[2型糖尿病患者餐后血糖状态的特征]

[The features of postprandial glucose state in type 2 diabetes mellitus].

作者信息

Zhou Jian, Jia Wei-ping, Yu Ming, Ma Xiao-jing, Bao Yu-qian, Lu Wei

机构信息

Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Sixth People's Hospital, Jiaotong University, Shanghai 200233, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2006 Apr 11;86(14):970-5.

DOI:

PMID:16759538

Abstract

OBJECTIVE

To study the features of postprandial glucose state in individuals with normal glucose regulation (NGR) and type 2 diabetes (T2DM) and the relations between hemoglobin A1c (HbA1c) and postprandial glucose in T2DM.

METHODS

41 NGR individuals and 60 newly diagnosed T2DM patients without previous management in Shanghai were measured by continuous glucose monitoring system for 3 days. The postprandial glucose spike (PGS), time to PGS (Deltat), postprandial glucose excursion (PPGE), duration of postprandial glucose (DUR) and incremental area under the curve of postprandial glucose (IAUC) were calculated in each individual.

RESULTS

(1) The levels of PGS and Deltat in the T2DM group were significantly higher than those of the NGR group (all P < 0.01). The levels of PPGE, DUR and IAUC of the T2DM group were 5.87 mmol/L +/- 0.19 mmol/L, 14.1 h +/- 0.3 h and 2.04 mmol.L(-1).d +/- 0.09 mmol.L(-1).d respectively, all significantly higher than those of the NGR group (2.10 mmol/L +/- 0.12 mmol/L, 8.3 h +/- 0.4 h and 0.43 mmol.L(-1).d +/- 0.03 mmol.L(-1).d respectively, all P < 0.01). The breakfast had higher PGS and lower Deltat than those of lunch and dinner in the T2DM group (both P < 0.01). The PPGE was arranged from high to low in the order of breakfast, dinner and lunch. The highest IAUC appeared during dinner. (2) There was a significantly correlation between PPGE and IAUC (r = 0.93, P < 0.01) in the T2DM group. After being adjusted by preprandial glucose, the partial correlation of HbA1c and IAUC disappeared (before r = 0.29, P = 0.03, after P = 0.05). (3) The relative contribution of postprandial glucose to overall glucose levels in the T2DM group was significantly higher than that of the NGR group (18.1% +/- 0.8% vs 8.0% +/- 0.7%, P < 0.01), but both were significantly lower than those of preprandial glucose. (4) Relative contribution of postprandial hyperglycemia to overall diurnal hyperglycemia decreased progressively from the lowest to the highest quarter of HbA1c. By contrast, the relative contribution of preprandial hyperglycemia showed a significant increase with increasing levels of HbA1c. Postprandial hyperglycemia played a major role when the HbA1c level below 7.5% (P < 0.05).

CONCLUSION

(1) The features of postprandial glucose state in T2DM is representative in the delay of PGS and excessive glucose excursion for a long time after the ingestion of a meal. (2) HbA1c can't reflect postprandial glucose excursions. PPGE can be used as a simple clinic index to evaluate the amplitude of postprandial glucose excursions. (3) Postprandial glucose excursions play a major role in T2DM suffering from mild or moderate hyperglycemia. The present results suggest that postprandial hyperglycemia is an important target for intervention when T2DM patients are approaching the ideal glycemic control.

摘要

目的

研究血糖正常调节（NGR）个体和2型糖尿病（T2DM）患者的餐后血糖状态特征，以及T2DM患者糖化血红蛋白（HbA1c）与餐后血糖的关系。

方法

采用连续血糖监测系统对上海41例NGR个体和60例未接受过治疗的新诊断T2DM患者进行为期3天的测量。计算每个个体的餐后血糖峰值（PGS）、达到PGS的时间（Deltat）、餐后血糖波动（PPGE）、餐后血糖持续时间（DUR）和餐后血糖曲线下增量面积（IAUC）。

结果

（1）T2DM组的PGS和Deltat水平显著高于NGR组（均P<0.01）。T2DM组的PPGE、DUR和IAUC水平分别为5.87 mmol/L±0.19 mmol/L、14.1 h±0.3 h和2.04 mmol·L⁻¹·d±0.09 mmol·L⁻¹·d，均显著高于NGR组（分别为2.10 mmol/L±0.12 mmol/L、8.3 h±0.4 h和0.43 mmol·L⁻¹·d±0.03 mmol·L⁻¹·d，均P<0.01）。T2DM组早餐的PGS高于午餐和晚餐，Deltat低于午餐和晚餐（均P<0.01）。PPGE从高到低依次为早餐、晚餐和午餐。晚餐时IAUC最高。（2）T2DM组中PPGE与IAUC之间存在显著相关性（r = 0.93，P<0.01）。经餐前血糖校正后，HbA1c与IAUC的偏相关性消失（校正前r = 0.29，P = 0.03；校正后P = 0.05）。（3）T2DM组餐后血糖对总体血糖水平的相对贡献显著高于NGR组（18.1%±0.8%对8.0%±0.7%，P<0.01），但两者均显著低于餐前血糖。（4）餐后高血糖对总体日间高血糖的相对贡献从HbA1c最低的四分之一到最高的四分之一逐渐降低。相反，餐前高血糖的相对贡献随HbA1c水平升高而显著增加。当HbA1c水平低于7.5%时，餐后高血糖起主要作用（P<0.05）。

结论

（1）T2DM患者餐后血糖状态的特征表现为PGS延迟和进食后长时间过度血糖波动。（2）HbA1c不能反映餐后血糖波动。PPGE可作为评估餐后血糖波动幅度的简单临床指标。（3）餐后血糖波动在轻度或中度高血糖的T2DM患者中起主要作用。目前的结果表明，当T2DM患者接近理想血糖控制时，餐后高血糖是一个重要的干预靶点。