Sources of glucose variability in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES)
Sources of glucose variability in insulin-treated type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES)
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DOI：
10.1111/j.1365-2265.2004.02001.x
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发表时间：
2004-04-01
影响因子：
3.2
通讯作者：
Hoffman, RM
中科院分区：
文献类型：
--
作者：
Murata, GH;Duckworth, WC;Hoffman, RM
目的血糖变异性可能是胰岛素治疗糖尿病患者血糖控制的重要障碍。该研究确定了与2型糖尿病葡萄糖变异性相关的临床和行为因素。设计观察性研究。对象随机选择稳定的、胰岛素治疗的2型糖尿病退伍军人。测量基线数据包括人口统计学、临床特征、饮食、活动和血红蛋白A1 c。受试者在所有餐前和睡前自我监测血糖8周。使用监测数据推导出每例受试者的总体葡萄糖平均值和葡萄糖变异系数（100*SD/平均值）。结果204例受试者完成了血糖监测方案，血糖变异系数与临床因素的关系采用单因素和多因素分析。8周平均（+/- SD）葡萄糖为9.9 +/- 2.2 mmol/l，平均总体变异系数为35.6 +/-7.7%。单变量分析显示，年龄较大的受试者和胰岛素治疗持续时间较长、糖摄入量较大和对自我护理能力有更大信心的受试者的变异更大。肥胖、更依从药物治疗和接受更大胰岛素剂量的受试者的变异较低。多因素分析显示，治疗持续时间、糖摄入量、服药依从性和胰岛素剂量与血糖变化独立相关。服药依从性更有影响力的空腹变化，而体重指数是更有影响力的午餐前variation.CONCLUSIONS许多行为，临床和治疗因素独立与血糖变异。减少糖的消耗和改善药物依从性可能会抵消长期糖尿病瘦患者观察到的更大的血糖波动。
OBJECTIVE Glucose variability can be a significant barrier to glycaemic control for diabetic patients on insulin. The study identified clinical and behavioural factors associated with glucose variability in type 2 diabetes.DESIGN Observational study.SUBJECTS Randomly selected veterans with stable, insulin-treated type 2 diabetes.MEASUREMENTS Baseline data included demographics, clinical characteristics, diet, activity and haemoglobin A1c. Subjects self-monitored blood glucose before all meals and at bedtime for 8 weeks. Monitoring data were used to derive an overall glucose mean and glucose coefficient of variation (100*SD/mean) for each subject. Univariate and multivariate analyses were used to evaluate the relationship between glucose coefficient of variation and clinical factors.RESULTS Two-hundred and four subjects completed the protocol. The 8-week mean (+/- SD) glucose was 9.9 +/- 2.2 mmol/l, and the average overall coefficient of variation was 35.6 +/- 7.7%. Univariate analysis showed a higher variation in older subjects and in those with longer duration of insulin treatment, greater consumption of sugars and greater confidence in their self-care abilities. Variation was lower in subjects who were obese, more compliant with medications and receiving larger insulin doses. Multivariate analysis showed that treatment duration, sugar consumption, medication compliance and insulin dose were independently associated with glucose variation. Medication compliance was more influential for fasting variation, while body mass index was more influential for before lunch variation.CONCLUSIONS Numerous behavioural, clinical and treatment factors were independently associated with glucose variability. Reducing sugar consumption and improving medication compliance might offset the greater glucose fluctuation observed in lean patients with longstanding diabetes.