Continuous Monitoring of Circadian Glycemic Patterns in Patients Receiving Prednisolone for COPD
Continuous Monitoring of Circadian Glycemic Patterns in Patients Receiving Prednisolone for COPD
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DOI：
10.1210/jc.2010-2729
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发表时间：
2011-06-01
影响因子：
5.8
通讯作者：
Stranks, Stephen N.
中科院分区：
文献类型：
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作者：
Burt, Morton G.;Roberts, Gregory W.;Stranks, Stephen N.
背景：内源性糖皮质激素过量（库欣综合征）主要增加餐后血糖浓度。泼尼松龙引起的高血糖模式尚未得到很好的表征。目的：我们的目的是确定泼尼松龙对血糖浓度的昼夜节律影响，以优化泼尼松龙引起的高血糖的管理。设计和背景：这是在教学医院进行的一项横断面研究。参与者：参与者包括 60 名连续同意的入院慢性阻塞性肺病受试者：13 名无已知糖尿病，因其他适应症入院且未接受治疗糖皮质激素（第 1 组）、40 名因慢性阻塞性肺病恶化而入院并接受泼尼松龙治疗的无已知糖尿病患者（第 2 组，泼尼松龙 = 30 +/- 6 mg/d）和 7 名已知糖尿病患者，接受泼尼松龙治疗（第 3 组，泼尼松龙 = 26 +/- 9 mg/d）。 主要结果测量：在连续血糖期间评估间质葡萄糖浓度结果：第 2 组 [40 名中的 21 名 (53%)，P = 0.02] 和第 3 组 [7 名中的 7名 (100%)，P = 0.003] 在连续血糖监测期间记录到的血糖至少为 200 mg/dl (>= 11.1 mmol/L) 的受试者明显多于第 1 组 [13 名中的一名 (8%)]。第 3 组 2400-1200 小时之间的平均葡萄糖浓度 (142 +/- 36 mg/dl) 显着高于其他两组 (P < 0.005)，而第 1 组 (108 +/- 16 mg/dl) 和第 2 组 (112 +/- 22 mg/dl) 2400-1200 小时之间的平均葡萄糖浓度没有显着差异。相比之下，第 2 组 (142 +/- 25 mg/dl) 和第 3 组 (189 +/- 32 mg/dl) 1200-2400 小时之间的平均葡萄糖浓度均显着高于第 1 组（117 +/- 14 mg/dl，两个比较 P < 0.05）。结论：泼尼松龙主要在下午和晚上引起高血糖。此时应针对泼尼松龙引起的高血糖进行治疗。 （临床内分泌代谢杂志 96：1789-1796，2011）
Context: Endogenous glucocorticoid excess (Cushing's syndrome) predominantly increases postprandial glucose concentration. The pattern of hyperglycemia induced by prednisolone has not been well characterized.Objective: Our objective was to define the circadian effect of prednisolone on glucose concentration to optimize management of prednisolone-induced hyperglycemia.Design and Setting: This was a cross-sectional study in a teaching hospital.Participants: Participants included 60 consecutive consenting subjects with chronic obstructive pulmonary disease admitted to hospital: 13 without known diabetes admitted for other indications and not treated with glucocorticoids (group 1), 40 without known diabetes admitted with an exacerbation of chronic obstructive pulmonary disease and treated with prednisolone (group 2, prednisolone = 30 +/- 6 mg/d), and seven with known diabetes treated with prednisolone (group 3, prednisolone = 26 +/- 9 mg/d).Main Outcome Measure: Interstitial glucose concentration was assessed during continuous glucose monitoring.Results: Significantly more subjects in group 2 [21 of 40 (53%), P = 0.02] and group 3 [seven of seven (100%), P = 0.003] recorded a glucose of at least 200 mg/dl (>= 11.1 mmol/liter) during continuous glucose monitoring than in group 1 [one of 13 (8%)]. The mean glucose concentration between 2400-1200 h for group 3 (142 +/- 36 mg/dl) was significantly greater than in the other two groups (P < 0.005), whereas mean glucose concentrations between 2400-1200 h in group 1 (108 +/- 16 mg/dl) and group 2 (112 +/- 22 mg/dl) were not significantly different. In contrast, the mean glucose concentrations between 1200-2400 h for group 2 (142 +/- 25 mg/dl) and group 3 (189 +/- 32 mg/dl) were both significantly greater than group 1 (117 +/- 14 mg/dl, P < 0.05 for both comparisons).Conclusions: Prednisolone predominantly causes hyperglycemia in the afternoon and evening. Treatment of prednisolone-induced hyperglycemia should be targeted at this time period. (J Clin Endocrinol Metab 96: 1789-1796, 2011)