胰岛素注射相关皮下脂肪增生对糖尿病患者短期血糖波动的影响  

The effects of insulin injection related lipohypertrophy on short-term glycemic variability in patients with diabetes

作　　者：周惠娟[1] 邹晟怡 吴江[2] 胡玉鲲 徐颖[2] ZHOU Huijuan;ZOU Shengyi;WU Jiang;HU Yukun;XU Ying(Department of Endocrinology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院内分泌科,215000 [2]苏州大学附属第一医院神经外科,215000

出　　处：《天津医药》2023年第2期171-175,共5页Tianjin Medical Journal

基　　金：江苏省医学重点人才项目(ZDRCA2016040)。

摘　　要：目的 探讨胰岛素注射相关的皮下脂肪增生(LH)对糖尿病患者短期胰岛素泵治疗期间血糖波动的影响。方法 回顾性分析同时接受短期胰岛素泵治疗和动态血糖监测的住院糖尿病患者232例,其中1型糖尿病(T1DM)52例,2型糖尿病(T2DM)180例。统计不同类型糖尿病患者胰岛素注射相关LH的发生率,比较LH患者和无LH患者短期血糖波动指标的差异。分析平均葡萄糖波动幅度(MAGE)与临床指标的关系。采用二元Logistic回归分析血糖波动的影响因素。结果 232例患者总体LH的发生率为61.2%,其中T1DM和T2DM患者LH的发生率分别为57.7%(30/52)和62.2%(112/180)。T1DM患者中LH组仅MAGE高于无LH组,T2DM患者中LH组的短期血糖波动指标均高于无LH组(P<0.01)。在T1DM和T2DM患者中,MAGE与LH均呈正相关,与BMI、胰岛素使用年限、糖尿病病程均呈负相关(均P<0.05)。多因素Logistic分析结果显示,LH升高是T1DM(OR=4.665,95%CI:1.134~19.200)和T2DM(OR=6.659,95%CI:3.248~13.654)患者血糖波动的危险因素。结论 胰岛素注射相关LH是糖尿病患者短期血糖波动的重要危险因素。Objective To investigate the effects of insulin-mediated lipohypertrophy(LH) on short-term glycemic variability of hospitalized diabetic patients treated with insulin pump.Methods A total of 232 inpatients with diabetes who received both short-term insulin pump therapy and dynamic blood glucose monitor were retrospectively analyzed,including52 cases of type 1 diabetes mellitus(T1DM) and 180 cases of type 2 diabetes mellitus(T2DM).The incidence of insulin injection-related LH in patients with different types of diabetes was counted,and the differences in short-term glucose fluctuation indicators between patients with LH and those without LH were compared.The relationship between mean glucose fluctuation amplitude(MAGE) and clinical indicators was analysed.Binary Logistic regression was used to analyse the factors influencing glucose fluctuations.Results The overall incidence of LH was 61.2% in 232 patients,with 57.7%(30/52) in T1DM patients and 62.2%(112/180) in T2DM patients.In both T1DM and T2DM patients,MAGE was positively correlated with LH and negatively correlated with BMI,years of insulin use,and duration of diabetes(P <0.05).Multi-factor Logistic analysis showed that LH was a risk factor for blood glucose fluctuations in both T1DM(OR=4.665,95%CI:1.134-19.200) and T2DM(OR=6.659,95%CI:3.248-13.654) patients.Conclusion Insulin-mediated lipohypertrophy is identified as a vital risk factor for short-term glycemic fluctuations in diabetes.

关 键 词：糖尿病 胰岛素泵 动态血糖监测 皮下脂肪增生 血糖波动 

分 类 号：R587.1[医药卫生—内分泌]