末梢血酮与尿酮在糖尿病酮症诊治中的临床应用价值比较

目的:比较末梢血酮即β-羟丁酸与尿酮在糖尿病酮症诊断和监测方面的临床价值。方法:收集2013年10月至2014年12月我院内分泌科收治的随机末梢血糖13.9 mmol/L的糖尿病患者161例,根据尿酮是否阳性分为糖尿病酮症患者29人,非糖尿病酮症患者132人。比较患者末梢血酮、尿酮的相关性;通过受试者工作特征曲线(ROC)寻找血酮诊断糖尿病酮症的诊断切点;比较血酮和尿酮对监测治疗反应性的优缺点。结果:糖尿病患者血酮和尿酮水平呈显著正相关,血酮随尿酮增加而增加(r=0.493,P0.001),而二者与血糖水平均无明显相关性(P=0.358,P=0.133)。以尿酮为糖尿病酮症诊断标准,ROC曲线下面积0.843(CI,0.746-0.939),末梢血酮诊断酮症的界值为0.25 mmol/L。在监测糖尿病酮症患者治疗的过程中,血酮较尿酮达峰更快,转阴更早。结论:血酮与尿酮有较好相关性,末梢血酮检测有良好的敏感性、及时性和精确性,对治疗策略有更好的指导意义,建议临床推广。     

影响Ⅱ型糖尿病动物模型KK／Upj—A^y／J小鼠血糖的因素

目的探讨营养,年龄及性别等因子对Ⅱ型糖尿病动物模型-KK／Upj-A^y／J小鼠血糖的影响。方法尾部取血,用血糖仪测定实验组和对照组动物的血糖并进行实验分析。结果实验组血糖值明显高于对照组;实验组发病动物的比例也明显高于对照组动物;对照组8月龄小鼠血糖值低于糖尿病的发病标准;实验组年龄对动物的血糖影响较小;实验组和对照组性别基本不影响动物的血糖。结论（1）在同样携带A^y黄色肥胖糖尿病基因的遗传作用的条件下,饲料中的营养成分是影响小鼠血糖的主要因素,（2）动物的年龄是影响血糖的另一主要因素。（3）性别对动物血糖的影响不大。     

高抗性淀粉主食对住院2型糖尿病患者血糖波动的影响

目的：探索高抗性淀粉主食对住院2型糖尿病患者血糖波动的影响。 方法：选取本院内分泌科2型糖尿病住院患者102例,均由医院给予个性化的医学营养治疗（MNT）。试验共3d,试验第2~3天午餐和晚餐用等热量高抗性淀粉主食替代普通米饭;连续3d监测患者三餐前后和睡前血糖值;分析监测点平均血糖变化、血糖波动指标及低血糖发生次数。 结果：试验期间早餐前后平均血糖无明显改变,差异无统计学意义（P>0.05）;试验第3天午餐前后血糖值低于前2d血糖值,且午餐后血糖值随试验天数有下降趋势;试验第3天晚餐前后血糖值均低于第1天血糖值;试验第2天、3天睡前血糖值均低于第1天血糖值,差异具有统计学意义（P<0.05）;试验期平均血糖逐日下降,差异有统计学意义（P<0.05）;试验第3天血糖波动指标明显降低,较试验前差异有统计学意义（P<0.05）;试验期间低血糖发生次数减少。 结论：含高抗性淀粉主食替代普通米饭可以改善患者监测点平均血糖水平、降低血糖波动及减少低血糖发生次数,为改善糖尿病血糖控制、合理选择主食提供临床依据。     

