老年2型糖尿病病人血糖变异情况以及平均血糖波动幅度与心功能的相关性

Study on glycemic variability and the relationship between mean amplitude of glycemic excursion and cardiac function in elderly patients with type 2 diabetes mellitus

目的 探讨老年T2DM病人血糖变异(GV)情况及平均血糖波动幅度(MAGE)与心功能的相关性。方法 选择2019年就诊于首都医科大学宣武医院综合科的老年T2DM病人共48例,测量FPG、HbA1c及糖化白蛋白(GA)水平,并根据其结果将病人分为HbA1c达标组(HbA1c<6.5%,n=16)及HbA1c未达标组(HbA1c≥6.5%,n=32)。予每位病人佩戴3 d的美敦力动态血糖监测(CGM),获取GV参数,包括平均血糖(MBG)、MAGE、血糖水平标准差(SDBG)、最大血糖波动幅度(LAGE)、变异系数(CV)及葡萄糖目标范围内时间(TIR)、葡萄糖高于目标范围时间(TAR)和葡萄糖低于目标范围时间(TBR),将病人分为MAGE达标组(MAGE<3.9 mmol/L,n=22)及MAGE未达标组(MAGE≥3.9 mmol/L,n=26)。每位病人完善超声心动图,获取心功能指标,包括LVEF、每搏心输出量(SV)、舒张末容积(EDV)及心输出量(CO)。比较HbA1c达标组与HbA1c未达标组的GV情况。分析MAGE与老年T2DM病人心功能指标的相关性。结果 HbA1c达标组的FPG、SDBG、TIR、TAR未达标率以及糖尿病病程显著低于HbA1c未达标组,TBR未达标率显著高于HbA1c未达标组,差异均有统计学意义(P<0.05或P<0.01)。MAGE达标组的SDBG、LAGE、CV低于MAGE未达标组,TIR、CO及LVEF高于MAGE未达标组,差异均有统计学意义(P<0.05或P<0.01)。Pearson相关分析显示,MAGE与CO及LVEF均呈明显负相关(r=-0.340、-0.319,P=0.018、0.027)。结论 HbA1c达标的老年T2DM病人仍存在GV问题,其低血糖风险尤其值得关注。MAGE与老年T2DM病人的心脏功能具有相关性,应全面监测血糖指标,及时改善GV,防治心脏病变。

Objective To explore the glycemic variability(GV)and the relationship between mean amplitude of glycemic excursion(MAGE)and cardiac function in the elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 48 elderly T2DM patients treated in Geriatric Comprehensive Department in Xuanwu Hospital,Capital Medical University in 2019 were enrolled in this study,and the levels of fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),glycated albumin(GA)were measured.The patients were divided into the HbA1c standard group(HbA1c<6.5%,n=16)and the HbA1c substandard group(HbA1c≥6.5%,n=32).Each patient received a 3-day continuous glucose monitoring(CGM)to obtain the blood glucose parameters including mean blood glucose(MBG),MAGE,standard deviations of blood glucose(SDBG),largest amplitude of glycemic excursion(LAGE),coefficient of variation(CV)and glucose target time in range(TIR),target time above range(TAR)and target time below range(TBR),and then the patients were divided into the MAGE standard group(MAGE<3.9 mmol/L,n=22)and the MAGE substandard group(MAGE≥3.9 mmol/L,n=26).Each patient underwent echocardiography detection to obtain the cardiac function indicators including left ventricular ejection fraction(LVEF),stroke volume(SV),end-systolic volume(EDV)and cardiac output(CO).The level of GV was compared between the HbA1c standard group and the HbA1c substandard group.The correlation between MAGE and cardiac function in the elderly T2DM patients was analyzed.Results Compared with the HbA1c substandard group,the substandard rate of FPG,SDBG,TIR,TAR and the duration of T2DM were lower,and substandard rate of TBR was higher in the HbA1c standard group(P<0.05 or P<0.01).Compared with the MAGE substandard group,the levels of SDBG,LAGE and CV were lower,and the levels of TIR,CO and LVEF were higher in the MAGE standard group(P<0.05 or P<0.01).Pearson correlation analysis showed that MAGE was negatively correlated with CO and LVEF(r=-0.340,-0.319;P=0.018,0.027,respectively).Conclusions The elderly T2DM patients who reach standard HbA1c range still have the problem of GV,and have the risk of hypoglycemia.MAGE is related to the heart function of the elderly patients with T2DM,and the glucose indexes should be comprehensively monitored and GV should be improved in time to prevent and control heart diseases.