2型糖尿病患者血糖水平及血糖变异性与糖化血红蛋白水平的相关性研究

The correlation between blood glucose levels,blood glucose variability and glycated hemoglobin A1c levels in patients with type 2 diabetes

目的探讨2型糖尿病患者血糖水平及血糖变异性与糖化血红蛋白(HbA1c)的相关性。方法选取2019年3月至2020年4月在克拉玛依市人民医院内分泌科就诊的240例2型糖尿病患者,根据HbA1c水平,分为Q1组(5.5%~6.8%)(n=60)、Q2组(6.9%~7.9%)(n=55)、Q3组(8.0%~9.0%)(n=62)和Q4组(9.1%~14.0%)(n=63);采用动态持续血糖监测系统(CGMS)进行连续72 h动态血糖监测,以HbA1c为因变量,以与HbA1c具有相关性的参数为自变量,采用多元线性回归方法进行回归分析。结果Q1、Q2、Q3和Q4组的空腹及餐后2 h血糖分别为5.92(4.81,6.64)mmol/L和10.27(8.79,12.34)mmol/L,6.37(5.49,8.49)mmol/L和12.02(9.98,15.27)mmol/L,8.45(6.78,9.97)mmol/L和14.45(11.51,18.12)mmol/L,10.16(8.09,11.52)mmol/L和16.08(12.47,19.27)mmol/L,4组患者72 h动态血糖平均值分别为7.41(6.71,8.14)mmol/L,8.20(7.40,9.30)mmol/L,8.91(7.93,10.35)mmol/L和10.36(9.12,11.79)mmol/L,4组间的平均空腹血糖、餐后2 h血糖随HbA1c的增高而增高,组间比较均差异有统计学意义(H=81.35,37.26,均P<0.05);空腹及餐后2 h血糖、72 h动态血糖平均值、血糖>10.0 mmol/L时间百分率、血糖>7.8 mmol/L时间百分率以及血糖平均标准差(SDBG)与HbA1c具有相关性(r=0.68,0.46,0.63,0.59,0.42,0.36,均P<0.05);多元线性回归分析结果显示72 h动态血糖平均值和空腹血糖为HbA1c的独立影响因素(B=0.23,0.53;均P<0.05)。结论血糖变异对HbA1c无影响,空腹血糖和平均血糖为影响HbA1c的主要因素。

Objective To investigate the relationship between blood glucose level,blood glucose variability and glycated hemoglobin A1c(HbA1c)in patients with type 2 diabetes.Methods A total of 240 patients with type 2 diabetes who were admitted to the Endocrinology Department of People′s Hospital of Karamay from March 2019 to April 2020 were selected.Based on the HbA1c level,240 patients were divided into 4 groups,Q1(5.5%-6.8%)(n=60),Q2(6.9%-7.9%)(n=55),Q3(8.0%-9.0%)(n=62)and Q4(9.1%-14.0%)(n=63).The continuous blood glucose monitoring system(CGMS)was used for continuous 72 h dynamic blood glucose monitoring.With HbA1c as the dependent variable,and parameters related to HbA1c as the independent variable,multiple linear regression method was used for regression analysis.Results The fasting and 2 h postprandial plasma glucose levels in the Q1-Q4 groups were 5.92(4.81,6.64)mmol/L and 10.27(8.79,12.34)mmol/L,6.37(5.49,8.49)mmol/L and 12.02(9.98,15.27)mmol/L,8.45(6.78,9.97)mmol/L and 14.45(11.51,18.12)mmol/L,10.16(8.09,11.52)mmol/L and 16.08(12.47,19.27)mmol/L,respectively.The mean values of dynamic blood glucose for 72 h in the 4 groups were 7.41(6.71,8.14)mmol/L,8.20(7.40,9.30)mmol/L,8.91(7.93,10.35)mmol/L and 10.36(9.12,11.79)mmol/L,respectively.The average fasting blood glucose and 2 h postprandial glucose of the 4 groups increased with the increase of HbA1c,and the differences between the groups were statistically significant(H=81.35,37.26,all P<0.05).Fasting and 2 h postprandial blood glucose,the average value of 72 h dynamic blood glucose,the time percentage of dynamic blood glucose>10.0 mmol/L,the time percentage of dynamic blood glucose>7.8 mmol/L and standard deviation of blood glucose levels(SDBG)were correlated with HbA1c(P<0.05),and the correlation coefficients were 0.68,0.46,0.63,0.59,0.42 and 0.36,respectively.The multiple linear regression analysis results showed that the average values of 72 h dynamic blood glucose and fasting glucose were HbA1c′s independent impact factors(B=0.23,0.53,all P<0.05).Conclusions The blood glucose variation has no effect on HbA1c.The levels of fasting blood glucose and mean blood glucose are the main affecting factors of HbA1c.