Gestational diabetes mellitus: Screening with fasting plasma glucose

Fasting plasma glucose(FPG) as a screening test for gestational diabetes mellitus(GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review:(1) traces the history;(2) weighs the advantages and disadvantages;(3) addresses the significance in early pregnancy;(4) underscores the benefits after delivery; and(5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM-thereby helping each and every pregnant woman.

Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

血清FPG、2 hPG和HbA1c在妊娠期糖尿病孕妇中的诊断价值分析

目的分析空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2-hour postprandial plasma glucose,2 hPG)、糖化血红蛋白(glycated hemoglobin A1c,HbA1c)在妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇中的诊断价值。方法选取2021年11月—2023年11月福建省三明市建宁县妇幼保健院收治的200例GDM孕妇纳入观察组,另将同期于本院行产前检查的198名健康孕妇纳入对照组。比较两组FPG、2 hPG、HbA1c水平,并描绘受试者操作特征(receiver operating characteristic,ROC)曲线,探究FPG、2 hPG、HbA1c诊断GDM的价值。结果观察组FPG、2 hPG、HbA1c水平均高于对照组,差异有统计学意义(P均<0.05)。ROC曲线分析结果显示,FPG、2 hPG、HbA1c联合诊断GDM的曲线下面积为0.957,高于三者单独诊断,差异有统计学意义(P<0.05)。结论FPG、2 hPG、HbA1c在GDM孕妇体内呈异常高表达,3项指标联合可有效诊断出GDM。

长效胰岛素对2型糖尿病患者FPG、2 hPG等指标的影响

目的分析长效胰岛素对2型糖尿病患者空腹血糖(Fasting Plasma Glucose,FPG)、餐后2 h血糖(2-hour Postprandial Plasma Glucose,2 hPG)等指标的影响。方法选择2021年7月-2023年7月滨州市沾化区第二人民医院收治的78例2型糖尿病患者为研究对象,以随机数表法分为对照组(口服降糖药)和研究组(口服降糖药+长效胰岛素),各39例。对比两组血糖指标、胰岛细胞功能指标及C肽水平。结果研究组FPG、2 hPG、糖化血红蛋白和胰岛素抵抗指数明显低于对照组,空腹胰岛素、胰岛β细胞分泌指数、空腹C肽和餐后2 h C肽明显高于对照组,差异有统计学意义(P均<0.05)。结论于常规口服降糖药基础上,增加长效胰岛素治疗,可提高2型糖尿病血糖控制效果,改善胰岛细胞功能。

Relationship between the level of fasting plasma glucose and beta cell functions in Chinese with or without diabetes

Background Type 2 diabetes is a chronic disease characterized by a progressive loss of beta cell functions. However, the evaluation of beta cell functions is either expensive or inconvenient for clinical practice. We aimed to elucidate the association between the changes of insulin responsiveness and the fasting plasma glucose （FPG） during the development of diabetes. Methods A total of 1192 Chinese individuals with normal blood glucose or hyperglycemia were enrolled for the analysis. The early insulinogenic index （△I30/△G30）, the area under the curve of insulin （AUC-Ⅰ）, and homeostasis model assessment were applied to evaluate the early phase secretion, total insulin secretion, and insulin resistance respectively. Polynomial regression analysis was performed to estimate the fluctuation of beta cell functions. Results The △I30/△G30 decreased much more rapidly than the AUC-Ⅰ accompanying with the elevation of FPG. At the FPG of 110 mg/dl （a pre-diabetic stage）, the AI30/AG30 lost 50% of its maximum while the AUC-Ⅰ was still at a compensated normal level. The AUC-Ⅰ exhibited abnormal and decreased gradually at the FPG of from 130 mg/dl to higher （overt diabetes）, while the △I30/△G30 almost remained at 25% of its maximum value. When hyperglycemia continuously existed at 〉 180 mg/dl, both the AI30/AG30 and AUC-Ⅰ were totally lost. Conclusion The increased fasting plasma glucose reflects progressive decompensation of beta cell functions, and could be used to guide the strategy of clinical treatments.

