Department of Medical and Surgical Sciences, University of Padova, Via Giustiniani n 2, 35128 Padua, Italy.
Acta Diabetol. 2012 Dec;49 Suppl 1:S153-60. doi: 10.1007/s00592-012-0391-4. Epub 2012 Apr 1.
Glucose variability has recently been investigated in diabetic patients in several studies, but most of them considered only a few variability indicators and did not systematically correlate them with patients' HbA1c levels and other important characteristics. In thus study, the correlations between HbA1c levels and metabolic control (average glucose, AG), glucose variability (SD, CONGA, MAGE, MODD, BG ROC), hyperglycemia (HBGI), hypoglycemia (LBGI) and postprandial (AUC PP) indices were investigated in patients with type 1 and type 2 diabetes. The study involved 68 patients divided into 3 groups as follows: 35 patients had type 1 diabetes (group 1); 17 had type 2 diabetes and were taking multiple daily injections (MDI) of insulin (group 2); and 16 patients had type 2 diabetes treated with OHA and/or basal insulin (group 3). The indicators were obtained over at least 48 h using a continuous glucose monitoring (CGM) system. HbA1c levels were measured at the baseline and after CGM. HbA1c correlated significantly with AG (r = 0.74), AUC PP (r = 0.69) and HBGI (r = 0.74), but only in type 1 diabetic patients. Patients with longstanding disease and type 1 diabetes had a greater glucose variability, irrespective of their HbA1c levels. Insulin therapy with MDI correlated strongly with HbA1c, but not with glucose variability. HbA1c levels identify states of sustained hyperglycemia and seem to be unaffected by hypoglycemic episodes or short-lived glucose spikes, consequently revealing shortcomings as a "gold standard" indicator of metabolic control. Glucose variability indicators describe the glucose profile of type 1 diabetic patients and identify any worsening glycemic control (typical of longstanding diabetes) more accurately than HbA1c tests.
血糖变异性最近在几项研究中被研究过，但大多数研究只考虑了几个变异性指标，并且没有系统地将其与患者的 HbA1c 水平和其他重要特征相关联。在这项研究中，我们研究了 1 型和 2 型糖尿病患者的 HbA1c 水平与代谢控制（平均血糖，AG）、血糖变异性（SD、CONGA、MAGE、MODD、BG ROC）、高血糖（HBGI）、低血糖（LBGI）和餐后（AUC PP）指标之间的相关性。研究涉及 68 名患者，分为以下 3 组：35 名患者患有 1 型糖尿病（组 1）；17 名患者患有 2 型糖尿病并接受多次每日胰岛素注射（MDI）（组 2）；16 名患者患有 2 型糖尿病，接受 OHA 和/或基础胰岛素治疗（组 3）。使用连续血糖监测（CGM）系统至少 48 小时获得这些指标。在 CGM 前后测量 HbA1c 水平。HbA1c 与 AG（r = 0.74）、AUC PP（r = 0.69）和 HBGI（r = 0.74）显著相关，但仅在 1 型糖尿病患者中如此。患有长期疾病和 1 型糖尿病的患者血糖变异性更大，而不管他们的 HbA1c 水平如何。MDI 胰岛素治疗与 HbA1c 密切相关，但与血糖变异性无关。HbA1c 水平可识别持续性高血糖状态，并且似乎不受低血糖发作或短暂性血糖峰值的影响，因此作为代谢控制的“金标准”指标存在缺陷。血糖变异性指标描述了 1 型糖尿病患者的血糖特征，并且比 HbA1c 检测更准确地识别任何血糖控制恶化（典型的长期糖尿病）。
