Shi Rui, Feng Lei, Liu Yan-Mei, Xu Wen-Bo, Luo Bei-Bei, Tang Ling-Tong, Bi Qian-Ye, Cao Hui-Ying
Department of Medical Laboratory, Sixth Affiliated Hospital of Kunming Medical University, Yunnan, China.
Department of Laboratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, People's Republic of China.
Diabetol Metab Syndr. 2023 May 9;15(1):95. doi: 10.1186/s13098-023-01077-y.
For patients with diabetes, high-frequency and -amplitude glycemic variability may be more harmful than continuous hyperglycemia; however, there is still a lack of screening indicators that can quickly and easily assess the level of glycemic variability. The aim of this study was to investigate whether the glycemic dispersion index is effective for screening high glycemic variability.
A total of 170 diabetes patients hospitalized in the Sixth Affiliated Hospital of Kunming Medical University were included in this study. After admission, the fasting plasma glucose, 2-hour postprandial plasma glucose, and glycosylated hemoglobin A1c were measured. The peripheral capillary blood glucose was measured seven times in 24 h, before and after each of three meals and before bedtime. The standard deviation of the seven peripheral blood glucose values was calculated, and a standard deviation of > 2.0 was used as the threshold of high glycemic variability. The glycemic dispersion index was calculated and its diagnostic efficacy for high glycemic variability was determined by the Mann-Whitney U test, receiver operating characteristic (ROC) curve and, Pearson correlation analysis.
The glycemic dispersion index of patients with high glycemic variability was significantly higher than that of those with low glycemic variability (p < 0.01). The best cutoff value of the glycemic dispersion index for screening high glycemic variability was 4.21. The area under the curve (AUC) was 0.901 (95% CI: 0.856-0.945) and had a sensitivity of 0.781 and specificity of 0.905. It was correlated with the standard deviation of blood glucose values (r = 0.813, p < 0.01).
The glycemic dispersion index had good sensitivity and specificity for screening high glycemic variability. It was significantly associated with the standard deviation of blood glucose concentration and is simple and easy to calculate. It was an effective screening indicator of high glycemic variability.
对于糖尿病患者，高频和高幅度血糖变异性可能比持续性高血糖更具危害性；然而，目前仍缺乏能够快速、简便地评估血糖变异性水平的筛查指标。本研究旨在探讨血糖离散指数对筛查高血糖变异性是否有效。
本研究纳入了昆明医科大学第六附属医院收治的170例糖尿病患者。入院后，测量空腹血糖、餐后2小时血糖和糖化血红蛋白A1c。在24小时内，于三餐前、三餐后及睡前共测量7次外周毛细血管血糖。计算7次外周血糖值的标准差，将标准差>2.0作为高血糖变异性的阈值。计算血糖离散指数，并通过曼-惠特尼U检验、受试者工作特征（ROC）曲线及Pearson相关性分析确定其对高血糖变异性的诊断效能。
高血糖变异性患者的血糖离散指数显著高于低血糖变异性患者（p<0.01）。筛查高血糖变异性的血糖离散指数最佳截断值为4.21。曲线下面积（AUC）为0.901（95%CI：0.856 - 0.945），敏感性为0.781，特异性为0.905。它与血糖值标准差相关（r = 0.813，p<0.01）。
血糖离散指数在筛查高血糖变异性方面具有良好的敏感性和特异性。它与血糖浓度标准差显著相关，且计算简单。它是高血糖变异性的有效筛查指标。