Value of fasting plasma glucose to screen gestational diabetes mellitus before the 24th gestational week in women with different pre-pregnancy body mass index

Background:Gestational diabetes mellitus(GDM)is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test(OGTT).It is difficult to predict GDM before 24th gestational week because fast plasma glucose(FPG)decreases as the gestational age increases.It is controversial that if FPG≥5.1 mmol/L before 24th gestational week should be intervened or not.The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy body mass index(BMI).Methods:This was a multi-region retrospective cohort study in China.Women who had a singleton live birth between June 20,2013 and November 30,2014,resided in Beijing,Guangzhou and Chengdu,and received prenatal care in 21 selected hospitals,were included in this study.Pre-pregnancy BMI,FPG before the 24th gestational week,and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical charts and analyzed.The pregnant women were classified into four groups based on pre-pregnancy BMI:Group A(underweight,BMI<18.5 kg/m^2),Group B(normal,BMI 18.5-23.9 kg/m^2),Group C(overweight,BMI 24.0-27.9 kg/m^2)and Group D(obesity,BMI≥28.0 kg/m^2).The trend of FPG before 24th week of gestation was described,and the sensitivity and specificity of using FPG before the 24th gestational week to diagnose GDM among different pre-pregnancy BMI groups were reported.Differences in the means between groups were evaluated using independent sample t-test and analysis of variance.Pearson Chi-square test was used for categorical variables.Results:The prevalence of GDM was 20.0%(6806/34,087)in the study population.FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.FPG was higher in women with higher pre-pregnancy BMI.FPG before the 24th gestational week and pre-pregnancy BMI could be used to predict GDM.The incidence of GDM in women with FPG≥5.10 mmol/L in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG≥5.10 mmol/L and pre-pregnancy BMI<24.0 kg/m^2(78.5%[62/79]vs.52.9%[64/121],χ^2=13.425,P<0.001).Conclusions:FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week.Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week.FPG≥5.10 mmol/L between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.

Performance of Fasting Plasma Glucose and Postprandial Urine Glucose in Screening for Diabetes in Chinese High-risk Population

Background： The conventional approaches to diabetes screening are potentially limited by poor compliance and laboratory demand. This study aimed to evaluate the performance of fasting plasma glucose （FPG） and postprandial urine glucose （PUG） in screening for diabetes in Chinese high-risk population. Methods： Nine hundred and nine subjects with high-risk factors of diabetes underwent oral glucose tolerance test after an overnight fast. FPG, hemoglobin A 1 c, 2-h plasma glucose （2 h-PG）, and 2 h-PUG were evaluated. Diabetes and prediabetes were defined by the American Diabetes Association criteria. The area under the receiver operating characteristic （ROC） curve was used to evaluate the diagnostic accuracy of 2 h-PUG, and the optimal cut-off determined to provide the largest Youden index. Spearman correlation was used for relationship analysis. Results： Among 909 subjects, 33.4% （304/909） of subjects had prediabetes, and 17.2% （156/909） had diabetes. The 2 h-PUG was positively related to FPG and 2 h-PG （r = 0.428 and 0.551, respectively, both P 〈 0.001）. For estimation of 2 h-PG 〉 7.8 mmol/L and 2 h-PG ≥ 11.I mmol/L using 2 h-PUG, the area under the ROC curve were 0.772 （95% confidence interval [CI]： 0.738-0.806） and 0.885 （95% CI：0.850-0.921 ）, respectively. The corresponding optimal cut-offs for 2 h-PUG were 5.6 mmol/L and 7.5 retool/L, respectively. Compared with FPG alone, FPG combined with 2 h-PUG had a higher sensitivity fbr detecting glucose abnormalities （84.1% vs. 73.7%, P〈 0.001） and diabetes （82.7% vs. 48.1%, P〈 0.001）. Conclusion： FPG combined with 2 h-PUG substantially improves the sensitivity in detecting prediabetes and diabetes relative to FPG alone, and may represent an efficient layperson-oriented diabetes screening method.

