Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Sichuan, China.
Clin Endocrinol (Oxf). 2012 Jun;76(6):810-5. doi: 10.1111/j.1365-2265.2011.04205.x.
Glycemic variability is poorly studied in the nondiabetic individuals and newly diagnosed patients with type 2 diabetes. The aim of the study is to investigate the characteristics of glucose fluctuations in subjects with normal glucose tolerance (NGT), impaired glucose regulation (IGR) and newly diagnosed, drug-naïve type 2 diabetes mellitus (DM-2).
This is a cross-sectional study of three groups including 53 subjects with IGR, 56 DM-2 patients and 53 NGT individuals. Monitoring by a continuous glucose monitoring system (CGMS(®) System Gold(™)) was performed for three consecutive days.
Mean blood glucose (MBG), standard deviation of MBG (SDBG), largest amplitude of glycemic excursions (LAGE) and mean amplitude of glycemic excursions (MAGE) were calculated to estimate intraday blood glucose variability. Interday variability of glucose was evaluated by absolute means of daily differences (MODD). Postprandial glucose excursion (PPGE) was calculated to assess the influence of meals on glucose fluctuation.
Twenty-two percentage of NGT and 33.9% of IGR individuals experienced blood glucose ≥ 11.1 mmol/l; 49.1% of NGT, 50.9% of IGR and 30.8% of DM-2 participants had hypoglycemic episodes (CGM values <3.9 mmol/l). The IGR and DM-2 groups had greater SDBG (P = 0.010 and P < 0.001), LAGE (P = 0.014 and P < 0.001) and MAGE (P = 0.044 and P < 0.001) compared with the NGT group. Significantly greater MODD and PPGEs were found in the DM-2 groups than in the IGR and NGT groups (P < 0.001). The DM-2 patients had higher 72-MBG and glucose levels overnight than the NGT and IGR subjects (P < 0.001). In the patients with diabetes, MAGE was positively associated with MODD (r = 0.558, P < 0.001) and PPGEs (r = 0.738-0.843, P < 0.001).
Glucose variability is present to an increasing degree from NGT to IGR and IGR to DM-2. Compared with the NGT individuals, the IGR and DM-2 subjects show more predominant intraday glucose fluctuations. The DM-2 patients demonstrate increased PPGEs, higher glucose levels overnight and greater interday fluctuations.
血糖变异性在非糖尿病个体和新诊断的 2 型糖尿病患者中研究甚少。本研究旨在探讨正常糖耐量（NGT）、糖调节受损（IGR）和新诊断、未经药物治疗的 2 型糖尿病（DM-2）患者血糖波动的特征。
这是一项包括 53 例 IGR 患者、56 例 DM-2 患者和 53 例 NGT 个体的三组横断面研究。连续 3 天通过连续血糖监测系统（CGMS(®) System Gold(™)）进行监测。
计算平均血糖（MBG）、MBG 的标准差（SDBG）、最大血糖波动幅度（LAGE）和平均血糖波动幅度（MAGE），以评估日内血糖变异性。通过每日平均差异（MODD）评估日间血糖变异性。计算餐后血糖波动（PPGE）以评估进餐对血糖波动的影响。
22%的 NGT 和 33.9%的 IGR 个体的血糖≥11.1mmol/l；49.1%的 NGT、50.9%的 IGR 和 30.8%的 DM-2 参与者出现低血糖发作（CGM 值<3.9mmol/l）。与 NGT 组相比，IGR 和 DM-2 组的 SDBG（P=0.010 和 P<0.001）、LAGE（P=0.014 和 P<0.001）和 MAGE（P=0.044 和 P<0.001）更高。与 IGR 和 NGT 组相比，DM-2 组的 MODD 和 PPGE 显著更高（P<0.001）。DM-2 患者的 72-MBG 和夜间血糖水平高于 NGT 和 IGR 患者（P<0.001）。在糖尿病患者中，MAGE 与 MODD（r=0.558，P<0.001）和 PPGE（r=0.738-0.843，P<0.001）呈正相关。
从 NGT 到 IGR 再到 DM-2，血糖变异性呈递增趋势。与 NGT 个体相比，IGR 和 DM-2 患者的日内血糖波动更为明显。DM-2 患者的 PPGE 增加，夜间血糖水平升高，日间波动更大。