桦褐孔菌与松口蘑菌粉降血糖作用的研究

为评价桦褐孔菌和松口蘑发酵菌粉的降血糖作用,本文观察了经不同浓度桦褐孔菌和松口蘑菌粉溶液灌胃后,小鼠正常血糖、给予葡萄糖小鼠以及四氧嘧啶糖尿病小鼠血糖的变化.结果表明:桦褐孔菌、松口蘑菌粉溶液(500、1000 mg/kg)对小鼠正常血糖值、正常小鼠糖耐量没有明显影响(P>0.05);对于糖尿病小鼠血糖,桦褐孔菌低剂量组(500 mg/kg)和桦褐孔菌高剂量组(1000 mg/kg)的降糖效果较为明显(P<0.01),用药前与用药后第21 d的血糖值分别为(14.94±1.85)、(10.43±2.22)和(14.89±1.65)、(10.17±2.14) mmol/L,降糖率分别为30.23% 和31.7%.桦褐孔菌和松口蘑菌粉对于小鼠正常血糖、正常小鼠糖耐量无明显影响,对于四氧嘧啶糖尿病小鼠具有一定的降血糖效果.     

城乡接合社区2型糖尿病患者体成分分析与血糖控制状况及影响因素研究

目的：了解城乡接合社区2型糖尿病患者的人体成分与血糖控制状况，探讨血糖控制影响因素。方法：选择2016年10-12月在北京市朝阳区王四营社区卫生服务中心招募的132例糖尿病患者作为研究对象，以糖化血红蛋白（HbA1c）＜7%和HbA1c≥7%为界点，将研究对象分为血糖控制良好组（68例）和血糖控制不佳组（64例），比较两组血糖、血脂、人体成分指标的差异，分析血糖控制不佳的影响因素。结果：132例研究对象的体质指数（BMI）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇水平（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和血压的总体达标率分别为12.9%、50.8%、51.5%、38.6%、58.3%、47.7%、59.8%、20.5%。两组患者的FPG、HbA1c、糖化血清蛋白（GSP）、胰岛素分泌指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）、HDL-C、基础代谢率（BMR）、去脂体重（FFM）、肌肉重（MM）、体脂百分比（PBF）存在显著性差异（P＜0.05）。多因素Logistic逐步回归分析结果显示，治疗策略（以生活方式干预作为参照，单种口服降糖药OR=4.565，95% CI：1.483～14.050，多种口服降糖药OR=11.312，95% CI：3.834～33.377）、HDL-C（OR=0.099，95%CI：0.022～0.444）、体脂百分比（OR=1.087，95%CI：1.022～1.157）是血糖控制不佳的影响因素。结论：城乡接合社区2型糖尿病患者的血糖和体脂控制情况欠佳，治疗策略、HDL-C、体脂百分比是血糖控制不佳的主要影响因素，应采取积极的综合措施开展干预。     

食蟹猴的基础血糖值调查

目的 调查圈养食蟹猴基础血糖值情况.方法 采用快速血糖仪对153只6～19岁雄性食蟹猴和87只6～24岁雌性食蟹猴的血糖进行测定.结果 不同性别的食蟹猴血糖值存在显著性差异(P＜0.05),其中雌性食蟹猴血糖平均值为4.09 mmol/L±1.03 mmol/L,雄性食蟹猴血糖平均值为3.32 mmol/L±0.59 mmol/L;不同年龄段的食蟹猴血糖值差异显著(P＜0.05),年龄大的食蟹猴血糖值比年龄小的食蟹猴血糖值整体较高;体重指数与基础血糖值之间无显著相关性.结论 食蟹猴基础血糖值与人类基础血糖值相比,水平较低;性别和年龄是影响食蟹猴血糖值的主要因素.食蟹猴基础血糖值调查为糖尿病动物模型的建立及其相关研究提供了有关血糖值的基础数据参考.     

中老年食蟹猴群体自发型糖尿病的筛选

筛选440只中老年偏胖食蟹猴群体中自发糖尿病个体,并探讨食蟹猴群体中糖尿病粗筛的方法。以调查基础血糖值为基础,推断疑似糖尿病血糖值,后经OGTT(口服糖耐量)和尿检结果验证该血糖值是否准确。结果显示中老年偏胖食蟹猴群体血糖值为(3.88±0.98)mmol/L,其中56只食蟹猴血糖值大于5.0mmol/L,被初步定为糖尿病个体。这些个体全部糖耐量异常,且36只(69.23%)出现尿糖阳性,证明血糖值大于5.0mmol/L可作为本群体食蟹猴糖尿病的粗筛标准。由于针对中老年偏胖食蟹猴群体,患病率为12.72%(56/440),高于我国糖尿病患病率(9.7%)。虽然该实验的糖尿病血糖指标并不适用于所有食蟹猴群体,但是该筛选的流程简单快捷,对动物损伤小,可适用于大群体糖尿病的筛选。     

