摘要
目的分析住院2型糖尿病患者皮下胰岛素泵强化降糖后血糖波动的影响因素,为临床治疗提供预测因素从而更好地控制血糖。方法选取2018年11月至2020年6月于该院内分泌科住院的2型糖尿病患者165例,入院给予皮下胰岛素泵强化降糖,血糖达标后给予撤泵,其中96例患者给予地特+门冬胰岛素注射液(Det+Asp),69例患者给予门冬胰岛素30注射液(Asp30)。皮下注射胰岛素3 d后,于第4天记录餐后血糖波动幅度(aPPGE)。以aPPGE=2.2 mmol/L为临界值,将患者分为组1(aPPGE<2.2 mmol/L)和组2(aPPGE≥2.2 mmol/L)。比较两组的一般临床资料、撤泵当日的血糖变异指标:血糖水平的标准差(bSDBG)、bPPGE、最大血糖波动幅度(bLAGE)。相关分析采用Pearson或Spearman相关分析,采用多因素logistic回归分析确定aPPGE的影响因素。结果组1有74例,组2有91例。组2胰岛素抵抗指数(HOMA-IR)明显高于组1(Z=-2.046,P=0.041)。组2胰岛功能指数对数值[Lg(HOMA-β)]明显低于组1(Z=3.295,P=0.001)。组2撤泵当日bSDBG、bPPGE、bLAGE明显高于组1(t=-3.161,P=0.002;Z=-2.574,P=0.010;t=-2.743,P=0.007)。aPPGE与Lg(HOMA-β)呈负相关(r=-0.166,P=0.034),与HOMA-IR无明显相关性(P>0.05),与bSDBG、bPPGE、bLAGE呈正相关(r=0.243、0.209、0.186,P=0.002、0.008、0.018)。Lg(HOMA-β)为减少aPPGE波动的保护性因素[OR(95%CI):0.043(0.009,0.193),P<0.001],HOMA-IR、bSDBG为aPPGE波动的危险因素[OR(95%CI):4.650(2.071,10.440),P<0.001;OR(95%CI):4.013(1.653,9.747),P=0.002]。结论住院2型糖尿病患者经皮下胰岛素泵强化降糖后的血糖波动主要受胰岛β细胞功能、胰岛素抵抗及撤泵时bSDBG的影响。
Objective To analyze the factors influencing blood glucose fluctuation after intensive hypoglycemic therapy with subcutaneous insulin pump in hospitalized patients with type 2 diabetic,and to provide predictors for clinical treatment so as to better control blood glucose.Methods A total of 165 patients with type 2 diabetes mellitus hospitalized in the endocrinology department of this hospital from November 2018 to June 2020 were selected.Subcutaneous insulin pumps were given on admission for intensive hypoglycemic therapy,and the pumps were withdrawn after the blood glucose reached the standard.Among them,96 patients were given Det+Menthol insulin injection(Det+Asp),and the other 69 patients were given Menthol insulin 30 injection(Asp30).After subcutaneous insulin injection for three days,the amplitude of postprandial glucose fluctuations(aPPGE)was recorded on the fourth day.Using aPPGE=2.2 mmol/L as the threshold value,patients were divided into group one(aPPGE<2.2 mmol/L)and group two(aPPGE≥2.2 mmol/L).The general clinical data and glucose variables on the day of pump withdrawal,including standard deviation of blood glucose(bSDBG),bPPGE,and maximum blood glucose fluctuation amplitude(bLAGE)were compared between the two groups.Correlation analysis was performed using Pearson or Spearman correlation analysis,and multi-factor logistic regression analysis was used to determine the factors influencing aPPGE.Results There were 74 cases in group one and 91 cases in group two.The insulin resistance index(HOMA-IR)in group two was significantly higher than that in group one(Z=-2.046,P=0.041).The logarithm of theβcell function index[Lg(HOMA-β)]in group two was significantly lower than that in group one(Z=3.295,P=0.001).The bSDBG,bPPGE and bLAGE on the day of pump withdrawal in group two were significantly higher than those in group one(t=-3.161,P=0.002;Z=-2.574,P=0.010;t=-2.743,P=0.007).aPPGE was negatively correlated with Lg(HOMA-β)(r=-0.166,P=0.034),had no significant correlation with HOMA-IR(P>0.05),while was positively correlated with bSDBG,bPPGE and bLAGE(r=0.243,0.209,0.186,P=0.002,0.008,0.018).Lg(HOMA-β)was a protective factor for reducing the fluctuation of aPPGE[OR(95%CI):0.043(0.009,0.193),P<0.001],and HOMA-IR,bSDBG were risk factors for the fluctuation of aPPGE[OR(95%CI):4.650(2.071,10.440),P<0.001;OR(95%CI):4.013(1.653,9.747),P=0.002].Conclusion Glycemic fluctuations after intensive hypoglycemic therapy by subcutaneous insulin pump in hospitalized patients with type 2 diabetic are mainly influenced by isletβ-cell function,insulin resistance and bSDBG at the time of pump withdrawal.
作者
刘晴晴
孙殿静
侯丽萍
徐怡
荣义华
LIU Qingqing;SUN Dianjing;HOU Liping;XU Yi;RONG Yihua(Department of Endocrinology,Hengshui Peolpe′s Hospital/Harrison International Peace Hospital,Hengshui,Hebei 053000,China)
出处
《重庆医学》
CAS
2022年第4期601-606,共6页
Chongqing medicine
基金
河北省医学科学研究课题(20200184)。
关键词
2型糖尿病
胰岛素
血糖波动
血糖变异
影响因素
type 2 diabetes mellitus
insulin
glucose fluctuation
glycemic variability
influencing factor
