3C疗法对2型糖尿病患者血糖波动控制的效果研究-现代医学

3C疗法对2型糖尿病患者血糖波动控制的效果研究

单位：惠州市中心人民医院内分泌科, 广东惠州 516001

分类号：R587.1

出版年·卷·期（页码）：2020·48·第二期（230-234）

摘要：

目的： 探讨3C疗法对2型糖尿病患者的临床疗效，并与传统的持续皮下胰岛素输注疗法比较，分析其在控制血糖波动方面的优势。方法： 选取2017年1月~2017年12月在惠州市中心人民医院内分泌科住院的60例2型糖尿病患者为研究对象，采用随机数字法将研究对象分为3C治疗组和CSII治疗组。3C治疗组给予动态血糖监测（CGMS）、持续皮下胰岛素输注（CSII）、糖尿病管理软件（CareLink）联合治疗，CSII治疗组给予胰岛素泵强化治疗。于入院第一天和治疗第四天行C肽检测，采用美敦力动态血糖监测系统实时监测两组血糖变化，绘制24 h血糖变化曲线。结果： 治疗后，两组FPG、2 h PG较治疗前均明显降低，且3C治疗组FPG较CSII治疗组降低幅度更为显著（P<0.05）；两组空腹C肽及餐后2 h C肽治疗前后比较均无明显变化（P>0.05）。3C治疗组NGE、SDBG、MAGE及MODD指标较CSII治疗组降低幅度更为显著（P<0.05）。治疗后，两组血糖整体水平降低，餐后峰值显著降低，且夜间空腹血糖逐渐改善。对比治疗后组间血糖参数，3C治疗组夜间空腹血糖值、餐前血糖、餐后2 h血糖及全天血糖波动于10 mmol·L^-1以上的高血糖分布时间百分比均CSII治疗组显著降低。结论： 3C疗法具有良好的临床疗效，在控制2型糖尿病患者血糖波动方面具有优势，值得临床推广。

Objective: To investigate the clinical efficacy of 3C therapy in patients with type 2 diabetes and to compare its advantages in controlling blood glucose fluctuations with traditional continuous subcutaneous insulin infusion therapy. Methods: Sixty patients with type 2 diabetes mellitus who were admitted to the endocrinology department of our hospital from January 2017 to December 2017 were enrolled. The subjects were divided into two groups by random number method. 3C therapy group was treated using continuous glucose monitoring system (CGMS), continuous subcutaneous insulin infusion (CSII), and CareLink, a diabetes management software, while CSII therapy group was given intensive treatment with insulin pump. On the first day of admission and the fourth day of treatment,blood routine examination, C-peptide detection and steady-state model method were used to simulate the release process of insulin in vivo. Blood glucose changes of the two groups were monitored in real time using Medtronic dynamic blood glucose monitoring system, and blood glucose in 24 hours curve was drawn. Results: After treatment, FPG and 2 h PG were significantly lower than those before treatment, and FPG in the 3C treatment group was significantly lower than those in the CSII treatment group (P<0.05). There were no significant changes in fasting C-peptide and 2 h C-peptide after treatment (P>0.05). NGE, SDBG, MAGE and MODD in the 3C treatment group were significantly lower than those in the CSII treatment group (P<0.05). After treatment, the overall level of blood glucose was reduced in both groups, the peak after meal was significantly reduced,and the fasting blood glucose at night gradually improved. Comparing the blood glucose parameters between the groups after treatment, the percentage of hyperglycemia distribution in the 3C treatment group at night, fasting blood glucose level, pre-prandial blood glucose, postprandial blood glucose and all day blood glucose fluctuations above 10 mmol·L^-1 were significantly lower in the CSII treatment group. Conclusion: 3C therapy has a good clinical effect and has advantages in controlling blood glucose fluctuation in patients with type 2 diabetes. It is worthy of clinical promotion.

参考文献：

[1] 陆卫颖.血糖波动对老年2型糖尿病患者认知功能的影响[J].上海医药,2018,41(12):44-46.
[2] KOHNERT K D,HEINKE P,VOGT L,et al.Associations of blood glucose dynamics with antihyperglycemic treatment and glycemic variability in type 1 and type 2 diabetes[J].J Endocrinol Invest,2017,40(11):1201-1207.
[3] 许琳,钟绍,潘颖,等.住院糖尿病患者空腹高血糖及其相关因素的分析-一项多中心的临床调查研究[J].南京医科大学学报(自然科学版),2015,35(12):1722-1726.
[4] 赵明慧.糖尿病3C疗法的研究进展[J].护士进修杂志,2016,31(13):1176-1178.
[5] 中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[6] 方福生,成晓玲,李剑,等.老年2型糖尿病血糖波动与夜间低血糖风险的相关性[J].中国药物应用与监测,2011,8(6):338-340.
[7] OMORI K,NOMOTO H,NAKAMURA A,et al.Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide:a randomized controlled trial of repaglinide vs sulfonylurea[J].J Diabetes Investig,2018,10(2),367-374.
[8] EINARSON T R,ACS A,LUDWIG C,et al.The economic burden of cardiovascular disease in type 2 diabetes:A systematic review[J].Value Health,2018,20(9):476-477.
[9] 周婷,刘祥,李晓松,等.中国人群2型糖尿病影响因素的Meta分析[J].中华流行病学杂志,2016,37(5):730-736.
[10] MURATA M,ADACHI H,OSHIMA S,et al.Glucose fluctuation and the resultant endothelial injury are correlated with pancreatic β cell dysfunction in patients with coronary artery disease[J].Diabetes Res Clin Pract,2017,131:107-115.
[11] YIN T T,BI Y,LI P,et al.Comparison of glycemic variability in Chinese T2DM patients treated with exenatide or insulin glargine:A randomized controlled trial[J].Diabetes Ther,2018,9(3):1253-1267.
[12] COLAS A,VIGIL L,RODRIGUEZ DE CASTRO C,et al.New insights from continuous glucose monitoring into the route to diabetes[J].Diabetes Metab Res Rev,2018,34(5):e3002
[13] GU W,LIU Y,CHEN Y,et al.Multicentre randomized controlled trial with sensor-augmented pump vs multiple daily injections in hospitalized patients with type 2 diabetes in China:Time to reach target glucose[J].Diabetes Metab,2017,43(4):359-363
[14] 段建芳,金凤钟,王晓明,等.血糖波动与老年人糖尿病血管并发症的研究进展[J].中华老年多器官疾病杂志,2016,15(10):788-791.
[15] 陈正方,宋歌,裴泂.3C疗法在2型糖尿病患者强化治疗中的价值[J].实用临床医药杂志,2017,21(17):191-192.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录