一项住院2型糖尿病患者血糖控制、自我管理行为及心理评估的调查

目的:目前针对中国糖尿病教育管理现状的高质量调查仍然不是很多,因此我们对一家糖尿病专科医院的住院2型糖尿患者进行了问卷调查,收集其自我管理行为、血糖控制及抑郁与心理状况,以探讨糖尿病教育管理工作的重点。方法:对2014年9月至12月间在太原糖尿病专科医院住院治疗的2型糖尿病患者,进行面对面的问卷调查。调查问卷包括一般资料问卷、Toobert行为量表简化版及WHO-5幸福感指数量表(WHO-5Well-Being Index)和中文版简化糖尿病问题量表(short-form Chinese-version PAID[SFPAID-C]scale)。结果:共调查患者330例,经双份录入和数据澄清之后剩余有效问卷315份(95.5%),男性150(47.6%)例,女性165(52.4%)例。患者年龄(60.5±9.2)岁,病程(10.0±7.1)年,BMI(25.3±3.5)kg/m~2、腰围(91.4±9.9)厘米,糖化血红蛋白(Hb A1c)(8.5±2.0)%,超重与肥胖的患者分别为71.8%和88.5%,男性和女性腹型肥胖的患病率分别为75.0%和72.7%,8.6%的患者存在亚临床或临床抑郁问题(SF-PAID-C评分≥15)。73.3%的患者接受过糖尿病教育,86.0%的患者定期监测血糖,过去一年检测过Hb A1c和血脂的患者分别为66.7%、62.9%,87.3%的患者在诊断糖尿病后改变了饮食习惯,61.9%的患者定时定量进餐,74.6%的患者规律运动,66.7%的患者每周运动时间≥150分钟。Toobert行为量表显示,患者在执行每天吃五份以上的水果和蔬菜(2.5±2.5)、把碳水化合物均匀分布到一整天(3.5±2.8)、血糖监测(3.4±2.5)以及检查脚和鞋子(3.7±2.5)方面的天数较少,执行天数为0天的患者比例分别为36.0%、25.8%、13.3%和16.5%。将患者分为接受过(231例,75.2%)和未接受过糖尿病教育(76例,24.8%)两组,接受过糖尿病教育者,年龄更大,病程更长,合并糖尿病视网膜病变、神经病变的百分比及胰岛素治疗的百分比更高,自我管理行为更好,Hb A1c水平更低,但SF-PAID-C评分和WHO-5评分没有显著性差异。将患者根据病程分为5年、6-10年、11-15年、≥16年四组,随着病程增加,接受过糖尿病教育的患者比例增加,糖尿病并发症的患病率及胰岛素治疗的百分比显著增加,WHO-5评分下降,SF-PAID-C评分上升,自我管理行为和Hb A1c差异不显著。回归分析显示,影响Hb A1c的因素包括治疗方案和自我管理行为,影响SF-PAID-C评分的因素包括运动状况及是否合并糖尿病神经病变,影响WHO-5评分的因素包括病程和自我管理行为。结论:饮食、血糖监测、足部护理、社会支持及用药依从性方面的糖尿病教育指导需要更为细致。糖尿病人在病程较长、合并有并发症及使用胰岛素治疗时,才有更大机会获得糖尿病教育,但将错过教育的最佳时机,糖尿病教育的开始时间需更早。在提升幸福指数、改善抑郁和焦虑方面,糖尿病教育没有直接作用,改善疾病控制、坚持自我管理行为、推迟并发症的发生发展,有直接作用。     

