Huang I-Chin, Wang Pei-Wen, Liu Rue-Tsuan, Tung Shih-Chen, Chen Jung-Fu, Kuo Ming-Chun, Hsieh Ching-Jung
Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
Chang Gung Med J. 2012 Jan-Feb;35(1):46-53. doi: 10.4103/2319-4170.106167.
A fluctuating blood glucose level is one of the risks of chronic complications in diabetes. Previous studies indicated that hemoglobin A1c (HbA1c) values apparently improved after initiation of self-monitoring blood glucose (SMBG). The purpose of this study is to investigate the relationship between the frequency of SMBG, long-term fluctuatation of HbA1c, and risks of chronic complications in diabetes.
We enrolled 1052 patients with type 2 diabetes. The mean follow-up was 4.7 years. The HbA1c level and frequency of SMBG were recorded every 3 months. Non-mydriatic retinal photography, semiquantitative neuropathy assessment, the lipid profile, serum creatinine level, and urine protein were measured at the beginning of the study and then every year. The fluctuation in HbA1c throughout the period was expressed as the standard deviations (SDs) of all measurements of the HbA1c.
The frequency of SMBG was significantly and negatively correlated with the SDs of the HbA1c (r = -0.553, p < 0.001) but not with the average HbA1c. After controlling for age, sex, body mass index, duration of diabetes and comorbidities (dyslipidemia and hypertension), the correlation was still apparent (r = -0.511, p = 0.008). Patients with progression of nephropathy, neuropathy, and retinopathy, exhibited greater fluctuation of HbA1cs (2.38 ± 0.99 vs. 0.93 ± 1.16, p-value 0.002; 0.97 ± 1.59 vs. 0.90 ± 0.56, p-value 0.04; 0.99 ± 1.33 vs. 0.90 ± 0.56, p-value 0.04, respectively) and less frequent SMBG (3.2 ± 2.6 vs. 4.3 ± 3.1, p-value 0.02; 3.2 ± 2.6 vs. 4.1 ± 3.9, p-value 0.05; 3.0 ± 3.1 vs. 4.2 ± 2.8, p-value 0.01, respectively) than patients without progression of these complications.
This study shows that frequent SMBG decreased the fluctuation of HbA1c and decreased microvascular complications. Decreasing fluctuation of HbA1c may play an important role in diabetes treatment.
血糖水平波动是糖尿病慢性并发症的风险之一。既往研究表明，开始自我血糖监测（SMBG）后糖化血红蛋白（HbA1c）值明显改善。本研究的目的是探讨SMBG频率、HbA1c的长期波动与糖尿病慢性并发症风险之间的关系。
我们纳入了1052例2型糖尿病患者。平均随访时间为4.7年。每3个月记录一次HbA1c水平和SMBG频率。在研究开始时及之后每年测量非散瞳视网膜照相、半定量神经病变评估、血脂谱、血清肌酐水平和尿蛋白。整个期间HbA1c的波动以HbA1c所有测量值的标准差（SDs）表示。
SMBG频率与HbA1c的SDs显著负相关（r = -0.553，p < 0.001），但与平均HbA1c无关。在控制年龄、性别、体重指数、糖尿病病程和合并症（血脂异常和高血压）后，这种相关性仍然明显（r = -0.511，p = 0.008）。与未发生这些并发症进展的患者相比，发生肾病、神经病变和视网膜病变进展的患者HbA1c波动更大（分别为2.38±0.99对0.93±1.16，p值0.002；0.97±1.59对0.90±0.56，p值0.04；0.99±1.33对0.90±0.56，p值0.04），SMBG频率更低（分别为3.2±2.6对4.3±3.1，p值0.02；3.2±2.6对4.1±3.9，p值0.05；3.0±3.1对4.2±2.8，p值0.01）。
本研究表明，频繁的SMBG可降低HbA1c的波动并减少微血管并发症。降低HbA1c的波动可能在糖尿病治疗中起重要作用。
