmean延缓的危险因素(P<0.05)。结论高△I30/△G30、增龄及高HbA1c是初诊T2DM患者75 g葡萄糖负荷后血糖升高速率的影响因素,应当将改善胰岛β细胞早相分泌功能、控制HbA1c达标作为延缓初诊T2DM患者糖负荷后血糖急剧升高的重要举措。

Background Rapid changes in blood glucose can cause damage to tissues and organs of the body,but at present,domestic and foreign scholars generally pay insufficient attention to the rate of blood glucose change.It is of great significance to study the rate and influencing factors of blood glucose change for the prevention and treatment of diabetes complications.Objective To investigate the influencing factors of blood glucose elevation rate after 75 g glucose load in newly diagnosed type 2 diabetes mellitus(T2DM)patients.Methods Participants were 337 initially diagnosed T2DM inpatients who were treated in Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology between January 2016 and April 2019.A retrospective study was preformed on their clinical data,including general demographic information,routine blood test and biochemical parameters,HbA1c,results of a 3-hour 75 g OGTT〔glucose peak value(Gmax),time to peak glucose(Tmax),and mean post-load plasma glucose elevation velocity(Vmean)〕,first-phase insulinogenic index(ΔI30/ΔG30)measured by insulin response test(IRT),andβ-cell function and insulin resistance(IR)assessed by homeostatic model(HOMA).According to Vmean tertiles,participants were divided into low Vmean group(n=112),medium Vmean group(n=112)and high Vmean group(n=113).Logistic regression was used to analyze the influencing factors of post-load glucose elevation rate.Results The age,HbA1c,G120,I120,ΔI30/ΔG30,HOMA-β,neutrophil count,lymphocyte count and serum uric acid differed significantly across Vmean tertile groups(P<0.05).Spearman's correlation analysis showed that Vmean was positively correlated with HbA1c and G120,and was negatively correlated with age,I120,ΔI30/ΔG30 and HOMA-β(P<0.01).Ordinal Logistic regression analysis showed that highΔI30/ΔG30〔OR=0.758,95%CI(0.662,0.867)〕and older age〔OR=0.966,95%CI(0.949,0.984)〕were protective factors associated with Vmean delay,while high HbA1c〔OR=1.138,95%CI(1.011,1.280)〕was associated with increased risk of Vmean delay(P<0.05).Conclusion ElevatedΔI30/ΔG30,and high HbA1c and older age were associated with plasma glucose elevation velocity after a 75 g oral glucose load in initially diagnosed T2DM patients.In view of this,improving first-phaseΔI30/ΔG30,and HbA1c control rate should be considered as an important measure to delay the post-load sharp rise in blood glucose in such patients.