四氧嘧啶与链脲佐菌素诱导兔1型糖尿病模型的比较

目的观察四氧嘧啶(alloxan,ALX)与链脲佐菌素(streptozotocin,STZ)诱导新西兰兔1型糖尿病模型的差异,探讨建模的最佳方法。方法 70只新西兰兔分为3组:实验组56只,又随机分为ALX和STZ两组,每组28只,采用两次给药,第一次剂量为100 mg/kg,48 h后第二次给药,剂量为120 mg/kg;对照组C组14只,相同方法给予等量生理盐水。每组给药后于不同时间监测空腹血糖、尿糖、尿酮、空腹体重、饮水量、排尿量、渗透压及电解质变化情况。结果一周后ALX组和STZ组成模率分别为71.43%和64.26%,死亡率分别为25%和17.86%,两组之间比较成模率及死亡率均无明显统计学差异(P0.05);两组之间血糖浓度差异有统计学意义(P0.05)。结论 ALX与STZ分两次给药均可诱导稳定的兔1型糖尿病模型,从成模率、死亡率及建模成本综合考虑,ALX是建立兔1型糖尿病模型的优先选择。     

六个肥胖相关基因在食蟹猴2型糖尿病不同发病时期的差异表达

2型糖尿病(T2DM)是一种与基因密切相关的高发性代谢性疾病。采用高脂饮食(其中含15%猪油)喂养25只中老年雄性食蟹猴的方法,制备T2DM模型,通过检测血糖与血脂水平确定疾病发展进程,并利用实时PCR对外周血白细胞中的6个肥胖相关基因mRNA表达量进行测定。食蟹猴T2DM在临床前期和临床期口服糖耐量实验(OGTT)2-h血糖值分别为(11.06±6.05)mmol/L和(13.12±2.89)mmol/L,显著高于正常组;空腹血糖在临床期达到最大值,为(7.58±1.56)mmol/L(P<0.01),说明其T2DM模型被成功诱导。但所检测的6个糖尿病肥胖相关基因中只有CDKN2B、IGF2BP2和FTOmRNA表达量与糖尿病发病进程呈正相关,且临床期IGF2BP2和FTO的表达量分别是对照组的65.92倍和4.30倍,差异极显著(P<0.01)。因此,基因CDKN2B、IGF2BP2和FTO可作为食蟹猴糖尿病早期诊断及预后评价的参考指标。     

Postmortem Blood Sugar and Blood Urea Nitrogen Determinations

Glucose and urea nitrogen determinations were made on blood and cerebrospinal fluid samples collected during 160 postmortem examinations in order to determine the usefulness of such tests in diagnosing diabetes and uremia at the time of autopsy. The results indicated that: (1) Blood is unsuitable for postmortem glucose determination, and no postmortem normal can be established. (2) Cerebrospinal fluid gave more uniform but very low glucose values. (3) Diabetics as a group had very high postmortem glucose levels but showed a marked overlap with non-diabetics. (4) Infants less than 3 months of age showed high postmortem glucose values. (5) Postmortem blood urea nitrogen and cerebrospinal fluid urea nitrogen levels were within normal limits in previously healthy persons who died suddenly from accidental causes. (6) Hospital autopsy cases had high urea nitrogen levels. (7) Postmortem urea nitrogen levels higher than 100 mg.% were indicative of uremia.     

2 型糖尿病患者血糖波动与心律失常的相关性分析

目的:探讨2型糖尿病患者血糖波动与心律失常的相关性。方法:收集2型糖尿病住院患者410例为研究对象,连续3d对患者给予动态血糖监测,平均血糖水平(MBG)及标准差(SD)、日内平均血糖波动幅度(MAGE)以及日间血糖平均绝对差(MODD);按照患者住院期间的心电图检查分为心律失常组(n=112例)和非心律失常组(n=298例),分析两组患者血糖波动指标的差异。结果:410例住院的2型糖尿病患者中112例患者发心律失常,发生率为27.3%,心律失常中以房性早搏为主、其次为窦性心动过速。心律失常组患者收缩压(SBP),LDL-C、Hb A1c、HOMA-IR高于非心律失常组(P0.05);而MBG及SD、MAGE以及MODD亦高于非心律失常组(P0.05);Logistic回归分析提示,MAGE(OR=2.478,CI 1.632~5.145,P0.05)与心律失常的发生呈现独立相关。此外糖尿病病程、SBP、Hb A1c、HOMA-IR亦是心律失常的发生的独立危险因素(P0.05)。结论:2型糖尿病患者发生心律失常的比例较高,且与血糖波动具有一定的相关性,合理控制血糖波动水平对于降低心律失常的发生具有临床意义。     

