Mori Hiroko, Okada Yosuke, Kawaguchi Mayuko, Otsuka Takashi, Miyazaki Megumi, Sonoda Satomi, Sugai Kei, Uemura Fumi, Tanaka Kenichi, Hajime Maiko, Kurozumi Akira, Narisawa Manabu, Torimoto Keiichi, Tanaka Yoshiya
First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
J UOEH. 2018;40(4):287-297. doi: 10.7888/juoeh.40.287.
The purpose of this study was to determine the glycemic profiles of drug-naïve type 2 diabetes patients according to hemoglobin A1c (HbA1c) level using continuous glucose monitoring. We aimed to clarify factors associated with HbA1c and average blood glucose level. Patients were divided into three groups according to their HbA1c level (< 7.0% n=23, 7.0% ≤ HbA1c < 8.0% n=17 and ≥ 8.0% n=31), and the factors associated with HbA1c and average glucose of each group were evaluated. Pre-meal glucose levels were the highest before lunch, and the 2 hour postprandial blood glucose level was the lowest after lunch. The pre-meal and postprandial blood glucose levels increased after each meal with increases in HbA1c. Average glucose level was the most significant determinant of HbA1c, whereas pre-meal glucose level at dinner was the most significant determinant of average glucose level, and the range of increase in glucose from pre-meal at dinner was the most significant determinant of standard deviation (SD) of 24 hour glucose levels. HbA1c subgroup analysis indicated that pre-meal glucose level at lunch significantly correlated with average glucose level in the HbA1c < 8.0% group, while pre-meal glucose level at dinner significantly correlated with average glucose level in the HbA1c ≥ 8.0% group. The range of increase in glucose from pre-meal in the morning significantly correlated with SD of 24 hour glucose levels in the HbA1c < 8.0% group, and the postprandial peak glucose level at lunch significantly correlated with SD of 24 hour glucose levels in the HbA1c ≥ 8.0% group. The results suggest that improvement of the average glucose level is necessary to improve the HbA1c levels. For patients with HbA1c < 7.0%, it is important to improve blood glucose level after breakfast and before lunch to decrease the average glucose level. For patients with 7.0% ≤ HbA1c < 8.0%, it is important to improve blood glucose level before lunch and after dinner to decrease the average glucose level. For patients with HbA1c ≥ 8.0%, it is important to improve blood glucose levels after lunch and before dinner to decrease the average glucose level.
本研究的目的是通过持续葡萄糖监测，根据糖化血红蛋白（HbA1c）水平确定初治2型糖尿病患者的血糖谱。我们旨在阐明与HbA1c和平均血糖水平相关的因素。根据患者的HbA1c水平将其分为三组（HbA1c<7.0%，n=23；7.0%≤HbA1c<8.0%，n=17；≥8.0%，n=31），并评估每组中与HbA1c和平均血糖相关的因素。午餐前的餐前血糖水平最高，午餐后的餐后2小时血糖水平最低。随着HbA1c升高，每餐前后的血糖水平均升高。平均血糖水平是HbA1c的最主要决定因素，而晚餐前的餐前血糖水平是平均血糖水平的最主要决定因素，晚餐前至餐后血糖升高幅度是24小时血糖水平标准差（SD）的最主要决定因素。HbA1c亚组分析表明，午餐前的餐前血糖水平与HbA1c<8.0%组的平均血糖水平显著相关，而晚餐前的餐前血糖水平与HbA1c≥8.0%组的平均血糖水平显著相关。早餐前至餐后血糖升高幅度与HbA1c<8.0%组的24小时血糖水平标准差显著相关，午餐后的餐后血糖峰值水平与HbA1c≥8.0%组的24小时血糖水平标准差显著相关。结果表明，改善平均血糖水平对于改善HbA1c水平是必要的。对于HbA1c<7.0%的患者，改善早餐后和午餐前的血糖水平以降低平均血糖水平很重要。对于7.0%≤HbA1c<8.0%的患者，改善午餐前和晚餐后的血糖水平以降低平均血糖水平很重要。对于HbA1c≥8.0%的患者，改善午餐后和晚餐前的血糖水平以降低平均血糖水平很重要。
