Diabetes Care:别只关心糖化,2型糖尿病使用胰岛素治疗还要关注这些!

2021-10-13 MedSci原创 MedSci原创

高HbA1c并不能减少夜间低血糖的发生,而低HbA1c与最高的TIR无关。

糖化血红蛋白(HbA1c)是临床公认的监测血糖控制的标准,与过去2-3个月的平均血糖浓度呈线性相关,是监测糖尿病患者长期血糖控制的有用工具。预防与慢性高血糖有关的微血管并发症,是一个主要的治疗目标。

在1型和2型糖尿病中,HbA1c与微血管并发症的风险之间存在明显的关系。当HbA1c为53毫摩尔/摩尔(7.0%)或更低时,发生这种并发症的风险较少,这与大约平均血糖浓度为8.6毫摩尔/升相对应。

然而,HbA1c的使用有重要的局限性。首先,它的评估无助于减少低血糖发作,这是血糖调节的第二个目的。这对于使用胰岛素治疗的人来说尤其重要,因为较低的HbA1c可能伴随着低血糖的风险增加。

为了研究与胰岛素治疗的2型糖尿病(T2D)患者的HbA1c有关的葡萄糖变化,研究结果发表在Diabetes Care杂志上。研究人员纳入DIALECT-2的患者(n = 79)被分为三个HbA1c类别:低、中、高(分别为≤53、54-62和≥63mmol/mol或≤7、7.1-7.8和≥7.9%)。使用FreeStyle Libre传感器进行连续血糖监测(CGM),测定血糖在范围内的时间(TIR)、低于范围的时间(TBR)、高于范围的时间(TAR)、血糖变异性参数、昼夜持续时间以及TBR和TAR发作的频率,并在HbA1c类别之间进行比较。

结果显示,CGM的中位数(IQR)为10(7-12)天/患者。低级和中级HbA1c类别的TIR没有差异(76.8% [68.3-88.2] vs. 76.0% [72.5.0-80.1]),而在低级类别中,TBR较高,TAR较低(分别为7.7% [2.4-19.1] vs. 0.7% [0.3-6.1] 和8.2% [5.7-17.6] vs. 20.4% [11.6-27.0])。

TIR、TBR1、TBR2、TAR1和TAR2的中位值分为HbA1c≤53 mmol/mol、HbA1c 54-62 mmol/mol和HbA1c≥63 mmol/mol。

最高HbA1c类别的患者比其他HbA1c类别的患者有更低的TIR(52.7% [40.9-67.3])和更高的TAR(44.1% [27.8-57.0]),但夜间的TBR并没有减少。所有患者在夜间比白天有更多(0.06 ± 0.06/h vs. 0.03 ± 0.03/h)和更长(88.0 [45.0-195.5] vs. 53.4 [34.4-82.8] 分钟)的TBR发作。

在这项研究中,高HbA1c并不能减少夜间低血糖的发生,而低HbA1c与最高的TIR无关。优化血糖控制的个性化需要使用更新的工具,包括CGM衍生的参数。

 

 

参考文献:

Glucose Regulation Beyond HbA1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort. Diabetes Care 2021 Oct; 44(10): 2238-2244. https://doi.org/10.2337/dc20-2241

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    2021-11-29 baoya
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Cardiovasc Diabetol:糖化血红蛋白对老年房颤患者2年临床结局的影响

在日本老年非瓣膜性房颤患者中,只有HbA1c≥8.0%与全因死亡和净临床结局风险增加相关;在其他HbA1c亚组中,这些事件的风险没有增加。

糖化血红蛋白你了解吗?

HbA1c的检测虽然不受每天葡糖糖波动、运动和食物的影响,可反映患者过去6~8周的平均血糖浓度,但在使用HbA1c评估患者血糖控制情况时应综合考虑患者有没有以上影响因素的存在,从而做出正确判断。

糖化血红蛋白未出数值,为何?

是何原因引起的不出数值?本实验室采用的糖化血红蛋白分析仪的型号是TOSOH HLC-723G8,试剂、校准品均为配套试剂,方法为离子交换高效液相色谱法(HPLC)。