Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterology and Hepatology, JA Hiroshima General Hospital, Hiroshima, Japan.
PLoS One. 2018 Apr 3;13(4):e0195028. doi: 10.1371/journal.pone.0195028. eCollection 2018.
The feature of blood glucose dynamics in patients with chronic liver disease (CLD) is marked blood glucose fluctuations. However, the detail of blood glucose dynamics is not well known. The aim of the present study was to evaluate glycemic fluctuations by continuous glucose monitoring (CGM).
A total of 105 CLD patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. Various parameters of glycemic variability were evaluated. The association of these parameters with liver functional reserve was examined. The parameters were also evaluated according to glycated hemoglobin A1c (HbA1c) levels.
Data of all patients showed that mean blood glucose (MBG) levels and the difference between highest and lowest blood glucose (ΔBG) increased significantly with worsening of liver functional reserve (P < 0.001 and P = 0.005, respectively). Although many of the cases were being treated for diabetes, postprandial hyperglycemia was seen in 92% of patients. Nocturnal hypoglycemia was seen in 22% of patients. In non-anemic patients with HbA1c levels of < 7.0%, the percentage of patients with mean amplitude of glycemic excursion (MAGE) of ≥ 77.4 mg/dL and that of MBG levels of > 145 mg/dL were higher in liver cirrhosis (LC) patients than in chronic hepatitis (CH) patients. In them, homeostasis model assessment for insulin resistance (HOMA-IR) of > 2.5 and LC were significantly associated with the increase in MAGE. LC was also significantly associated with increased MBG levels.
The CGM systems were useful in finding hidden abnormalities of blood glucose fluctuations in CLD patients with T2DM, especially in non-anemic CLD patients with HbA1c levels of < 7.0%.
慢性肝脏疾病（CLD）患者的血糖动力学特征表现为明显的血糖波动。然而，血糖动力学的细节尚不清楚。本研究旨在通过连续血糖监测（CGM）评估血糖波动。
共纳入 105 例 2 型糖尿病合并 CLD 患者。评估了各种血糖变异性参数。检查了这些参数与肝储备功能的关系。还根据糖化血红蛋白 A1c（HbA1c）水平评估了这些参数。
所有患者的数据均显示，平均血糖（MBG）水平和最高与最低血糖之间的差值（ΔBG）随肝储备功能的恶化而显著增加（分别为 P < 0.001 和 P = 0.005）。尽管大多数患者正在接受糖尿病治疗，但 92%的患者仍存在餐后高血糖。22%的患者出现夜间低血糖。在 HbA1c 水平<7.0%且无贫血的非肝硬化患者中，MBG 水平>145mg/dL 和平均血糖波动幅度（MAGE）≥77.4mg/dL的患者比例在肝硬化（LC）患者中高于慢性肝炎（CH）患者。在这些患者中，HOMA-IR（胰岛素抵抗指数）>2.5 和 LC 与 MAGE 的增加显著相关。LC 也与 MBG 水平的升高显著相关。
CGM 系统有助于发现 T2DM 合并 CLD 患者血糖波动的隐匿性异常，尤其是 HbA1c 水平<7.0%且无贫血的 CLD 患者。
