Kaufman Francine Ratner, Austin Juliana, Neinstein Aaron, Jeng Lily, Halvorson Mary, Devoe Debra J, Pitukcheewanont Pisit
Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California, USA.
J Pediatr. 2002 Nov;141(5):625-30. doi: 10.1067/mpd.2002.129175.
To use the Continuous Glucose Monitoring System (CGMS, MiniMed, Sylmar, Calif) to determine if bedtime blood glucose levels were associated with the occurrence of nocturnal hypoglycemia.
Patients (n = 47, 18 boys, mean age 11.8 +/- 4.6 years) with type 1 diabetes used CGMS for 167 nights. Data were analyzed for glucose </=40 or </=50 mg/dL, comparing bedtime blood glucose levels of </=100 or >100 mg/dL and </=150 or >150 mg/dL.
A glucose value of </=40 mg/dL occurred on 27% of nights and </=50 mg/dL on 35% of nights. There was a 2-fold increase (45% vs 22%, P =.015) in the incidence of hypoglycemia with a bedtime glucose </=100 mg/dL and a 1.7-fold increase (46% vs 26%, P =.01) with a value of </=150 mg/dL; most episodes occurred between 9 PM and 1 AM. There was no difference in hypoglycemia duration (86.4 minutes for glucose </=100 mg/dL vs 84.5 minutes for >100 mg/dL, P = NS), and no bedtime glucose value between 110 and 300 mg/dL decreased the incidence of nocturnal hypoglycemia to </=10%. The incidence of nocturnal hypoglycemia was similar for patients using insulin pump and injection therapy, and there was no correlation between hemoglobin A1c and incidence or duration of hypoglycemia.
Nocturnal hypoglycemia is frequent, of long duration, associated with bedtime glucose values </=100 to 150 mg/dL, and predominately in the early part of the night. CGMS is a useful tool to diagnose asymptomatic nocturnal hypoglycemia.
使用动态血糖监测系统（CGMS，美敦力公司，加利福尼亚州西尔玛）来确定睡前血糖水平是否与夜间低血糖的发生有关。
1型糖尿病患者（n = 47，18名男孩，平均年龄11.8±4.6岁）使用CGMS监测167个夜晚。分析血糖≤40或≤50mg/dL的数据，比较睡前血糖水平≤100或>100mg/dL以及≤150或>150mg/dL的情况。
血糖值≤40mg/dL出现在27%的夜晚，≤50mg/dL出现在35%的夜晚。睡前血糖≤100mg/dL时低血糖发生率增加2倍（45%对22%，P = 0.015），≤150mg/dL时增加1.7倍（46%对26%，P = 0.01）；大多数发作发生在晚上9点至凌晨1点之间。低血糖持续时间无差异（血糖≤100mg/dL时为86.4分钟，>100mg/dL时为84.5分钟，P = 无显著差异），睡前血糖值在110至300mg/dL之间时，夜间低血糖发生率均未降至≤10%。使用胰岛素泵和注射治疗的患者夜间低血糖发生率相似，糖化血红蛋白与低血糖的发生率或持续时间之间无相关性。
夜间低血糖很常见，持续时间长，与睡前血糖值≤100至150mg/dL有关，且主要发生在夜间早期。CGMS是诊断无症状性夜间低血糖的有用工具。
