应用预混人胰岛素血糖控制良好的老年2型糖尿病患者血糖波动特点分析

Analysis of characteristics of blood glucose fluctuation in elderly type 2 diabetes patients with good blood glucose control by premixed human insulin

中文关键词: 老年  动态血糖监测  预混胰岛素  血糖波动

英文关键词: elderly  dynamic glucose monitoring  premixed insulin  blood glucose fluctuation

中文摘要:

      目的 预混人胰岛素在临床上应用广泛,但并不能完美模拟生理胰岛素分泌.本研究分析糖化血红蛋白(HbA1c)达标的老年预混人胰岛素30R应用者血糖波动的特点,为更理想的临床治疗方案提供依据.方法 选取 2020年7 月—2022 年12 月复旦大学附属华东医院内分泌科门诊HbA1c≤7.0%的2 型糖尿病(T2DM)患者共102 例,治疗方案为单用预混人胰岛素30R、合并使用二甲双胍和(或)α-糖苷酶抑制剂(AGI).安装 72h动态血糖监测,并录入人口统计学、既往病史、胰岛素剂量等数据,分析血糖波动特点以及低血糖发生情况,进一步分析血糖波动大者的危险因素.结果 (1)102 例患者中男性62 例,女性40 例,平均年龄(71.4±8.0)岁,HbA1c(6.5±0.4)%,C肽(1.6±1.0)ng/mL,2hC肽(4.2±3.2)ng/mL.(2)血糖波动特点:平均血糖波动(MAGE)(4.08±1.83)mmol/L,血糖标准差(SDBG)(1.68±0.69)mmol/L,日间血糖波动(MODD)(1.69±0.83)mmol/L,最大血糖波动(LAGE)(6.95±2.54)mmol/L,有36 例发生低血糖(35.3%),与无低血糖患者比较,发生低血糖患者AGI应用较少(P＜0.05).(3)高MAGE组患者体质量指数(BMI)较低,餐后血糖较高,2hC肽/空腹C肽比值较高,AGI应用较少(P均＜0.05).(4)MAGE与餐后血糖、2hC肽/空腹C肽比值呈正相关(r =0.246、0.200,P＜0.05),与AGI呈负相关(r =-0.273,P＜0.05).(5)2hC肽/空腹C肽比值和AGI 是血糖波动较大的影响因素.结论 应用预混人胰岛素的患者,在HbA1c达标情况下,仍有较高的血糖波动以及低血糖发生率.血糖波动大与BMI低、餐后血糖高、2hC肽/空腹C肽比值较高、AGI应用较少有关.

英文摘要:

      Objective Premixed human insulin is widely used in clinical practice,but it cannot perfectly simulate physi-ological insulin secretion.This study analyzed the characteristics of blood glucose fluctuations in elderly premixed human insu-lin 30R users who meet the standard of glycated hemoglobin(HbA1c),and provided a basis for more ideal clinical treatment plans.Methods 102 patients with type 2 diabetes mellitus(T2DM)with HbA1c≤7.0%treated in the outpatient of Depart-ment of Endocrinology of Huadong Hospital Affiliated to Fudan University from July 2020 to December 2022 were selected.Their treatment plan was to use premixed human insulin 30R alone,combined with metformin and/or α-glycosidase inhibitor(AGI).They received 72 h dynamic blood glucose monitoring.Their demographics,medical history,and insulin dosage were recorded.The characteristics of blood glucose fluctuation and the occurrence of hypoglycemia were analyzed,and the risk fac-tors of individuals with large blood glucose fluctuations were furtherly analyzed.Results(1)Among the 102 patients,62 were males and40 were females.Their mean age was(71.4±8.0)years,the HbA1c was(6.5±0.4)%,the C-peptide was(1.6±1.0)ng/mL,and 2-hour C-peptide was(4.2±3.2)ng/mL.(2)Characteristics of blood glucose fluctuations:mean amplitude of glycemic excursions(MAGE)was(4.08±1.83)mmol/L,standard deviation of blood glucose(SDBG)was(1.68±0.69)mmol/L,daytime blood glucose fluctuation was(1.69±0.83)mmol/L,and maximal blood glucose fluctua-tion was(6.95±2.54)mmol/L.36 cases(35.3%)experienced hypoglycemia.Compared with patients without hypoglyce-mia,AGI was less used in patients with hypoglycemia(P＜0.05).(3)Body mass index(BMI)was lower in the MAGE group,postprandial blood glucose was higher,the ratio of 2-hour C-peptide/fasting C-peptide was higher,and AGI was less used(all P＜0.05).(4)MAGE was positively correlated with postprandial blood glucose and the ratio of 2-hour C-peptide/fasting C-peptide(r =0.246,0.200,P＜0.05),and negatively correlated with AGI(r =-0.273,P＜0.05).(5)The ratio of 2-hour C-peptide/fasting C-peptide and AGI were the significant factors affecting blood glucose fluctuation.Conclusion Patients who use premixed premixed human insulin still have large blood glucose fluctuation and high incidence of hypoglycemia even when HbA1 c meets the standard.The large blood glucose fluctuation is related to low body mass index,high postprandial blood glucose,higher ratio of 2-hour C-peptide/fasting C-peptide,and less AGI application.