Laboratory of Human Nutrition and Atherosclerosis, Institute of Clinical Research of Montpellier I, Montpellier, France.
Diabetes Technol Ther. 2011 Aug;13(8):813-8. doi: 10.1089/dia.2011.0049. Epub 2011 May 11.
The present study was designed to define the relative contributions of glucose variability and ambient glycemia to the incidence of asymptomatic hypoglycemia in type 2 diabetes.
Two hundred twenty-two persons with type 2 diabetes were divided into three groups: Group I (n = 53) on insulin sensitizers alone, Group II (n = 87) on oral hypoglycemic agents (OHAs) to include at least one insulin secretagogue, and Group III (n = 82) on insulin alone or in combination with OHAs. Ambient mean glucose concentration (MG) values (in mmol/L) and glycemic variability (SD around the mean glucose value) (in mmol/L) or mean amplitude of glycemic excursions (in mmol/L) were assessed by a continuous glucose monitoring system. Asymptomatic hypoglycemia was recorded over a 48-h period. Poisson regression analysis was used for assessing the potential predictors of hypoglycaemia.
The best model fit was obtained with the two following explanatory variables: MG and SD. Hypoglycemia frequency was negatively associated with MG and positively with SD: Log (number of hypoglycemia episodes) = 1.37 - (0.72 × MG) + (1.33 × SD). Odds ratios (95% confidence interval) for hypoglycemic risk were significantly different from 1 for MG at 0.96 (0.95-0.97) (P < 0.0001) and for SD at 1.08 (1.06-1.10) (P < 0.0001). In addition, the risk for hypoglycemia was completely or virtually eliminated when the SD was <1.7 mmol/L irrespective of the ambient glucose level and treatment modality.
As the risk of asymptomatic hypoglycemia increases in the presence of increased glucose variability, avoidance of excess glucose fluctuations should be an important consideration for either reducing or preventing the risk of hypoglycemia in type 2 diabetes.
本研究旨在确定血糖波动和环境血糖对 2 型糖尿病无症状性低血糖发生的相对贡献。
将 222 例 2 型糖尿病患者分为三组：I 组（n=53）单独使用胰岛素增敏剂，II 组（n=87）使用包括至少一种胰岛素分泌剂的口服降糖药（OHA），III 组（n=82）单独使用胰岛素或与 OHA 联合使用。通过连续血糖监测系统评估环境平均血糖浓度（MG）值（mmol/L）和血糖变异性（均值周围的血糖值标准差，mmol/L）或平均血糖波动幅度（mmol/L）。记录 48 小时内无症状性低血糖发生情况。采用泊松回归分析评估低血糖的潜在预测因素。
最佳模型拟合采用以下两个解释变量：MG 和 SD。低血糖发生频率与 MG 呈负相关，与 SD 呈正相关：Log（低血糖发作次数）=1.37-（0.72×MG）+（1.33×SD）。MG 的比值比（95%置信区间）为 0.96（0.95-0.97）（P＜0.0001），SD 的比值比为 1.08（1.06-1.10）（P＜0.0001），低血糖风险显著不同于 1。此外，当 SD＜1.7mmol/L 时，无论环境血糖水平和治疗方式如何，低血糖风险几乎完全消除。
由于血糖波动增加时无症状性低血糖的风险增加，因此避免血糖波动过大应是降低或预防 2 型糖尿病低血糖风险的重要考虑因素。