定期血糖监测对糖尿病患者血糖控制及生活方式的影响

目的:探讨定期血糖监测对糖尿病血糖控制及生活方式的影响。方法:随机抽取我中心2010-2011年度确诊的老年2型糖尿病患者110例,随机分为干预组和对照组,每组各55例;2组均接受正规降糖药物治疗及生活方式指导,干预组每周进行一次血糖监测,每3个月测一次糖化血红蛋白,对照组按患者意愿测定血糖指标,通过12个月的观察,研究两组患者在血糖控制及生活方式上的差异。结果:干预组患者空腹血糖(FPG)由定期监测血糖前的(7.26±1.36)mmol/L降至(6.68±1.10)mmol/L;餐后2小时血糖(2HPG)由定期监测血糖前的(12.34±2.29)mmol/L降至(11.09±1.98)mmol/L;糖化血红蛋白由监测前的(7.99±1.61)%降至(6.60±0.87)%;差异具有显著性(P<0.05);生活方式亦有明显改善,差异具有显著性(P<0.05);而对照组的改变不如干预组。结论:通过定期血糖监测可以有效地控制血糖、糖化血红蛋白,促使老年2型糖尿病患者改变不良生活方式。     

Insulin secretory responses in patients with glucose intolerance due to extra-pancreatic causes. Comparison with idiopathic diabetes mellitus

Insulin responses during 100 g glucose tolerance tests (GTT) were compared between three groups of patients with varying degrees of glucose intolerance. Patients who had no disease known to be associated with secondary diabetes were classified as patients with idiopathic diabetes mellitus. Those whose present and past fasting blood glucose (FBG) exceeded 140 mg/100 ml were assigned to Group A, and the rest of the patients to Group B. Group C included patients with liver disease, thyrotoxicosis, or myocardial infarction, or those treated with corticosteroids or who had undergone gastrectomy. Patients in Group A were found to have consistently subnormal insulin responses whether glucose tolerance was normal (i.e. previous abnormality of glucose tolerance), borderline, or diabetic. In contrast, patients in Group C without fasting hyperglycemia had enhanced rather than decreased insulin responses when glucose tolerance was the more impaired. Patients in Group B had insulin responses similar to those either of Group A or of Group C. The relationship between the sum of six insulin and six blood glucose values during GTT (sigma IRI and sigma BG) was examined. The sigma BG-sigma IRI plot revealed distinctly different distribution zones for Group A and Group C (Zones A and C). In Group A, sigma IRI values were below 300 microU/ml irrespective of sigma BG values. In Group C, sigma IRI tended to increase, paralleling the increase in sigma BG values in the range of sigma BG values lower than 1400 mg/100 ml. In patients whose sigma BG rose above 1400/100 ml during corticosteroid treatment, the sigma IRI values decreased and entered into Zone A. After the cessation of corticosteroids in a few of these patients, the sigma IRI values recovered and reentered Zone C, concomitant with an improvement in glucose tolerance. Similar recovery of insulin response from Zone A to Zone C was also observed after the treatment of two obese diabetic patients. Thus, patients with glucose intolerance due to extra-pancreatic causes may secrete insulin at a higher rate than normal so long as the FBG level remains below 120 mg/100 ml, but a further deterioration in glucose metabolism may lead to a failure of insulin secretory mechanisms.     