Gender differences in the relationship between plasma lipids and fasting plasma glucose in non-diabetic urban Chinese popula- tion： a cross-section study

The association between dyslipidemia and elevated fasting glucose in type 2 diabetes is well known. In non-diabetes, whether this association still exists, and whether dyslipidemia is an independent risk factor for high fasting plasma glucose （FPG） levels are not clear. This cross-sectional study recruited 3460 non-diabetic Chinese subjects （1027 men, and 2433 women, aged 35-75 years old） who participated in a health survey. Men and women were classified into tertiles by levels of plasma lipids respectively. In women, the prevalence of impaired fasting glucose （IFG） was decreased with increased HDL-C. A stepwise increase in HDL-C was associated with decreasing FPG levels （lowest tertiles, FPG： 5.376 ± 0.018; middle tertiles, 5.324± 0.018; highest tertiles, 5.276±0.018mmol/L; P = 0.001）. Reversely, FPG levels increased from lowest tertiles to highest tertiles of LDL-C, TC, and TG. we found that women in the first tertile with lower HDL-C level had a 1.75-fold increase in risk of IFG compared with non-diabetic women in the third tertile with higher HDL-C level （OR： 1.75; 95% CI： 1.20-2.56）. In men, no significant association was found. We took age, BMI, waist/hip ratio, education, smoking, alcohol drinking, and physical exercise as adjusted variables. In Chinese non-diabetic women, dyslipidemia is independently associated with high levels of FPG; TG, HDL-C, and LDL-C are predictors of IFG independent of BMI and waist/hip ratio.

HbA1c与FPG联合筛查诊断糖尿病的应用价值

目的探索糖化血红蛋白(HbA1c)与空腹血糖(FPG)联合筛查糖尿病(DM)及DM高危人群的应用价值。方法测定沧州行政和企事业单位6 533例健康体检者的HbA1c和FPG,筛查DM患者及DM高危人群,对DM诊断有疑问者进一步作糖耐量实验(OGTT)。结果采用ADA推荐的HbA1c≥6.5%或FPG≥7.0mmol/L为筛查DM标准,本研究人群DM筛查率为10.51%,DM高危人群为18.69%。如果用HbA1c≥6.5%单项筛查DM,漏诊率占联合检出DM人数的20.23%;用FPG≥7.0mmol/L单项筛查DM,漏诊率为21.83%。依据联合筛查提出了适于本地筛查DM的切点:HbA1c≥6.5%与FPG≥6.0mmol/L,HbA1c≥6.0%与FPG≥7.0mmol/L可直接诊断DM;5.5%≤HbA1c<6.0%与FPG≥7.0mmol/L,HbA1c<5.5%与FPG≥7.0mmol/L,这部分人群应重新验证或作OGTT明确诊断,高者诊断DM,低者降为高危人群,对DM高危人群也提出了筛查切点。结论 HbA1c与FPG联合检测在筛查DM中可以达到较高的灵敏度和保持较高的特异性,最大限度地提高了体检人群筛查诊断DM效率。

FPG、GA、HbA1c及GA/HbA1c比值在T1DM/T2DM中的诊疗价值

目的:探讨空腹血糖(FPG)、糖化清蛋白(GA)、糖化血红蛋白(HbA1c)及GA/HbA1c比值在1型糖尿病(T1DM)和2型糖尿病(T2DM)中的诊疗价值。方法:采用病例对照研究。以30例健康体检人群为正常对照组,以临床明确诊断的160例糖尿病患者为研究病例组,其中1型糖尿病(T1DM)组为76例、2型糖尿病(T2DM)组为84例,应用SPSS软件进行独立样本t检验、绘制受试者工作曲线(ROC曲线)及Pearson相关性检验,统计分析对照组与病例组,T1DM及T2DM组各组间FPG、GA及HbA1c的检测结果的相关性、GA/HbA1c比值及诊断切点的差异。结果:T1DM及T2DM组FPG、GA及HbA1c的检测结果及GA/HbA1c比值均明显高于对照组,且T1DM组高于T2DM组,P值均<0.01;T1DM组中HbA1c与GA成显著性正相关(P<0.01),FPG与GA呈弱正相关(P>0.05)、与HbA1c呈弱负相关(P>0.05);T2DM组中FPG、GA及HbA1c均成正相关(P值均<0.05),相关程度依次为HbA1c/GA>FPG/GA>FPG/HbA1c;评估各指标的ROC曲线分析:T1DM组中,FPG、GA、HbA1c及GA/HbA1c比值作为诊断糖尿病(DM)的切点分别为5.86 mmol/L[曲线下面积(AUC)=0.922]、15.5%(AUC=1.00)、6.10%(AUC=1.00)及2.95(AUC=0.992),其敏感性为86.8%、100%、98.7%及93.4%,特异性均为100%,P值均<0.05;T2DM组中,FPG、GA及HbA1c作为诊断DM的切点分别为5.94 mmol/L(AUC=0.941)、15.5%(AUC=0.977)及5.95%(AUC=0.991),其敏感性为91.7%、85.7%及97.6%,特异性均为100%(P值均<0.05),GA/HbA1c比值无诊断切点(AUC=0.644,P值>0.05)。结论:FPG、GA、HbA1c及GA/HbA1c比值在T1DM和T2DM中具有极高的疗效观察、诊断及分型价值,应用各指标生物参考区间上限诊断T1DM和T2DM均存在漏检现象,T1DM患者密切关注FPG水平更为重要。

