摘要
目的 应用动态血糖监测系统（CGMS）探讨2型糖尿病患者胰岛素泵（CSⅡ）治疗期间睡前血糖与夜间低血糖发生的关系.方法 2006年7月至2008年6月257例上海交通大学附属第六人民医院住院的2型糖尿病患者,男156例,女101例,糖化血红蛋白（10.97±2.11）%,糖化血清白蛋白（31.88±7.51）%,入院后予胰岛素泵治疗同时进行动态血糖监测 根据CGMS监测结果中是否出现夜间低血糖事件分为低血糖组和无低血糖组,分析睡前血糖与夜间低血糖发生的关系.结果 （1）胰岛素泵治疗期间全天平均血糖（9.66±2.00）mmol/L,血糖标准差（2.98±1.03）mmol/L,血糖水平最高出现在早餐后（11.62±3.07）mmol/L,最低出现在夜间（8.06±2.43）mmol/L.（2）CGMS监测显示胰岛素泵治疗初期有118例患者共发生了243次低血糖事件,其中128次发生于夜间.（3）应用受试者工作曲线（ROC）分析睡前血糖预测夜间低血糖,当睡前血糖为5.9 mmol/L时约登指数最大,其敏感度为54.8%,特异度为77.8%.阳性预测值为44.3%,阴性预测值为84.2%.结论 （1）CGMS监测显示胰岛素泵治疗初期血糖波动仍较大,约1/2患者检出发生一次以上低血糖事件.（2）睡前血糖〈5.9 mmol/L发生夜间低血糖的危险增加.
Objective To find out the features of glycemic excursion via continuous glucose monitoring system （CGMS） during continuous subcutaneous insulin infusion （CS Ⅱ） treatment in type 2diabetics and discuss the possibility of predicting nocturnal hypoglycaemia with bedtime glucose level. Methods A total of 257 diabetes patients （156 males and 101 females, aged from 27 -88 years old）with 0. 1 -40 years diabetic history were recruited. Their HbAI c level was （10. 97 ± 2. 11）%. Glycated albumin level was （31.88 ±7.51）%. All patients were switched to CS Ⅱ therapy while a 72-hour period of CGMS was performed. Participants were divided into hypoglycemia group and non-hypoglycemia group according to the reading of hypoglycemic events from CGMS data. Results （1） From CGMS profiles, the investigators found that MBG was （9. 66 ±2. 00） mmol/L and SDBG （2.98 ± 1. 03）mmol/L. （2） A total of 243 hypoglycemia events occurred in 118 participants at early stage of CS Ⅱ treatment. （3） When bedtime blood glucose was below 5.9 mmol/L, the youden index was maximal on a receiver operating characteristic curve. The sensitive was 54. 8% and specificity 77.8%. Positive predictive value was 44. 3% and negative predictive value 84.2%. So the cut-off point of bedtime blood glucose to predict nocturnal hypoglycemia might be 5. 9 mmol/L, Conclusion（1） Hypoglycemia as detected by CGMS occurs in almost 1/2 type 2diabetics during CS Ⅱ therapy. （2） There is a higher risk of nocturnal hypoglycemia if the bedtime blood glucose concentration falls below 5.9 mmol/L.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第42期2962-2966,共5页
National Medical Journal of China
基金
基金项目：上海市市级医院新兴前沿技术联合攻关基金（SHDCl2010115）
关键词
糖尿病
2型
低血糖症
血糖自我监测
胰岛素泵
Diabetes mellitus,type 2 Hypoglycemia Boold glucose self monitoring Continuous subcutaneous insulin infusion
