Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Endocr J. 2010;57(3):259-66. doi: 10.1507/endocrj.k09e-199. Epub 2010 Jan 19.
Studies from overseas have indicated that postprandial glucose excursions are predominant in subjects with moderate hyperglycemia, while fasting hyperglycemia become the predominant abnormality with worsening of hyperglycemia; however, few studies have yet investigated the correlation between HbA1c and fasting and/or postprandial hyperglycemia in Japanese subjects. We investigated the correlation between fasting and postprandial hyperglycemia and the overall diabetic status, as assessed by measurement of HbA1c, in Japanese patients with type 2 diabetes. Blood glucose (BG) concentrations were determined in the fasting state (8:00 A.M.), during the postprandial phases (at 10:30 A.M., 2:30 P.M. and 8:30 P.M.) and during the postabsorptive periods (at 11:30 A.M. and 17:30 P.M.) in 66 patients with type 2 diabetes who were not being treated with prandial/premixed insulins or alpha-glucosidase inhibitors. The areas under the curve above the fasting BG concentrations (AUC1) and over 110 mg/dl (AUC2) were calculated for further evaluation of the correlations of the postprandial (AUC1) and fasting (AUC2 - AUC1) BG increments to the overall diurnal hyperglycemic status. Subjects were separated into two groups using the HbA1c cutoff value of 8%. The fasting BG was not correlated with the HbA1c in the group with a HbA1c values of less than 8% (r = 0.125, p = 0.473). On the other hand, fasting hyperglycemia was strongly correlated with the HbA1c level in the group with HbA1c values of over 8.0% (r = 0.406, p = 0.023). Furthermore, postprandial hyperglycemia was strongly correlated with the HbA1c in the group with HbA1c levels less than 8.0% (r = 0.524, p = 0.001). Thus, there existed a progressive shift in the contribution of fasting and postprandial hyperglycemia to the overall hyperglycemic status with progression from moderate to severe diabetes mellitus in Japanese type 2 diabetic patients.
海外的研究表明，在血糖中度升高的患者中，餐后血糖波动占主导地位，而随着血糖恶化，空腹高血糖成为主要异常；然而，很少有研究调查日本患者的糖化血红蛋白（HbA1c）与空腹和/或餐后高血糖之间的关系。我们调查了日本 2 型糖尿病患者的空腹和餐后高血糖与通过 HbA1c 评估的整体糖尿病状态之间的关系。在未接受餐时/预混胰岛素或α-葡萄糖苷酶抑制剂治疗的 66 例 2 型糖尿病患者中，测定空腹状态（上午 8:00）、餐后阶段（上午 10:30、下午 2:30 和晚上 8:30）以及吸收后阶段（上午 11:30 和下午 17:30）的血糖（BG）浓度。进一步评估餐后（AUC1）和空腹（AUC2-AUC1）BG 增量与整个日间高血糖状态的相关性时，计算了空腹 BG 浓度以上的曲线下面积（AUC1）和 110mg/dl 以上的曲线下面积（AUC2）。将患者根据 HbA1c 切点值 8%分为两组。在 HbA1c 值低于 8%的组中，空腹 BG 与 HbA1c 不相关（r=0.125，p=0.473）。另一方面，在 HbA1c 值大于 8.0%的组中，空腹高血糖与 HbA1c 水平呈强相关（r=0.406，p=0.023）。此外，在 HbA1c 值小于 8.0%的组中，餐后高血糖与 HbA1c 呈强相关（r=0.524，p=0.001）。因此，在日本 2 型糖尿病患者中，随着从中度糖尿病向严重糖尿病的进展，空腹和餐后高血糖对整体高血糖状态的贡献逐渐发生变化。