A cohort study on the association between fasting plasma glucose level over 5. 3 mmol / L and risks of abnormal glucose metabolism and cardiovascular diseases in the elderly

Objective To evaluate the association of fasting plasma glucose(FPG)level over 5.3 mmol/L with the development of abnormal glucose metabolism and cardiovascular disease(CVD).Methods This was a retrospec-tive cohort study with 1 064 non-diabetic subjects(980males;84 females)aged 60 or over,who carried out annual health check-up in Chinese PLA General

FPG联合选择性OGTT模式在糖尿病筛查中的应用研究

探索空腹血糖(FPG)和选择性口服葡萄糖耐量试验(OGTT)相结合的糖尿病(DM)筛查模式。应用OGTT对无DM史人群行DM筛查,运用ROC曲线评价FPG对DM、IPH的诊断价值。FPG切点为7.0mmol/L时,诊断DM的敏感性为69%,特异性为100%;FPG切点为5.6mmol/L时,诊断IPH的敏感性为100%,特异性为83.3%。对FPG初筛在5.6mmol/L～6.9mmol/L者行OGTT,可在保证筛查准确性的基础上,最大程度节约成本。

糖尿病病人FPG水平变化与hs-TSH的相关性研究

目的观察糖尿病病人的空腹血糖(FPG)水平变化与超敏促甲状腺激素(hs-TSH)的相关性,评估糖尿病人的病情发展程度.方法正常对照组50人.糖尿病组:住院病人100例,男43例,女57例,平均年龄57 y.将FPG浓度在7～10mmol/L之间的65人编为A组,FPG>10 mmol/L的35人编为B组.在100例糖尿病人中无合并症者67人编为C组,有急性合并症者33人编为D组.正常对照组和糖尿病组病人均于清晨空腹采静脉血3 ml,分离血清,FPG采用全自动生化分析仪检测,hs-TSH采用化学发光免疫分析法(CLIA)定量检测.结果A组hs-TSH浓度为1.03±0.25 mIU/L,B组hs-TSH浓度为0.70±0.41 mIU/L,C组hs-TSH浓度为0.97±0.32 mIU/L,D组hs-TSH浓度为0.47±0.19 mIU/L.A组hs-TSH浓度与B组比较P=0.0006,有统计学意义(P＜0.001).对糖尿病组进行FPG和hs-TSH的相关性统计,其相关系数r=-0.1835.因此,FPG浓度与hs-TSH浓度呈负相关,主要是促甲状腺素释放激素(TRH)较少,从而使得hs-TSH呈低弱反应.当糖尿病人的hs-TSH浓度为0.47±0.19 mIU/L时有发生急性合并症的可能.C组与D组的hs-TSH浓度比较P=0.000 1,有统计学意义(P＜0.001).结论糖尿病患者hs-TSH浓度随FPG浓度的上升而下降,两者之间呈负相关.有急性合并症时hs-TSH浓度比无合并症组下降更明显,hs-TSH对糖尿病产生合并症有预测作用.

