Jin S-M, Kim T-H, Oh S, Baek J, Joung J Y, Park S-M, Cho Y Y, Sohn S Y, Hur K Y, Lee M-S, Lee M-K, Kim J H
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Diabet Med. 2015 Feb;32(2):274-9. doi: 10.1111/dme.12607. Epub 2014 Oct 29.
The contribution of glycaemic variability to the microvascular complication of diabetes has not been established. We examined whether there is an independent association between indices of glycaemic variability in continuous glucose monitoring and extent of albuminuria.
A total of 173 patients with Type 2 diabetes (without insulin therapy, n = 96; with insulin therapy, n = 77) who had unexplained large fluctuations in blood glucose values underwent three-day continuous glucose monitoring. We used a multinomial logistic regression model to determine whether the indices of glycaemic variability independently affected the odds of having a spot urine albumin/creatinine ratio of 30-299 mg/g and ≥ 300 mg/g.
Higher standard deviation (P = 0.002), mean of daily differences (P = 0.023) and mean amplitude of glycaemic excursion (P = 0.043) significantly increased the odds of having a urine albumin/creatinine ratio of ≥ 300 mg/g. In multivariable analysis, only higher standard deviation, but not mean amplitude of glycaemic excursion and mean of daily differences, independently increased the odds of having a urine albumin/creatinine ratio of ≥ 300 mg/g (P = 0.025). Coefficient of variation (sd/mean) was not associated with the odds of having a urine albumin/creatinine ratio of 30-299 or ≥ 300 mg/g.
The independent association between standard deviation and the extent of albuminuria was lost when the measures were normalized by mean glucose level. At least in terms of relative measures of glycaemic variability, we failed to demonstrate an independent association between glycaemic variability and albuminuria extent in patients with inadequately controlled Type 2 diabetes.
血糖变异性对糖尿病微血管并发症的影响尚未明确。我们研究了连续血糖监测中的血糖变异性指标与蛋白尿程度之间是否存在独立关联。
共有173例2型糖尿病患者（未接受胰岛素治疗者96例，接受胰岛素治疗者77例），其血糖值出现不明原因的大幅波动，接受了为期三天的连续血糖监测。我们使用多项逻辑回归模型来确定血糖变异性指标是否独立影响随机尿白蛋白/肌酐比值为30 - 299 mg/g和≥300 mg/g的几率。
较高的标准差（P = 0.002）、平均日差值（P = 0.023）和血糖波动平均幅度（P = 0.043）显著增加了尿白蛋白/肌酐比值≥300 mg/g的几率。在多变量分析中，只有较高的标准差，而不是血糖波动平均幅度和平均日差值，独立增加了尿白蛋白/肌酐比值≥300 mg/g的几率（P = 0.025）。变异系数（标准差/均值）与尿白蛋白/肌酐比值为30 - 299或≥300 mg/g的几率无关。
当测量值通过平均血糖水平进行标准化时，标准差与蛋白尿程度之间的独立关联消失。至少就血糖变异性的相对测量而言，我们未能证明血糖变异性与控制不佳的2型糖尿病患者的蛋白尿程度之间存在独立关联。
