Gordin D, Rönnback M, Forsblom C, Mäkinen V, Saraheimo M, Groop P-H
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland.
Diabetes Res Clin Pract. 2008 Jun;80(3):e4-7. doi: 10.1016/j.diabres.2008.01.010. Epub 2008 Mar 5.
Evidence suggests that chronic hyperglycaemia predicts not only microvascular disease but also macrovascular disease, however it is not known whether it is the glucose variability per se or the total glucose exposure that confers risk. The objective of this study was to investigate whether daily glucose variability influence blood pressure and arterial stiffness, an early sign of macrovascular disease, at baseline and during a hyperglycaemic clamp in patients with type 1 diabetes.
Twenty-two non-smoking male patients with type 1 diabetes without any diabetic complications, participated in the study. The patients were monitored for 72-h using a continuous glucose monitoring system. Before and during a 2-h hyperglycaemic clamp, blood pressure as well as pulse wave analysis and pulse wave velocity (PWV) were performed to assess arterial stiffness.
No correlation was observed between mean amplitude of glycaemic excursions (MAGE) and arterial stiffness at baseline. There was a correlation between mean daily glucose and aortic PWV even after adjusting for BMI, HbA(1c), and duration of diabetes in a multiple regression analysis (r=0.48; P<0.01). MAGE (r=0.52; P<0.01) correlated independently with the change in aortic DBP during the clamp.
This study suggests that high mean daily blood glucose but not glucose variability per se is associated with arterial stiffness in patients with T1D. Daily glucose variability is positively associated with the change in central blood pressure during a hyperglycaemic clamp.
有证据表明，慢性高血糖不仅可预测微血管疾病，还能预测大血管疾病，但尚不清楚是血糖变异性本身还是总的葡萄糖暴露量会带来风险。本研究的目的是调查1型糖尿病患者在基线期及高血糖钳夹期间，每日血糖变异性是否会影响血压和动脉僵硬度（大血管疾病的早期迹象）。
22名无任何糖尿病并发症的非吸烟1型糖尿病男性患者参与了本研究。使用连续血糖监测系统对患者进行72小时监测。在2小时高血糖钳夹之前和期间，测量血压以及进行脉搏波分析和脉搏波速度（PWV）测量，以评估动脉僵硬度。
在基线期，未观察到血糖波动幅度均值（MAGE）与动脉僵硬度之间存在相关性。在多元回归分析中，即使校正了体重指数、糖化血红蛋白（HbA1c）和糖尿病病程后，平均每日血糖与主动脉PWV之间仍存在相关性（r = 0.48；P < 0.01）。MAGE（r = 0.52；P < 0.01）与钳夹期间主动脉舒张压的变化独立相关。
本研究表明，1型糖尿病患者的动脉僵硬度与每日平均血糖水平高有关，而非血糖变异性本身。每日血糖变异性与高血糖钳夹期间中心血压的变化呈正相关。
