Rodríguez de Castro Carmen, Vigil Luis, Vargas Borja, García Delgado Emilio, García Carretero Rafael, Ruiz-Galiana Julián, Varela Manuel
Internal Medicine, Hospital Universitario de Mostoles, Mostoles, Spain.
Internal Medicine, Universidad Europea de Madrid, Madrid, Spain.
Diabetes Metab Res Rev. 2017 Feb;33(2). doi: 10.1002/dmrr.2831. Epub 2016 Jun 30.
Complexity analysis of glucose profile may provide valuable information about the gluco-regulatory system. We hypothesized that a complexity metric (detrended fluctuation analysis, DFA) may have a prognostic value for the development of type 2 diabetes in patients at risk.
A total of 206 patients with any of the following risk factors (1) essential hypertension, (2) obesity or (3) a first-degree relative with a diagnosis of diabetes were included in a survival analysis study for a diagnosis of new onset type 2 diabetes. At inclusion, a glucometry by means of a Continuous Glucose Monitoring System was performed, and DFA was calculated for a 24-h glucose time series. Patients were then followed up every 6 months, controlling for the development of diabetes.
In a median follow-up of 18 months, there were 18 new cases of diabetes (58.5 cases/1000 patient-years). DFA was a significant predictor for the development of diabetes, with ten events in the highest quartile versus one in the lowest (log-rank test chi2 = 9, df = 1, p = 0.003), even after adjusting for other relevant clinical and biochemical variables. In a Cox model, the risk of diabetes development increased 2.8 times for every 0.1 DFA units. In a multivariate analysis, only fasting glucose, HbA and DFA emerged as significant factors.
Detrended fluctuation analysis significantly performed as a harbinger of type 2 diabetes development in a high-risk population. Complexity analysis may help in targeting patients who could be candidates for intensified treatment. Copyright © 2016 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
血糖谱的复杂性分析可为葡萄糖调节系统提供有价值的信息。我们推测一种复杂性指标（去趋势波动分析，DFA）可能对有风险的2型糖尿病患者的病情发展具有预后价值。
共有206例具有以下任何一种风险因素的患者纳入生存分析研究，以诊断新发2型糖尿病：（1）原发性高血压；（2）肥胖症；（3）有糖尿病诊断的一级亲属。纳入研究时，通过连续血糖监测系统进行一次血糖检测，并计算24小时血糖时间序列的DFA。随后每6个月对患者进行随访，监测糖尿病的发生情况。
在中位随访18个月期间，有18例新发糖尿病病例（58.5例/1000患者年）。DFA是糖尿病发生的显著预测指标，最高四分位数组有10例事件发生，而最低四分位数组只有1例（对数秩检验chi2 = 9，自由度 = 1，p = 0.003），即使在调整了其他相关临床和生化变量之后也是如此。在Cox模型中，每0.1个DFA单位，糖尿病发生风险增加2.8倍。在多变量分析中，只有空腹血糖、糖化血红蛋白和DFA是显著因素。
在高危人群中，去趋势波动分析是2型糖尿病病情发展的显著预兆。复杂性分析可能有助于确定可作为强化治疗候选对象的患者。版权所有© 2016作者。由John Wiley & Sons Ltd出版的《糖尿病/代谢研究与评论》
