Institute of Clinical Research, University of Montpellier, Montpellier, France
Institute of Clinical Research, University of Montpellier, Montpellier, France.
Diabetes Care. 2017 Jul;40(7):832-838. doi: 10.2337/dc16-1769. Epub 2016 Dec 30.
To define the threshold for excess glucose variability (GV), one of the main features of dysglycemia in diabetes.
A total of 376 persons with diabetes investigated at the University Hospital of Montpellier (Montpellier, France) underwent continuous glucose monitoring. Participants with type 2 diabetes were divided into several groups-groups 1, 2a, 2b, and 3 ( = 82, 28, 65, and 79, respectively)-according to treatment: ) diet and/or insulin sensitizers alone; ) oral therapy including an insulinotropic agent, dipeptidyl peptidase 4 inhibitors (group 2a) or sulfonylureas (group 2b); or ) insulin. Group 4 included 122 persons with type 1 diabetes. Percentage coefficient of variation for glucose (%CV = [(SD of glucose)/(mean glucose)] × 100) and frequencies of hypoglycemia (interstitial glucose <56 mg/dL [3.1 mmol/L]) were computed.
Percentages of CV (median [interquartile range]; %) increased significantly ( < 0.0001) from group 1 (18.1 [15.2-23.9]) to group 4 (37.2 [31.0-42.3]). In group 1, the upper limit of %CV, which served as reference for defining excess GV, was 36%. Percentages of patients with %CVs above this threshold in groups 2a, 2b, 3, and 4 were 0, 12.3, 19.0, and 55.7%, respectively. Hypoglycemia was more frequent in group 2b ( < 0.01) and groups 3 and 4 ( < 0.0001) when subjects with a %CV >36% were compared with those with %CV ≤36%.
A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects.
定义葡萄糖变异性过高（GV）的阈值，GV 是糖尿病患者糖代谢紊乱的主要特征之一。
在法国蒙彼利埃大学医院（Montpellier）接受连续血糖监测的 376 名糖尿病患者参与了此项研究。根据治疗方式，将 2 型糖尿病患者分为以下几组：第 1 组、第 2a 组、第 2b 组和第 3 组（分别为 82、28、65 和 79 人），分别为饮食和/或胰岛素增敏剂单独治疗；口服药物治疗，包括胰岛素促分泌剂、二肽基肽酶 4 抑制剂（第 2a 组）或磺酰脲类药物（第 2b 组）；或胰岛素治疗。第 4 组包括 122 名 1 型糖尿病患者。计算葡萄糖的变异系数（%CV = [（血糖标准差）/（平均血糖）] × 100）和低血糖（间质葡萄糖 <56mg/dL[3.1mmol/L]）的频率。
%CV（中位数[四分位间距]；%）从第 1 组（18.1[15.2-23.9]）显著增加（<0.0001）至第 4 组（37.2[31.0-42.3]）。在第 1 组中，作为定义葡萄糖变异性过高的参考上限，%CV 为 36%。第 2a 组、第 2b 组、第 3 组和第 4 组中，%CV 超过此阈值的患者比例分别为 0、12.3%、19.0%和 55.7%。与%CV≤36%的患者相比，第 2b 组（<0.01）和第 3 组和第 4 组（<0.0001）的低血糖发生率更高。
36%的变异系数似乎是区分糖尿病患者稳定和不稳定血糖的合适阈值，因为超过这个界限，低血糖的频率会显著增加，尤其是在接受胰岛素治疗的患者中。
