Praet Stephan F E, Manders Ralph J F, Meex Ruth C R, Lieverse A G, Stehouwer Coen D A, Kuipers Harm, Keizer Hans A, van Loon Luc J C
Department of Movement Sciences, Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands.
Clin Sci (Lond). 2006 Aug;111(2):119-26. doi: 10.1042/CS20060041.
The aim of the present study was to assess the level of glycaemic control by the measurement of 24 h blood glucose profiles and standard blood analyses under identical nutritional and physical activity conditions in patients with Type II diabetes and healthy normoglycaemic controls. A total of 11 male patients with Type II diabetes and 11 healthy matched controls participated in a 24 h CGMS (continuous subcutaneous glucose-monitoring system) assessment trial under strictly standardized dietary and physical activity conditions. In addition, fasting plasma glucose, insulin and HbA(1c) (glycated haemoglobin) concentrations were measured, and an OGTT (oral glucose tolerance test) was performed to calculate indices of whole-body insulin sensitivity, oral glucose tolerance and/or glycaemic control. In the healthy control group, hyperglycaemia (blood glucose concentration >10 mmol/l) was hardly present (2+/-1% or 0.4+/-0.2/24 h). However, in the patients with Type II diabetes, hyperglycaemia was experienced for as much as 55+/-7% of the time (13+/-2 h over 24 h) while using the same standardized diet. Breakfast-related hyperglycaemia contributed most (46+/-7%; P<0.01 as determined by ANOVA) to the total amount of hyperglycaemia and postprandial glycaemic instability. In the diabetes patients, blood HbA(1c) content correlated well with the duration of hyperglycaemia and the postprandial glucose responses (P<0.05). In conclusion, CGMS determinations show that standard measurements of glycaemic control underestimate the amount of hyperglycaemia prevalent during real-life conditions in Type II diabetes. Given the macro- and micro-vascular damage caused by postprandial hyperglycaemia, CGMS provides an excellent tool to evaluate alternative therapeutic strategies to reduce hyperglycaemic blood glucose excursions.
本研究的目的是，在相同营养和身体活动条件下，通过测量24小时血糖谱以及标准血液分析，评估II型糖尿病患者和血糖正常的健康对照者的血糖控制水平。共有11名II型糖尿病男性患者和11名匹配的健康对照者，在严格标准化的饮食和身体活动条件下，参与了一项24小时动态血糖监测系统（CGMS）评估试验。此外，测量了空腹血糖、胰岛素和糖化血红蛋白（HbA1c）浓度，并进行了口服葡萄糖耐量试验（OGTT），以计算全身胰岛素敏感性、口服葡萄糖耐量和/或血糖控制指标。在健康对照组中，高血糖（血糖浓度>10 mmol/L）几乎不存在（2±1%或0.4±0.2/24小时）。然而，在II型糖尿病患者中，采用相同的标准化饮食时，高血糖出现的时间高达55±7%（24小时内为13±2小时）。与早餐相关的高血糖对高血糖总量和餐后血糖不稳定性的贡献最大（46±7%；方差分析确定P<0.01）。在糖尿病患者中，血液HbA1c含量与高血糖持续时间和餐后血糖反应密切相关（P<0.05）。总之，CGMS测定表明，血糖控制的标准测量低估了II型糖尿病患者在实际生活中普遍存在的高血糖量。鉴于餐后高血糖会导致大血管和微血管损伤，CGMS提供了一个很好的工具来评估替代治疗策略，以减少高血糖性血糖波动。
