无症状低血糖2型糖尿病患者血糖波动特点及危险因素分析

Blood glucose fluctuation and risk factors in type 2 diabetic patients with asymptomatic hypoglycemia

目的探讨无症状低血糖2型糖尿病患者血糖波动特点及危险因素。方法选取2018年9月至2021年7月在安徽医科大学附属合肥医院内分泌科住院的2型糖尿病患者342例。通过连续动态血糖监测(continuous glucose monitoring,CGM)获取日内平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、血糖变异系数(coefficient of variation,CV)、24 h平均血糖水平(24 hour mean blood glucose level,MG)、血糖在目标范围内时间(time in range,TIR)等相关指标,根据CGM结果及患者有无低血糖症状,分为无低血糖组、有症状低血糖组和无症状低血糖组;比较3组间血糖波动的差异;采用logistic回归分析2型糖尿病患者发生无症状低血糖的危险因素,通过受试者工作特征曲线分析MAGE对无症状低血糖的预测价值。结果与无低血糖组相比,无症状低血糖组TIR更高(Z=-2.042,P=0.041);与无低血糖组和有症状低血糖组相比,无症状低血糖组MG更低,MAGE和CV更高(均P<0.05)。多因素logistic回归分析显示,尿白蛋白/肌酐比值(urinary albumin/creatinine ratio,UACR)、MAGE、CV为无症状低血糖的危险因素,MG为保护因素。进一步校正其他危险因素,MAGE与无症状低血糖发生仍密切相关(OR=1.111,95%CI 0.999~1.235,P=0.049)。受试者工作特征曲线结果显示,MAGE对无症状低血糖预测的灵敏度为0.769,特异度为0.776。结论无症状低血糖患者血糖波动的特点为具有更高的TIR值,但MAGE更大,MAGE、UACR、CV为无症状低血糖的危险因素,且MAGE对无症状低血糖的发生有一定的预测价值。

Objective To investigate the characteristics of blood glucose fluctuation and risk factors in type 2 diabetic patients with asymptomatic hypoglycemia.Methods From September 2018 to July 2021,342 patients with type 2 diabete mellitus who were hospitalized in the Department of Endocrinology of Hefei Hospital Affilitated to Anhui Medical University were enrolled for a retrospective study.The mean amplitude of glycemic excursions(MAGE),coefficient of variation(CV),24 hour mean blood glucose level(MG),and time in range(TIR)were obtained by continuous glucose monitoring(CGM).According to the results of CGM and whether the patients have hypoglycemia symptoms,they were divided into three groups:no hypoglycemia group,symptomatic hypoglycemia group,and asymptomatic hypoglycemia group.The differences in blood glucose fluctuations were compared among the three groups.Multivariate logistic regression analysis was used to evaluate the risk factors in type 2 diabete mellitus patients with asymptomatic hypoglycemia.The predictive value of MAGE for asymptomatic hypoglycemia was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-hypoglycemia group,the TIR in asymptomatic hypoglycemia group was higher(Z=-2.042,P=0.041).The asymptomatic hypoglycemia group had lower MG,higher MAGE and CV compared with the other two groups(all P<0.05).Multivariate logistic regression analysis showed that urinary albumin/creatinine ratio(UACR),MAGE,and CV were the risk factors for asymptomatic hypoglycemia,while MG was the protective factor.After adjustment for other risk factors,MAGE was still associated with asymptomatic hypoglycemia(OR=1.111,95%CI 0.999-1.235,P=0.049).The sensitivity and specificity of MAGE in predicting asymptomatic hypoglycemia were 0.769 and 0.776,respectively.Conclusions Patients with asymptomatic hypoglycemia present with larger TIR and MAGE.MAGE,UACR,and CV were risk factors for asymptomatic hypoglycemia.Moreover,MAGE has some predictive value for the occurrence of asymptomatic hypoglycemia.