The effect of glycemic variability on counterregulatory hormone responses to hypoglycemia in young children and adolescents with type 1 diabetes.
The effect of glycemic variability on counterregulatory hormone responses to hypoglycemia in young children and adolescents with type 1 diabetes.
复制标题
血糖变异性对患有 1 型糖尿病的幼儿和青少年低血糖的反调节激素反应的影响。
DOI：
10.1089/dia.2011.0026
复制
发表时间：
2011
影响因子：
5.4
通讯作者：
Dungan,KathleenM
中科院分区：
文献类型：
--
作者：
Alghothani,Nora;Dungan,KathleenM
背景：血糖变异性(GV)与低血糖相关，也可能与糖尿病相关。我们假设GV和葡萄糖漂移风险可以预测对低血糖的反调节(CR)激素反应。研究设计和方法：这是对儿童糖尿病研究网络研究的二次分析，该研究包含28名3岁至8岁或12岁至18岁的1型糖尿病患者的连续间质血糖监测记录。在胰岛素诱导低血糖前72 h计算GV和游程指标，包括持续总血糖净作用(COMA)、高血糖指数(HBGI)、低血糖指数和变异系数(CV)。结果：CV值与血糖浓度变化呈负相关(r=−0.41，P=0.046)，单因素分析显示COMA(模型的对数转换)与血糖浓度变化无统计学意义(r=−0.34，P=0.10)。其他CR激素与变异性的测量没有显著的相关性。在多变量分析中，更高的COGA，而不是CV，与诱导低血糖后胰高血糖素的升高较小相关(估计值=−9.73，P=0.048)，与血红蛋白A1c、糖尿病病程和胰岛素剂量无关。HBGI、LBGI和既往低血糖时间与后续低血糖的CR反应无显著相关性。结论：CV和COGA可能是1型糖尿病患者胰岛素诱导低血糖时胰高血糖素反应受损的预测因子。进一步的研究表明，GV和血糖漂移在低血糖防御反应中的作用。
Background:Glycemic variability (GV) is associated with hypoglycemia and possibly diabetes-related outcomes. We hypothesized that GV and glucose excursion risk may predict counterregulatory (CR) hormone responses to hypoglycemia.Research Design and Methods:This is a secondary analysis of a Diabetes Research in Children Network study containing continuous interstitial glucose monitoring records for 28 patients with type 1 diabetes between 3 to <8 or 12 to <18 years of age. GV and excursion measures, including continuous overall net glycemic action (CONGA), High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI), and coefficient of variation (CV), were calculated 72 h prior to insulin-induced hypoglycemia. CR hormones were measured during the progressive fall in plasma glucose.Results:CV was inversely correlated with change in glucagon concentration (r=−0.41,P=0.046), but CONGA (log-transformed for better fit of the models) was not statistically significant in univariate analysis (r=−0.34,P=0.10). Other CR hormones were not significantly associated with measures of variability. In multivariate analysis, higher CONGA, but not CV, was associated with a smaller rise in glucagon following induced hypoglycemia (estimate=−9.73,P=0.048), independent of hemoglobin A1c, duration of diabetes, and insulin dose. HBGI, LBGI, and antecedent time spent in hypoglycemia were not significantly correlated with CR response to subsequent hypoglycemia.Conclusions:CV and CONGA may be predictors of impaired glucagon responses to insulin-induced hypoglycemia in patients with type 1 diabetes. Further study is indicated to characterize the role of GV and glycemic excursions on the defensive response to hypoglycemia.