2 型糖尿病的黎明现象：如何在临床实践中评估它？

The dawn phenomenon in type 2 diabetes: how to assess it in clinical practice?

机构信息

Institute of Clinical Research, University Montpellier 1, France.

出版信息

Diabetes Metab. 2015 Apr;41(2):132-7. doi: 10.1016/j.diabet.2014.10.002. Epub 2014 Nov 6.

DOI:10.1016/j.diabet.2014.10.002

PMID:25457475

Abstract

AIM

The study was aimed at determining whether the dawn phenomenon in type 2 diabetes (T2D) can be predicted and quantified using simple and easily accessible glucose determinations.

METHODS

A total of 210 non-insulin-treated persons with T2D underwent continuous glucose monitoring (CGM). The dawn phenomenon was quantified as the absolute increment from the nocturnal glucose nadir to the pre-breakfast value (Δdawn, mg/dL). Pre-lunch (preL) and pre-dinner (preD) glucose, and their averaged values (preLD), were compared with the nocturnal nadir. These pre-meal values were subtracted from the pre-breakfast values. The differences obtained (Δpre-mealL, Δpre-meal D and Δpre-meal LD) were correlated with Δdawn values. The receiver operating characteristic (ROC) curve was used to select the optimal Δpre-meal value that best predicted a dawn phenomenon, set at a threshold of 20mg/dL.

RESULTS

All pre-meal glucose levels and differences from pre-breakfast values (Δpre-meal) significantly correlated (P<0.0001) with the nocturnal nadir and Δdawn values, respectively. The strongest correlations were observed for the parameters averaged at preL and preD time points: r=0.83 for preLD and r=0.58 for Δpre-meal LD. ROC curve analysis indicated that the dawn phenomenon at a threshold of 20mg/dL can be significantly predicted by a Δpre-meal LD cut off value of 10mg/dL. The relationship between Δdawn (Y, mg/dL) and Δpre-meal LD (X, mg/dL) was Y=0.49 X+15.

CONCLUSION

The self-monitoring of preprandial glucose values at the three main mealtimes can predict the presence/absence of the dawn phenomenon, and permits reliable assessment of its magnitude without requiring continuous overnight glucose monitoring.

摘要

目的

本研究旨在确定是否可以使用简单且易于获得的血糖测定来预测和量化 2 型糖尿病（T2D）中的黎明现象。

方法

共对 210 例未接受胰岛素治疗的 T2D 患者进行了连续血糖监测（CGM）。将黎明现象定义为从夜间血糖最低点到早餐前值的绝对增加量（Δdawn，mg/dL）。比较了午餐前（preL）和晚餐前（preD）的血糖及其平均值（preLD）与夜间最低点的关系。将这些餐前值从早餐前值中减去。得到的差值（Δpre-mealL、Δpre-meal D 和 Δpre-meal LD）与Δdawn 值相关。使用受试者工作特征（ROC）曲线选择最佳的餐前值，最佳餐前值预测黎明现象的阈值设定为 20mg/dL。

结果

所有餐前血糖水平及其与早餐前值的差值（Δpre-meal）与夜间最低点和Δdawn 值均呈显著相关（P<0.0001）。在 preL 和 preD 时间点平均参数中观察到最强的相关性：preLD 的 r 值为 0.83，Δpre-meal LD 的 r 值为 0.58。ROC 曲线分析表明，以 20mg/dL 为阈值，Δpre-meal LD 的截断值为 10mg/dL 时，可以显著预测黎明现象。Δdawn（Y，mg/dL）与Δpre-meal LD（X，mg/dL）之间的关系为 Y=0.49 X+15。