Lady Hardinge Medical College, Delhi.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Assessment of diabetes with daily blood glucose fluctuations including peaks and nadirs forms the crux of the modern management. Use of glycemic variability (GV) as a parameter to assess these fluctuations is emerging. It is important to determine the hyperglycemic and hypoglycemic episodes which are the culprits for increasing glycemic variation. Diabetes mellitus patients follow different clinical trajectories which can be traced by the ambulatory glucose profile (AGP) obtained from flash glucose monitoring system (FGMS).
This comparative observational study enrolled 106 adult (>18 years) type 2 diabetes patients with HbA1c<8%. Patients were divided into two groups (group A & group B) with 53 patients each. Group A included patients on OAD's (oral antidiabetic drug) with insulin and Group B included patients on OAD's without insulin. The patients were put on FGMS for 14 days and their AGP was analysed. Hyperglycemic episodes (level 1- >180 mg/dl, level 2- >250 mg/dl) and hypoglycemic episodes (level 1- 54-70 mg/dl, level 2- <54 mg/dl) were determined between the groups.
Group A patients had significantly higher (29.99%) total number of hyperglycemic episodes (Level 1+ Level 2) as compared with group B (9.08%) (p <0.0001). Amongst group A, proportion of patients with total number of hyperglycemic episodes was significantly higher in insulin only subgroup (58.11%) followed by insulin +metformin+ 1 OAD (29.14%) & insulin+ metformin (26.82%) (p <0.0001). Amongst group B, total number of hyperglycemic episodes were found to be significantly higher with metformin only subgroup (10.19%) followed by metformin + 1 OAD (9.72%) & metformin + >1 OAD (8.1%) (p<0.0001). Amongst the add on OAD's, sulfonylurea contributed to 61.07% hyperglycemic episodes in group A & 11.63% in group B which was statistically more than DPP-4 inhibitors with 14.91% & 2.84% respectively (p <0.0001). Total number of hypoglycemic episodes seen in group A patients (8.66%) were significantly less as compared with group B (13.27%) (p<0.0001). Sulfonylurea contributed to 7.5% hypoglycemic episodes in group A & 13.2% in group B which was statistically more than DPP-4 inhibitors with 6.49% & 12.35% respectively when added to metformin (p<0.0001).
Amongst the OAD's used in type 2 diabetes mellitus patients in this study, total number of hyperglycemic and hypoglycemic episodes were found to be more in patients taking sulfonylurea as compared with DPP4 inhibitors when used in combination with metformin with or without insulin.
评估包括峰值和谷值在内的日常血糖波动的糖尿病构成了现代管理的核心。将血糖变异性（GV）用作评估这些波动的参数正在出现。确定导致血糖变化增加的高血糖和低血糖发作非常重要。糖尿病患者遵循不同的临床轨迹，可以通过从闪光葡萄糖监测系统（FGMS）获得的动态血糖图谱（AGP）来追踪。
这项比较观察性研究纳入了 106 名（>18 岁）HbA1c<8%的 2 型糖尿病成年患者。患者分为两组（A 组和 B 组），每组 53 人。A 组包括服用胰岛素的口服降糖药（OAD）的患者，B 组包括服用 OAD 而不服用胰岛素的患者。患者接受 FGMS 治疗 14 天，并分析其 AGP。确定两组之间的高血糖发作（水平 1- >180mg/dl，水平 2- >250mg/dl）和低血糖发作（水平 1- 54-70mg/dl，水平 2- <54mg/dl）。
与 B 组（9.08%）相比，A 组患者的总高血糖发作次数（水平 1+水平 2）明显更高（29.99%）（p <0.0001）。在 A 组中，胰岛素仅亚组的总高血糖发作次数比例明显更高（58.11%），其次是胰岛素+二甲双胍+1 种 OAD（29.14%）和胰岛素+二甲双胍（26.82%）（p <0.0001）。在 B 组中，发现仅使用二甲双胍的亚组的总高血糖发作次数明显更高（10.19%），其次是二甲双胍+1 种 OAD（9.72%）和二甲双胍+>1 种 OAD（8.1%）（p<0.0001）。在添加的 OAD 中，磺酰脲类药物在 A 组中导致 61.07%的高血糖发作，在 B 组中导致 11.63%，这明显高于 DPP-4 抑制剂，分别为 14.91%和 2.84%（p <0.0001）。A 组患者发生的低血糖发作次数（8.66%）明显少于 B 组（13.27%）（p<0.0001）。磺酰脲类药物在 A 组中的低血糖发作次数为 7.5%，在 B 组中的低血糖发作次数为 13.2%，这明显高于与二甲双胍联合使用时的 DPP-4 抑制剂，分别为 6.49%和 12.35%（p<0.0001）。
在这项研究中，在 2 型糖尿病患者中使用的 OAD 中，与 DPP4 抑制剂相比，当与胰岛素联合使用或不联合使用时，磺酰脲类药物导致的高血糖和低血糖发作次数更多。
