Insititut d'Investigacions Biomédiques August Pi i Sunyer, Barcelona, Spain.
Diabet Med. 2010 Aug;27(8):862-7. doi: 10.1111/j.1464-5491.2010.02967.x.
Much attention has been paid recently to the possibility that oscillating glucose may superimpose on glycated haemoglobin (HbA(1c)) in determining the risk for diabetes complications. Furthermore, recent evidence suggests that glucose variability, particularly if accompanied by frequent hypoglycaemic episodes, may adversely alter the prognosis of acutely ill patients. In vitro and animal studies confirm that oscillating glucose is more dangerous than stable constant high glucose, particularly in activating the pathways involved in the pathogenesis of diabetes complications. The production of free radicals, accompanied by an insufficient increase in intracellular antioxidant defences, seems to account for this phenomenon. In humans, studies also confirm that fluctuating glucose levels produce an increase in free radicals as well as endothelial dysfunction, and that these changes are greater than those produced by stable high glucose. Avoiding glucose fluctuations in diabetic patients and in critically ill patients seems to be an emerging therapeutic challenge.
最近，人们越来越关注血糖波动是否会与糖化血红蛋白（HbA1c）共同作用，从而增加糖尿病并发症的风险。此外，最近的证据表明，葡萄糖变异性，特别是伴有频繁低血糖发作，可能会对急性疾病患者的预后产生不利影响。体外和动物研究证实，血糖波动比稳定的高血糖更危险，特别是在激活糖尿病并发症发病机制相关途径方面。自由基的产生，伴随着细胞内抗氧化防御的不足增加，似乎解释了这一现象。在人类中，研究也证实波动的血糖水平会增加自由基和内皮功能障碍，并且这些变化比稳定的高血糖产生的变化更大。避免糖尿病患者和危重病患者的血糖波动似乎是一个新的治疗挑战。
