Guillod L, Comte-Perret S, Monbaron D, Gaillard R C, Ruiz J
Service of Endocrinology, Diabetology and Metabolism,Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
Diabetes Metab. 2007 Nov;33(5):360-5. doi: 10.1016/j.diabet.2007.03.007. Epub 2007 Jul 24.
In type 1 diabetic patients (T1DM), nocturnal hypoglycaemias (NH) are a serious complication of T1DM treatment; self-monitoring of blood glucose (SMBG) is recommended to detect them. However, the majority of NH remains undetected on an occasional SMBG done during the night. An alternative strategy is the Continuous glucose monitoring (CGMS), which retrospectively shows the glycaemic profile. The aims of this retrospective study were to evaluate the true incidence of NH in T1DM, the best SMBG time to predict NH, the relationship between morning hyperglycaemia and NH (Somogyi phenomenon) and the utility of CGMS to reduce NH.
Eighty-eight T1DM who underwent a CGMS exam were included. Indications for CGMS evaluation, hypoglycaemias and correlation with morning hyperglycaemias were recorded. The efficiency of CGMS to reduce the suspected NH was evaluated after 6-9 months.
The prevalence of NH was 67% (32% of them unsuspected). A measured hypoglycaemia at bedtime (22-24 h) had a sensitivity of 37% to detect NH (OR=2.37, P=0.001), while a single measure < or =4 mmol/l at 3-hour had a sensitivity of 43% (OR=4.60, P<0.001). NH were not associated with morning hyperglycaemias but with morning hypoglycaemias (OR=3.95, P<0.001). After 6-9 months, suspicions of NH decreased from 60 to 14% (P<0.001).
NH were highly prevalent and often undetected. SMBG at bedtime, which detected hypoglycaemia had sensitivity almost equal to that of 3-hour and should be preferred because it is easier to perform. Somogyi phenomenon was not observed. CGMS is useful to reduce the risk of NH in 75% of patients.
在1型糖尿病患者（T1DM）中，夜间低血糖（NH）是T1DM治疗的严重并发症；建议通过自我血糖监测（SMBG）来检测。然而，夜间偶尔进行的SMBG仍无法检测出大多数NH。另一种策略是持续葡萄糖监测（CGMS），它能回顾性地显示血糖情况。这项回顾性研究的目的是评估T1DM中NH的真实发生率、预测NH的最佳SMBG时间、清晨高血糖与NH的关系（苏木杰现象）以及CGMS减少NH的效用。
纳入88例接受CGMS检查的T1DM患者。记录CGMS评估的指征、低血糖情况以及与清晨高血糖的相关性。在6 - 9个月后评估CGMS降低疑似NH的效果。
NH的发生率为67%（其中32%未被怀疑）。睡前（22 - 24时）测得低血糖对检测NH的敏感性为37%（OR = 2.37，P = 0.001），而3小时时单次测量血糖≤4 mmol/l的敏感性为43%（OR = 4.60，P < 0.001）。NH与清晨高血糖无关，但与清晨低血糖有关（OR = 3.95，P < 0.001）。6 - 9个月后，对NH的怀疑从60%降至14%（P < 0.001）。
NH非常普遍且常常未被检测到。睡前进行的SMBG检测低血糖的敏感性几乎与3小时检测相同，且因其操作更简便应被优先选用。未观察到苏木杰现象。CGMS对75%的患者降低NH风险有效。
