Li Wei, Du Si-Na, Shi Min-Jia, Sun Zhan-Zhan
Department of Endocrinology, Cixi People's Hospital (Affiliated Cixi Hospital, Wenzhou Medical University), Cixi, China.
Medicine (Baltimore). 2016 Nov;95(47):e5440. doi: 10.1097/MD.0000000000005440.
Blood glucose fluctuations have higher risk than absolute blood glucose level in diabetic chronic complications. At present, "dawn phenomenon" is well known by clinicians, but "dusk phenomenon" has not been recognized. This study explored the objective existence of "dusk phenomenon" (spontaneous and transient predinner hyperglycemia) and its clinical significance.The data of 54 patients with diabetes, who received routine insulin pump therapy between December 2010 and October 2012 in our hospital, were retrospectively analyzed. These patients included 4 patients with type 1 diabetes mellitus (DM) (T1DM) and 50 patients with type 2 DM (T2DM). According to the difference between predinner and postlunch blood glucose levels, the 50 patients with T2DM were divided into dusk phenomenon group (4 patients, all the differences ≥0 mmol/L during insulin pump therapy), nondusk phenomenon group (12 patients, all the differences <0 mmol/L during insulin pump therapy), and suspicious group (34 patients, the differences were uncertain during insulin pump therapy). In the 4 patients with T1DM of this study, the differences all were more than 0 mmol/L during insulin pump therapy. The changes in blood glucose levels were observed, and the correlations of blood glucose level with other factors were analyzed in T1DM and T2DM patients, respectively.In T1DM patients, blood glucose level was significantly higher in predinner than in prebreakfast and prelunch (all P < 0.01), and in postdinner 2 hour than in postlunch 2 hour (P = 0.021). The predinner blood level had no significant correlations with the blood glucose level at other time points and insulin dosages (all P > 0.05). In T2DM patients, the predinner blood glucose level was significantly higher in dusk phenomenon group than in suspicious group and nondusk phenomenon group (all P < 0.05). In dusk phenomenon group, the blood glucose level remained rising from predinner to prebed, and the predinner blood glucose level was only significantly correlated with postdinner 2-hour blood glucose level (P < 0.05).The "dusk phenomenon" (spontaneous and transient predinner hyperglycemia) is an objective existence in some patients with diabetes. The predinner hyperglycemia can affect blood glucose control between postdinner and prebed. Awareness of the "dusk phenomenon" has important clinical significance.
在糖尿病慢性并发症中，血糖波动比血糖绝对值具有更高的风险。目前，“黎明现象”已为临床医生所熟知，但“黄昏现象”尚未得到认识。本研究探讨了“黄昏现象”（晚餐前自发性短暂高血糖）的客观存在及其临床意义。回顾性分析了2010年12月至2012年10月在我院接受常规胰岛素泵治疗的54例糖尿病患者的数据。这些患者包括4例1型糖尿病（T1DM）患者和50例2型糖尿病（T2DM）患者。根据午餐后与晚餐前血糖水平的差异，将50例T2DM患者分为黄昏现象组（4例，胰岛素泵治疗期间所有差异≥0 mmol/L）、非黄昏现象组（12例，胰岛素泵治疗期间所有差异<0 mmol/L）和可疑组（34例，胰岛素泵治疗期间差异不确定）。本研究的4例T1DM患者在胰岛素泵治疗期间差异均大于0 mmol/L。分别观察了T1DM和T2DM患者的血糖水平变化，并分析了血糖水平与其他因素的相关性。在T1DM患者中，晚餐前血糖水平显著高于早餐前和午餐前（均P<0.01），晚餐后2小时血糖水平高于午餐后2小时（P=0.021）。晚餐前血糖水平与其他时间点的血糖水平及胰岛素剂量均无显著相关性（均P>0.05）。在T2DM患者中，黄昏现象组晚餐前血糖水平显著高于可疑组和非黄昏现象组（均P<0.05）。在黄昏现象组，从晚餐前到睡前血糖水平持续上升，晚餐前血糖水平仅与晚餐后2小时血糖水平显著相关（P<0.05）。“黄昏现象”（晚餐前自发性短暂高血糖）在部分糖尿病患者中客观存在。晚餐前高血糖可影响晚餐后至睡前的血糖控制。认识“黄昏现象”具有重要的临床意义。
