Morning hyperglycemic excursions - A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes
Morning hyperglycemic excursions - A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes
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DOI：
10.2337/diacare.25.4.737
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发表时间：
2002-04-01
期刊：
影响因子：
16.2
通讯作者：
Boniface, H
中科院分区：
文献类型：
--
作者：
Monnier, L;Colette, C;Boniface, H
目的-为了确定是否，在白天，一个或几个高血糖波动存在，可以在血糖控制的患者与2型diabetes.Research设计和方法的一般故障-在200非胰岛素使用2型糖尿病患者，昼夜血糖和胰岛素的档案进行了研究。空腹过夜后（早餐前8：00）、餐后（11：00 A.M.和2：00 P.m.）以及在吸收后期间（在下午5：00，结果--在作为一个整体考虑的人群中，发现午餐前葡萄糖浓度（12.0 mmol/l）与8：00 A.M.（8.8 mmol/l）、2：00 P.m.（10.5 mmol/l）和5：00 P.m.（8.6 mmol/l）相比显著增加（P < 0.0001）。类似的重大偏离（P <0.0001），在选自以下标准的患者亚组中观察到：1）体重，2）HbA（1c），3）治疗类别，和4）残余β细胞功能，根据日间血糖曲线下面积的计算，发现餐后和空腹血糖对总血糖增量的相对贡献是相似的。使用胰岛素的2型糖尿病患者，无论其临床（BMI）、生物学HbA（1c）、治疗和病理生理学（残余β细胞功能）状态如何。建议进行上午血糖测试，以检测此类异常并通过适当的治疗进行纠正。
OBJECTIVE - To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients With type 2 diabetes.RESEARCH DESIGN AND METHODS - In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.m.), and during the postabsorptive period (at 5:00 P.M., extended postlunch Lime),RESULTS - in the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.m. (10.5 mmol/l), and at 5:00 P.m. (8.6 mmol/l). Similar significant excursions (P < 0,0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight, 2) HbA(1c), 3) categories of treatment, and 4) residual beta-cell function, From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar.CONCLUSIONS - High plasma glucose excursions over morning periods seem to be a permanent failure in non-insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological HbA(1c)), therapeutic, and pathophysiological (residual beta-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.