HbA_(1c)6.5%与FPG和2hPG诊断糖尿病性能比较

目的探讨糖尿病HbA1c诊断标准与FPG、2hPG标准之间的关系。方法收集可疑糖尿病患者352例,分别检测FPG、2hPG、HbA1c浓度,分析HbA1c与FPG以及HbA1c与2hPG相关性;以FPG≥7.0mmol/L,2hPG≥11.1mmol/L分别为诊断DM标准,HbA1c≥6.5%为切点诊断DM,比较HbA1c≥6.5%与FPG、2hPG标准在诊断DM的性能。结果以FPG为标准,HbA1c6.5%为切点诊断DM的灵敏度、特异性、阳性预测值、阴性预测值、总有效率、相关系数分别为88.89%、88.63%、76.19%、95.12%、88.7%、0.9;以2hPG为标准,则分别为50.7%、84.8%、70.75%、70.32%、70.45%、0.76。在以FPG为标准诊断时,HbA1c诊断DM的灵敏度、阴性预测值、总有效率显著高于以2hPG为标准诊断时(P<0.05)。结论与HbA1c和2hPG相比,HbA1c和FPG之间有较好的相关性和更接近的诊断性能。

糖尿病视网膜病变不同分期患者的HbAlc、FPG、FAZ、MVD水平变化及临床意义

目的探讨糖尿病视网膜病变不同分期患者的糖化血红蛋白(HbAlc)、空腹血糖(FPG)、黄斑中心凹无血管区域(FAZ)、微血管密度(MVD)水平变化及临床意义。方法选择2018年7月至2020年12月惠州市第三人民医院收治的120例糖尿病患者为研究对象,根据视网膜病变不同分期,将患者分为A组(无视网膜病变,41例)、B组(轻度非增殖性视网膜病变,23例)、C组(中度或重度非增殖性视网膜病变,20例)和D组(增殖性视网膜病变,36例),并选择同期在上述医院体检的50例健康者作为对照组。比较五组受检者的HbAlc、FPG、FAZ、MVD水平,并采用Spearman秩相关分析法分析HbAlc、FPG、FAZ、MVD水平与糖尿病视网膜病变不同分期的相关性。结果对照组受检者的HbAlc、FPG水平分别为(5.48±0.50)mmol/L、(5.77±0.56)mmol/L,均明显低于B组的(10.25±1.01)mmol/L、(10.08±1.00)mmol/L、C组的(10.79±1.06)mmol/L、(10.59±1.04)mmol/L和D组的(11.02±1.09)mmol/L、(10.87±1.07)mmol/L,且A组患者的HbAlc、FPG水平分别为(8.27±0.82)mmol/L、(8.32±0.84)mmol/L,均明显低于B组、C组和D组,差异均有统计学意义(P<0.05),而对照组受检者的HbAlc、FPG水平与A组比较差异均无统计学意义(P>0.05);对照组受检者的FAZ面积为(0.278±0.02)mm^(2),明显小于B组的(0.408±0.04)mm^(2)、C组的(0.420±0.04)mm^(2)和D组的(0.606±0.06)mm^(2),且A组患者的FAZ面积为(0.372±0.03)mm^(2),明显小于D组,差异均有统计学意义(P<0.05),而对照组受检者的FAZ面积与A组比较差异无统计学意义(P>0.05);五组受检者外层视网膜的MVD比较差异无统计学意义(P>0.05);对照组受检者表层视网膜、深层视网膜及脉络膜毛细血管层的MVD分别为(0.527±0.05)%、(0.574±0.06)%、(0.667±0.07)%,均明显高于A组[(0.506±0.05)%、(0.551±0.05)%、(0.639±0.06)%]、B组[(0.485±0.04)%、(0.520±0.05)%、(0.623±0.06)%]、C组[(0.481±0.04)%、(0.516±0.05)%、(0.620±0.06)%]和D组[(0.475±0.04)%、(0.503±0.05)%、(0.611±0.06)%],且A组患者表层视网膜、深层视网膜的MVD均明显高于B组、C组,脉络膜毛细血管层的MVD明显高于D组,差异均有统计学意义(P<0.05);经Spearman秩相关分析结果显示,HbAlc、FPG水平及FAZ面积与糖尿病视网膜病变不同分期呈正相关(r=0.568、0.447、0.326,P<0.05),MVD与糖尿病视网膜病变不同分期呈负相关(r=-0.282,P<0.05)。结论糖尿病视网膜病变不同分期患者的HbAlc、FPG、FAZ、MVD水平明显异于健康者,且HbAlc、FPG、FAZ、MVD水平与糖尿病视网膜病变不同分期有一定相关性。

