1型糖尿病患者胰岛素注射皮下脂肪增生与多维度血糖波动的相关性研究

Impact of insulin injection induced lipohypertrophy on multidimensional glucose variability in patients with type 1 diabetes mellitus

目的探讨胰岛素注射所致皮下脂肪增生对1型糖尿病患者血糖波动的影响。方法选取2021年6月至12月于南京医科大学第一附属医院内分泌科就诊、接受胰岛素注射治疗≥6个月的80例1型糖尿病患者为研究对象,借助高频超声筛查皮下脂肪增生发生率,应用扫描式血糖监测系统(flash glucose monitoring system,FGM)获取血糖波动核心指标,采用单因素和多元线性回归分析皮下脂肪增生与血糖波动核心指标的关系。结果与无皮下脂肪增生患者相比,皮下脂肪增生患者平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)、血糖变异系数(coefficient of variation,CV)、日间血糖平均绝对差(mean of daily differences,MODD)、血糖水平标准差(standard deviation,SD)、高于目标范围内时间(time above range,TAR)以及高血糖指数(high blood glucose index,HBGI)均显著性升高(均P<0.05),而目标范围内时间(time in range,TIR)显著降低(P<0.01)。多元线性回归分析显示,在校正了确诊年龄、胰岛素注射时长、空腹C肽、单位体重日胰岛素剂量条件下,超声检出皮下脂肪增生是TIR(β=-9.423,P=0.032)、MAGE(β=1.114,P=0.039)、CV(β=4.304,P=0.041)和MODD(β=0.717,P=0.046)发生显著变化的独立影响因素。结论皮下脂肪增生会增加1型糖尿病患者血糖波动度、降低血糖达标率,增加血糖控制难度。

Objective This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University.And these patients all received insulin injection more than six months.Lipohypertrophy was assessed by ultrasound scanning,and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM).Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results Compared with patients without lipohypertrophy,patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE),coefficient of variation(CV),mean of daily differences(MODD),standard deviation(SD)of blood glucose,time above range(TAR),and high blood glucose index(HBGI;all P<0.05),while time in range(TIR)of glucose markedly become lower(P<0.01).Moreover,multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR(β=-9.423,P=0.032),MAGE(β=1.114,P=0.039),CV(β=4.304,P=0.041),MODD(β=0.717,P=0.046)after adjusting for age at diagnosis,duration of insulin injection,fasting C-peptide,and daily dose of insulin per unit weight.Conclusion Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.