通过连续血糖监测评估全胰切除术后糖尿病的血糖控制和变异性。
Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring.
机构信息
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
出版信息
J Clin Endocrinol Metab. 2021 Jan 1;106(1):168-173. doi: 10.1210/clinem/dgaa731.
CONTEXT
The extent of the glycemic variability in diabetes secondary to total pancreatectomy is not fully understood.
OBJECTIVE
To evaluate glycemic variability in totally pancreatectomized (PX) patients and compare it to glycemic variability in hemoglobin A1c (HbA1c)-matched patients with long-standing type 1 diabetes (T1D).
DESIGN
A case-control study was performed.
SETTING
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
PATIENTS OR OTHER PARTICIPANTS
Ten PX patients (mean [SEM]: age 64.3 [9.8] years; body mass index (BMI) 34.4 [5.0] kg/m2; duration of diabetes 3 [2.8] years), 10 HbA1c-matched patients with T1D (63.9 [8.6] years; 24.6 [3.1] kg/m2; 22 [4] years), and 10 gender-, age-, and BMI-matched healthy controls. All patients were managed on multiple daily injections of insulin.
INTERVENTION
Continuous glucose monitoring (CGM) (Medtronic MiniMed iPro 2) during 12 consecutive days.
MAIN OUTCOME MEASURES
Glycemic variability.
RESULTS
HbA1c levels were similar in the PX group and the T1D group. The PX group had greater continuous overall net glycemic action per 60 minutes (CONGA60 min) compared with the T1D group (mean [SEM]: 9.5 [0.3] vs 8.3 [0.2] mmol/L, P < 0.003) and mean plasma glucose values were higher in the PX group (10.6 [0.9] vs 9.0 [0.9] mmol/L, P < 0.001), whereas coefficient of variation for plasma glucose and standard deviation of mean plasma glucose, respectively, were similar in the 2 groups. Time spent below range was not different between the PX and the T1D group (2.3 [0.8] vs 4.5 [0.8]%, P = 0.065), whereas time spent above range was higher in the PX group (51.4 [3.3] vs 37.6 [1.9]%, P < 0.001).
CONCLUSIONS
CGM-assessed glycemic variability showed higher CONGA60 min and time spent above range in our PX patients compared with HbA1c-matched T1D patients. This study is registered at www.ClinicalTrials.gov (NCT02944110).
背景
全胰切除术后糖尿病患者的血糖变异性程度尚不完全清楚。
目的
评估全胰切除（PX）患者的血糖变异性，并将其与血糖变异性匹配的长期 1 型糖尿病（T1D）患者进行比较。
设计
病例对照研究。
地点
丹麦哥本哈根大学赫勒鲁普嘉士汀内医院临床代谢研究中心。
患者或其他参与者
10 例 PX 患者（平均[SEM]：年龄 64.3 [9.8]岁；体重指数（BMI）34.4 [5.0]kg/m2；糖尿病病程 3 [2.8]年），10 例血糖变异性匹配的 T1D 患者（63.9 [8.6]岁；24.6 [3.1]kg/m2；22 [4]年）和 10 例性别、年龄和 BMI 匹配的健康对照组。所有患者均接受多次胰岛素皮下注射治疗。
干预
连续血糖监测（CGM）（美敦力 MiniMed iPro 2）持续 12 天。
主要观察指标
血糖变异性。
结果
PX 组和 T1D 组的 HbA1c 水平相似。与 T1D 组相比，PX 组每 60 分钟连续总净血糖作用（CONGA60 min）更大（平均[SEM]：9.5 [0.3]vs 8.3 [0.2]mmol/L，P<0.003），且 PX 组平均血浆葡萄糖水平更高（10.6 [0.9]vs 9.0 [0.9]mmol/L，P<0.001），而两组的血浆葡萄糖变异系数和平均血浆葡萄糖标准差相似。PX 组和 T1D 组的血糖低于目标范围的时间无差异（2.3 [0.8]vs 4.5 [0.8]%，P=0.065），而血糖高于目标范围的时间 PX 组更高（51.4 [3.3]vs 37.6 [1.9]%，P<0.001）。
结论
与 HbA1c 匹配的 T1D 患者相比，我们的 PX 患者的 CGM 评估血糖变异性显示出更高的 CONGA60 min 和血糖高于目标范围的时间。本研究在 www.ClinicalTrials.gov（NCT02944110）注册。
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