Department of Endocrinology, Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China.
Chin Med J (Engl). 2011 Jan;124(1):144-7.
Glycemic variability, an HbA1c-independent risk factor, has more deleterious effects than sustained hyperglycemia in the development of diabetic complications. This study analyzed the characteristics of glycemic variability in type 2 diabetes mellitus (T2DM) with HbA1c < 6.5% in duration of twice daily premixed insulin treatment and the effect of further treatment with acarbose.
Eighty-six T2DM patients who used premixed insulin analogue (insulin aspart 30) twice daily and had HbA1c < 6.5% and 20 controlled subjects with normal glucose regulation (NGR) were monitored using the continuous glucose monitoring (CGM) system. The mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD) were used for assessing intra-day, inter-day glycemic variability. Hypoglycemia was defined as glucose level < 3.9 mmol/L for at least 15 minutes in CGM. According to reference values of MAGE, T2DM patients were classified into two groups: low-MAGE group with MAGE < 3.4 mmol/L (L-MAGE) and high-MAGE group with MAGE ≥ 3.4 mmol/L (H-MAGE). H-MAGE group received further treatment with acarbose for 2 weeks and was monitored a second time with CGM system.
After first CGM, L-MAGE group had 41 cases, and H-MAGE group had 45 cases. The MAGE and MODD of T2DM group were all higher than those of subjects with NGR (P < 0.01). Twenty-four percent (n = 11) in H-MAGE group had a total of 13 hypoglycemic events, 10 of the 13 events occurred at night, meanwhile 5% (n = 2) in L-MAGE group had a total of 2 hypoglycemic events, which also occurred at night (hypoglycemic events: 24% vs. 5%, χ(2) = 6.40, P < 0.01). MAGE value was correlated with hypoglycemia value and 2-hour postprandial plasma glucose value (r = -0.32 and 0.26, respectively, P < 0.05). After further acarbose therapy and secondly CGM, MAGE and MODD values in H-MAGE group were all significantly decreased (40%, P < 0.01, and 15%, P < 0.05, respectively), but remained higher than in the subjects with NGR (P < 0.05); 2% (n = 1) had a total of 1 hypoglycemic event, incidence significantly decreased (2% vs. 24%, χ(2) = 9.61, P < 0.01).
CGM system can detect the glycemic variability and asymptomatic hypoglycemic events of T2DM with well-controlled HbA1c in duration of insulin treatment. Combination therapy of premixed insulin twice daily with acarbose can flat glycemic variability and decrease hypoglycemic events.
血糖波动是糖化血红蛋白（HbA1c）以外的独立危险因素，其在糖尿病并发症的发展过程中造成的危害甚于持续高血糖。本研究分析了接受预混胰岛素（胰岛素门冬 30）每日两次治疗且 HbA1c＜6.5%的 2 型糖尿病（T2DM）患者的血糖波动特征，以及阿卡波糖进一步治疗的效果。
使用连续血糖监测（CGM）系统监测 86 例接受预混胰岛素类似物（门冬胰岛素 30）每日两次治疗且 HbA1c＜6.5%的 T2DM 患者和 20 例血糖控制正常（NGR）的对照者。采用血糖波动幅度（MAGE）、日间血糖平均差（MODD）评估日内和日间血糖波动。CGM 中血糖＜3.9mmol/L 至少 15min 定义为低血糖。根据 MAGE 的参考值，将 T2DM 患者分为两组：MAGE＜3.4mmol/L（低 MAGE 组，L-MAGE）和≥3.4mmol/L（高 MAGE 组，H-MAGE）。H-MAGE 组接受阿卡波糖进一步治疗 2 周，并再次使用 CGM 系统监测。
第一次 CGM 后，L-MAGE 组有 41 例，H-MAGE 组有 45 例。T2DM 组的 MAGE 和 MODD 均高于 NGR 组（P＜0.01）。H-MAGE 组中有 24%（n＝11）共发生 13 次低血糖事件，其中 10 次发生在夜间，而 L-MAGE 组中仅有 5%（n＝2）共发生 2 次低血糖事件，也发生在夜间（低血糖事件：24%比 5%，χ(2)＝6.40，P＜0.01）。MAGE 值与低血糖值和餐后 2h 血糖值呈负相关（r＝-0.32 和 0.26，P＜0.05）。接受阿卡波糖进一步治疗和第二次 CGM 后，H-MAGE 组的 MAGE 和 MODD 值均显著降低（40%，P＜0.01 和 15%，P＜0.05），但仍高于 NGR 组（P＜0.05）；发生 1 次低血糖事件，发生率显著降低（2%比 24%，χ(2)＝9.61，P＜0.01）。
CGM 系统可检测血糖控制良好且接受胰岛素治疗的 HbA1c＜6.5%的 T2DM 患者的血糖波动和无症状性低血糖事件。预混胰岛素每日两次联合阿卡波糖治疗可使血糖波动变平，减少低血糖事件。