FPG水平与妊娠期糖尿病的相关性分析

目的：探讨分析妊娠早期空腹血糖（FPG）水平与妊娠期糖尿病（GDM）的相关性。方法：回顾性分析我院收治的250例孕妇的临床资料,将48例妊娠早期空腹血糖高于5.1 mmol/L的孕妇作为高血糖组,202例妊娠早期空腹血糖低于5.1 mmol/L的孕妇作为对照组。比较妊娠各个时期高血糖组与对照组空腹血糖水平的差异、两组孕妇在妊娠中晚期被诊断为妊娠期糖尿病比例的差异及两组孕妇的母儿预后。结果：高血糖组妊娠中晚期确诊为GDM的孕妇要明显多于对照组（P〈0.05）;高血糖组妊娠1~13周,14~28周,28~36周的FPG水平均要高于对照组（P〈0.05）;高血糖组早产、大于胎龄儿、新生儿感染的情况及剖宫产例数要明显多于对照组（P〈0.05）。结论：妊娠早期FPG较高的孕妇患GDM的风险要高于普通孕妇,高FPG水平会导致不良母儿预后,故FPG检测是妊娠早期的一项必要检测,但还需要大样本量的临床研究来寻找一个合理的界值作为GDM的诊断标准。

糖尿病视网膜病变患者HbAlc、FPG与血小板参数的变化及危险因素分析

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者糖化血红蛋白(hemoglobin Alc,HbAlc)、空腹血糖(fasting plasma glucose,FPG)及血小板参数的变化。方法选取2008年1月至2011年12月于我院眼科门诊就诊的糖尿病患者45例,其中DR患者(DR组)25例,非DR患者(非DR组)20例。另选取同期进行门诊体检的健康人20例为对照组。三组所有观察对象均采用统一调查表详细登记一般情况,以分析DR的危险因素;均接受眼底照相及眼底荧光血管造影检查,观察DR患者的眼底表现,并进行DR分期;取静脉血进行HbAlc、FPG及血小板参数测定。结果 25例DR患者中Ⅰ期8例(10眼),Ⅱ期10例(13眼),Ⅲ期7例(9眼)。对照组HbAlc、FPG、血小板计数、血小板平均体积、血小板分布宽度分别为(5.09±0.45)%、(5.14±0.76)mmol·L-1、(196.25±52.08)×109L-1、(9.54±1.62)fL、(14.72±1.21)%,非DR组分别为(7.16±0.89)%、(8.28±2.98)mmol·L-1、(164.85±51.77)×109L-1、(10.25±2.04)fL、(16.05±1.56)%,DR组分别为(9.28±1.56)%、(10.26±3.45)mmol·L-1、(138.40±45.26)×109L-1、(14.21±2.35)fL、(18.12±1.25)%;与对照组相比,非DR组、DR组患者的HbAlc、FPG、血小板平均体积及血小板分布宽度均增高,血小板计数均降低,差异均有统计学意义(均为P<0.05);与非DR组相比,DR组上述改变更加明显,差异也均有统计学意义(均为P<0.05)。高血压、糖尿病家族史是DR的危险因素。结论 HbAlc、FPG及血小板参数测定的联合应用对于监测DR的发生、发展具有重要意义。

妊娠期糖尿病患者血清网膜素与FPG、FINS及胰岛素抵抗指数的相关性分析

目的:分析妊娠期糖尿病(GDM)患者血清网膜素(Omentin)与FPG、FINS及(HOMA-IR)的相关性。方法:选取2018年3月-2020年3月本院收治的孕前肥胖GDM患者60例作为研究1组,同时选择本院收治的孕前非肥胖GDM患者60例作为研究2组,同时选取同时间段在本院产检的健康妊娠期女性60例作为对照组。比较三组血压、血脂、血清Omentin、空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA-IR情况,采用Pearson相关性分析Omentin与FPG、FINS、HOMA-IR的相关性。结果:三组收缩压、舒张压、LDL-C、TG、TC、HDL-C比较,差异均有统计学意义(P<0.05);研究1、2组收缩压、舒张压及TC比较,差异均无统计学意义(P>0.05);研究1组LDL-C、TG及HDL-C水平均高于研究2组(P<0.05)。研究1、2组Omentin均低于对照组,FPG、FINS、HOMA-IR均高于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示:Omentin与FPG、FINS、HOMA-IR均呈负相关(r=-0.438、-0.579、-0.755,P<0.05)。结论:GDM患者血清Omentin与FPG、FINS及HOMA-IR的相关性分析中,GDM患者存在明显的胰岛素抵抗、脂代谢异常、糖代谢异常症状,且Omentin水平明显降低,伴肥胖的GDM患者胰岛素抵抗程度、代谢异常程度更高,Omentin水平更低。Omentin水平降低可能在GDM发生、发展中发挥了作用。

