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连续血糖监测(CGM)评估的血糖临床标志物与血糖波动之间的关系。

Relationship between clinical markers of glycemia and glucose excursion evaluated by continuous glucose monitoring (CGM).

机构信息

Metabolism and Endocrinology, Department of Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.

出版信息

Endocr J. 2010;57(2):135-40. doi: 10.1507/endocrj.k09e-234. Epub 2009 Nov 19.

Abstract

In order to evaluate the relationship between clinical markers of glycemia and glucose excursion, we performed 48-hour continuous glucose monitoring (CGM) in 43 diabetic patients. For the clinical markers, HbA(1c), glycoalbumin (GA), and 1,5-anhydroglucitol (1,5-AG) were measured, and for the parameters of glucose excursion from CGM, average glucose (AG), standard deviation of glucose (SD), the area under the curve for glucose levels >180 mg/dL (AUC(>180)), and the difference between the maximum and minimum glucose levels during 48 hours (DeltaG(48hr)) were analyzed. All patients were treated without any changes of the dosages of oral anti-diabetic agents or insulin for at least the previous 3 months with coefficient of variation (CV) of HbA(1c) less than 4 %. In results, while HbA(1c) did not show any single correlation with AG, SD, AUC(>180), or DeltaG(48hr), both GA and 1,5-AG were significantly related to all these parameters. Furthermore, GA significantly correlated to all CGM parameters, and SD significantly correlated to GA in multiple regression analyses. These results suggest that GA may be a different marker from HbA(1c) for diabetic complications, because GA, but not HbA(1c), may reflect not only short-term average glucose but also fluctuation of glucose.

摘要

为了评估血糖的临床标志物与血糖波动之间的关系,我们对 43 名糖尿病患者进行了 48 小时连续血糖监测(CGM)。对于临床标志物,我们测量了糖化血红蛋白(HbA(1c))、糖基化白蛋白(GA)和 1,5-脱水葡萄糖醇(1,5-AG),对于 CGM 中的血糖波动参数,我们分析了平均血糖(AG)、血糖标准差(SD)、血糖水平>180mg/dL 的曲线下面积(AUC(>180))以及 48 小时内最大和最小血糖水平之间的差值(DeltaG(48hr))。所有患者在过去 3 个月内未改变口服降糖药或胰岛素的剂量进行治疗,且 HbA(1c) 的变异系数(CV)小于 4%。结果显示,HbA(1c)与 AG、SD、AUC(>180)或 DeltaG(48hr)均无单项相关性,而 GA 和 1,5-AG 与所有这些参数均显著相关。此外,GA 与所有 CGM 参数均显著相关,SD 与 GA 在多元回归分析中也显著相关。这些结果表明,GA 可能是一种与糖尿病并发症相关的不同于 HbA(1c)的标志物,因为 GA 可能不仅反映短期平均血糖,还反映血糖波动,而不仅仅是 HbA(1c)。

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