老年2型糖尿病患者黎明现象的分析和对策  

Analysis and treatment of dawn phenomenon in elderly patients with type 2 diabetes mellitus

作　　者：郑晓敏 李彬[1] 刘翠平 周迎生[2] 崔丽梅 Zheng Xiaomin;Li Bin;Liu Cuiping;Zhou Yingsheng;Cui Limei(Department of Endocrinology,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100022,China;Department of Endocrinology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]清华大学附属垂杨柳医院内分泌科,北京100022 [2]首都医科大学附属北京安贞医院内分泌科,北京100029

出　　处：《首都医科大学学报》2023年第3期400-406,共7页Journal of Capital Medical University

基　　金：首都卫生发展基金重点攻关项目(2022-1G-2064);北京市朝阳区科技社会发展计划项目(CYSF2113)。

摘　　要：目的在老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者中使用持续葡萄糖监测系统(continuous glucose monitoring system,CGMS)分析黎明现象(dawn phenomenon,DP)的特点与相关因素,并探讨有效的解决方案。方法选取2019年7月至2020年3月在清华大学附属垂杨柳医院内分泌科治疗的T2DM患者94例,收集临床资料,测定生物化学指标,行眼底、血管彩超及感觉神经定量检查,完善CGMS,根据是否发生DP分为无DP组(non-dawn phenomenon group,NDP,n=46)和DP(n=37)组。DP组按照临床经验调整治疗3个月再次行CGMS 3 d,评估血糖情况。结果老年T2DM患者DP的发生率为39.36%(37/94)。与NDP组相比,DP组患者体质量指数(body mass index,BMI)、空腹胰岛素浓度低(P=0.029和P<0.001),空腹血糖、糖化血红蛋白增高(P<0.001和P=0.032),血糖波动的指标显著增高(P均<0.05)。DP组发生糖尿病周围神经病变的比率(86.49%)高于NDP组(67.39%)(P=0.043)。老年T2DM患者发生DP的Logistic回归分析,BMI和空腹胰岛素水平进入方程。37例发生DP的患者中,18例加用基础胰岛素或调整剂量、11例加用二甲双胍或调整剂量、7例加用二肽激肽酶-4抑制剂(dipeptidyl peptidase-4 inhibitor,DPP-4i)、1例加用胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)。其中5例使用胰岛素和DPP-4i的患者同时加用二甲双胍,另有5例患者调整生活方式。3个月后随访,患者空腹血糖及血糖波动指标均显著降低(P均<0.05),空腹血糖达标率(≤7.0 mmol/L)为72.97%(27/37)。结论老年T2DM患者DP较普遍,是空腹高血糖的主要原因,低BMI和空腹胰岛素浓度低可能是DP发生的原因。DP与血糖波动大有关,可能导致糖尿病周围神经病变风险增高。基础胰岛素、二甲双胍和DPP-4i是改善DP的有效治疗方法。Objective To analyze the characteristics and related factors of the dawn phenomenon in elderly patients with type 2 diabetes using the continuous glucose monitoring system and explore the effective therapies.Methods A total of 94 patients with type 2 diabetes aged 65 or older were selected from the Department of Endocrinology,Chuiyangliu Hospital Affiliated to Tsinghua University from July 2019 to March 2020.The general clinical data were collected,clinical biochemical level,fasting C-peptide,and fasting insulin were tested.Fundus photography,arterial ultrasonic doppler and quantitative detection of sensory nerves were performed on the patients.The continuous glucose monitoring system was carried out for three days.According to the results of continuous glucose monitoring system,46 cases were divided into patients without dawn phenomenon group(non-dawn phenomenon group,NDP group)and 37 cases with dawn phenomenon group(dawn phenomenon group,DP group).The patients with dawn phenomenon undertook continuous glucose monitoring system again 3 months after adjusting treatment.Results The incidence of DP in elderly patients with type 2 diabetes was 39.36%(37/94).Patients in the DP group had lower body mass index and fasting insulin levels(P=0.029 and P<0.001),higher fasting blood glucose and hemoglobin A1c(P<0.001 and P=0.032)compared with those in the NDP group.The glycemic variation(GV)metrics in DP group were statistically higher than those in the NDP group(P value all<0.05).The incidence of diabetic peripheral neuropathy in the DP group(86.49%)was higher than that in the NDP group(67.39%)(P=0.043).Logistic regression analysis with the dawn phenomenon as the dependent variable showed that low fasting insulin and low body mass index were independent risk factors for dawn phenomenon.Of the 37 patients with DP,18 were given basal insulin or titrated insulin dose,11 were given metformin or added dose,7 were given dipeptidyl peptidase-4 inhibitor(DPP-4i),and one was given glucagon-like peptide-1 receptor agonist.Five of th

关 键 词：2型糖尿病 黎明现象 持续葡萄糖监测系统 

分 类 号：R58[医药卫生—内分泌]