血清HbA1c、TG、FPG水平与糖尿病及并发症发生的相关性

目的:探讨血清糖化血红蛋白(HbA1c)、甘油三酯(TG)、空腹血糖(FPG)水平与糖尿病及并发症发生的相关性。方法:选择2018年4月-2019年6月糖尿病患者145例设为观察组,给予常规方法降糖治疗,并进行12个月随访,根据患者是否发生并发症分为并发症组与非并发症组;选择同期健康体检者69例设为对照组。采用全自动生化分析仪测定各组血糖水平;采用Pearson相关性分析软件对糖尿病并发症发生率与HbA1c、FPG及TG水平进行相关性分析。结果:观察组HbA1c、2 h PG、FPG、TC、TG、LDL-C水平均高于对照组(P<0.05);HDL-C水平低于对照组(P<0.05);145例糖尿病患者经治疗后完成12个月随访,27例患者发生糖尿病并发症,发生率为18.62%。糖尿病并发症排在前2位的分别为糖尿病足、糖尿病眼病,分别占55.56%和22.22%;并发症组HbA1c、2 h PG、FPG、TC、TG、LDL-C水平均高于非并发症组(P<0.05),HDL-C水平低于非并发症组(P<0.05)。Pearson相关分析结果表明:糖尿病患者并发症发生率与HbA1c、FPG及TG水平呈正相关性(P<0.05)。结论:HbA1c、FPG及TG水平在糖尿病患者中呈高表达,其表达水平与并发症发生率存在相关性,加强HbA1c、FPG及TG水平测定能预测并发症发生,指导临床治疗。

FPG等三项指标和糖尿病并发CHF患者心功能的关系

目的探讨入院空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(HbA1c)、C肽水平及是否并发糖尿病与慢性心力衰竭(CHF)患者心功能的关系。方法选取健康体检者100例作为对照组。选取CHF患者235例,划分为非糖尿病组(n=143)与糖尿病组(n=92),比较非糖尿病组与糖尿病组心功能NYHA分级与左心室射血分数(LVEF),比较CHF患者不同组别同组NYHA分级的FPG、HbA1c、C肽水平;应用Pearson相关性及多元线性回归分析CHF患者临床参数与LVEF的关系。结果三组一般资料差异无统计学意义;与对照组比较,非糖尿病组的BMI升高(P<0.05),HbA1和c肽升高(P<0.01),糖尿病组的体质量指数(BMI)、收缩压、FPG、HbA1c、C肽升高(P<0.01);与非糖尿病组相比,糖尿病组BMI升高(P<0.05),收缩压、FPG、C肽明显升高(P<0.01)。与非糖尿病组比较的秩和检验结果为,糖尿病组NYHA心功能分级整体更高(P<0.05)。非糖尿病组左心室射血分数LVEF水平为(48±8)%,糖尿病组LVEF水平为(43±8)%,非糖尿病组LVEF水平明显高于糖尿病组,差异具有统计学意义(P<0.01)。NYHA不同级的FPG、HbA1c、C肽水平比较存在显著差异,NYHAⅡ级<NYHAⅢ级<NYHAⅣ级,差异具有统计学意义(P<0.01)。多元线性回归分析表明:对于非糖尿病组和非糖尿病组,均有FPG、HbA1c、C肽与LVEF呈负相关(P<0.05)。结论非糖尿病及糖尿病CHF患者的FPG、HbA1c及C肽水平均有所升高,三项指标与心力衰竭严重程度存在关联性。