使用口服降糖药物治疗的老年2型糖尿病患者黎明现象的发生特点与危险因素探索

Occurrence characteristics and risk factors of dawn phenomenon in elderly patients with type 2 diabetes mellitus treated with oral hypoglycemic drugs

目的使用连续血糖监测,分析口服降糖药物治疗的老年2型糖尿病患者黎明现象的发生特点与危险因素,为老年患者安全降糖提供依据。方法选择65岁及以上、稳定应用1~2种口服降糖药物的2型糖尿病患者共147例。采用ipro2系统对入组患者进行72 h的连续血糖监测,记录患者的人口统计学、实验室指标等数据。剔除凌晨低血糖27例以及数据不完整的4例受试者。比较发生与不发生黎明现象的2组在年龄、性别、病程、化验指标、用药和血糖波动参数等方面的差异。并利用回归分析,探索老年糖尿病患者黎明现象的相关危险因素。结果(1)116例患者年龄(74.1±6.9)岁,共有52例(44.83%)发生黎明现象,其从夜间最低点至早餐前的血糖升高幅度为(1.9±0.7)mmol/L。(2)黎明现象组较无黎明现象组女性患者比例增高(71.2%和42.2%,P=0.002);黎明现象组空腹血糖[(6.9±1.5)和(5.8±1.5)mmol/L]、早餐后2 h血糖[(10.3±3.3)和(9.1±2.9)mmol/L]高于无黎明现象组(均P<0.05);黎明现象组平均血糖水平[(8.1±1.3)和(7.5±1.4)mmol/L],日内血糖波动最大幅度[(7.0±2.7)和(5.3±2.1)mmol/L],平均血糖波动幅度[(4.2±2.1)和(3.2±1.5)mmol/L],血糖标准差[(1.6±0.7)和(1.2±0.5)mmol/L],日间血糖波动[(1.4±0.5)和(1.2±0.5)mmol/L]以及葡萄糖目标范围内时间[88.5%(77.8~96.5)和96.4%(87.8~100.0)]高于无黎明现象组(均P<0.05);使用DPP-4i的患者较少出现黎明现象,与出现黎明现象的患者比较差异有统计学意义(P=0.02)。(3)Pearon相关分析显示,黎明现象与性别(r=0.29,P=0.002)呈正相关性,与使用DPP4i(r=-0.216,P=0.02)呈负相关性。Logistic回归分析显示女性与黎明现象的出现相关(OR=4.374,95%CI:1.822~10.502,P=0.001),使用DPP4i的患者更少出现黎明现象(OR=0.290,95%CI:0.107~0.787,P=0.015)。结论在老年2型糖尿病患者中,黎明现象较为普遍,其与过大的血糖波动关系密切。老年女性患者更容易发生黎明现象,使用DPP4i患者黎明现象出现较少。

Objective To analyze the occurrence characteristics and risk factors of dawn phenomenon in elderly patients with type 2 diabetes mellitus treated with oral hypoglycemic drugs by means of continuous blood glucose monitoring,and provide basis for safe hypoglycemic treatment of elderly patients.Methods A total of 147 patients with type 2 diabetes mellitus who were 65 years old and above and had taken 1-2 oral hypoglycemic drugs steadily were selected.Ipro2 system was used to monitor continuously the blood glucose of the patients for 72 hours,and the demographic data,laboratory indexes and other data of the patients were recorded.27 cases with hypoglycemia in the morning and 4 ones without complete data were excluded.The differences in age,gender,course of disease,laboratory indexes,medications and blood sugar fluctuation parameters were compared between the dawn phenomenon group and non-dawn phenomenon group.Regression analysis was used to explore the related risk factors of dawn phenomenon in elderly diabetic patients.Results(1)The age of 116 patients was(74.1±6.9)years old.A total of 52 patients(44.83%)had dawn phenomenon,and the increase range of blood glucose from the lowest point at night to before breakfast was(1.9±0.7)mmol/L.(2)The proportion of female patients in the dawn phenomenon group was higher than that in the non-dawn phenomenon group(71.2%and 42.2%,p=0.002).The fasting blood glucose[(6.9±1.5)and(5.8±1.5)mmol/L]and 2-hour postprandial blood glucose[(10.3±3.3)and(9.1±2.9)mmol/L]in the dawn phenomenon group were higher than those in the non—dawn phenomenon group(all P<0.05).The mean blood glucose[(8.1±1.3)and(7.5±1.4)mmol/L],the maximum intraday blood glucose fluctuation[(7.0±2.7)and(5.3±2.1)mmol/L],the mean blood glucose fluctuation[(4.2±2.1)and(3.2±1.5)mmol/L],and the standard deviation of blood glucose[(1.6±0.7)and(1.2±0.5)mmol/L],the daytime blood glucose fluctuation[(1.4±0.5)and(1.2±0.5)mmol/L]and the time within the glucose target range[88.5%(77.8-96.5)and 96.4%(87.8-100.0)]in the dawn phenomenon group were higher than those in the non-dawn group(all P<0.05).The patients who used DPP-4 i had less dawn phenomenon,and the difference was statistically significant compared with the patients with dawn phenomenon(P=0.02).(3)Pearson correlation analysis showed that the dawn phenomenon was positively correlated with gender(r=0.29,P=0.002),and negatively correlated with the use of DPP4 i(r=-0.216,P=0.02).Logistic regression analysis showed that women were associated with the occurrence of dawn phenomenon(OR=4.374,95%CI:1.822-10.502,P=0.001),and patients using DPP4 i had less dawn phenomenon(OR=0.290,95%CI:0.107-0.787),(P=0.015).Conclusion In the elderly patients with type 2 diabetes mellitus,dawn phenomenon is more common,and it is closely related to excessive blood glucose fluctuation.Dawn phenomenon is more likely to occur in elderly female patients and less in patients using DPP4i.