Self Blood Glucose Monitoring Underestimates Hyperglycemia And Hypoglycemia As Compared To Continuous Glucose Monitoring In Type 1 And Type 2 Diabetes

Objective: When glucose records from self blood glucose monitoring (SBGM) do not reflect estimated average glucose from glycosylated hemoglobin (HgBA1) or when patients' clinical symptoms are not explained by their SBGM records, clinical management of diabetes becomes a challenge. Our objective was to determine the magnitude of differences in glucose values reported by SBGM versus those documented by continuous glucose monitoring (CGM).Methods: The CGM was conducted by a clinical diabetes educator (CDE)/registered nurse by the clinic protocol, using the Medtronic iPRO2™ system. Patients continued SBGM and managed their diabetes without any change. Data from 4 full days were obtained, and relevant clinical information was recorded. De-identified data sets were provided to the investigators.Results: Data from 61 patients, 27 with type 1 diabetes (T1DM) and 34 with T2DM were analyzed. The lowest, highest, and average glucose recorded by SBGM were compared to the corresponding values from CGM. The lowest glucose values reported by SBGM were approximately 25 mg/dL higher in both T1DM (P = .0232) and T2DM (P = .0003). The highest glucose values by SBGM were approximately 30 mg/dL lower in T1DM (P = .0005) and 55 mg/dL lower in T2DM (P<.0001). HgBA1c correlated with the highest and average glucose by SBGM and CGM. The lowest glucose values were seen most frequently during sleep and before breakfast; the highest were seen during the evening and postprandially.Conclusion: SBGM accurately estimates the average glucose but underestimates glucose excursions. CGM uncovers glucose patterns that common SBGM patterns cannot.Abbreviations: CDE = certified diabetes educator; CGM = continuous glucose monitoring; HgBA1c = glycosylated hemoglobin; MAD = mean absolute difference; SBGM = self blood glucose monitoring; T1DM = type 1 diabetes; T2DM = type 2 diabetes     

动态血糖监测在老年2型糖尿病患者降糖治疗中的应用价值

目的：通过对老年2型糖尿病患者进行动态血糖监测了解降糖治疗的疗效,评价动态血糖监测系统的应用价值,确定其在治疗老年2型糖尿病患者中的地位。方法：选取2008年8月至2013年8月住院的老年2型糖尿病患者95例,随机分为对照组48例和观察组47例,对照组行予常规的指尖血糖监测,观察组行动态血糖监测,比较两组患者血糖的控制情况。结果：观察组患者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h血糖等与治疗前相比较比较,差异均有统计学意义,P〈0.05。对照组患者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h血糖等与治疗前相比较比较,差异均无统计学意义,P〉0.05。两组患者空腹血糖治疗前、后差异均无统计学意义,P〉0.05。结论：动态血糖监测系统用于监测老年2型糖尿病患者的降糖治疗疗效优于常规血糖检测。     

甘精胰岛素联合不同降糖药稳定2 型糖尿病血糖水平的效果

目的:评价甘精胰岛素联合沙格列汀或格列美脲稳定2型糖尿病血糖水平的作用效果。方法:将我院2收治的228例2型糖尿病患者按照随机数字表法分为研究组和对照组,每组114人。研究组给予沙格列汀联合甘精胰岛素进行治疗,对照组给予格列美脲联合甘精胰岛素进行治疗。全部病例在治疗前4 d及治疗满16周时应用动态血糖监测仪实施72 h动态血糖监测。对比两组治疗前后血糖水平相关指标及血糖水平浮动相关指标的变化。结果:研究组治疗后体质指数显著低于对照组(P0.05)。两组治疗后空腹血糖均比本组治疗前显著下降(P0.05)。两组治疗后糖化血红蛋白均比本组治疗前显著下降(P0.05)。两组治疗后胰岛素用量无显著差异。两组平均血糖水平治疗前后无显著差异(P0.05)。研究组治疗后血糖标准差、日内血糖平均波动幅度、日内血糖波动次数、日间血糖平均绝对差改善幅度显著优于对照组。两组高血糖治疗后均比治疗前显著改善,改善幅度无显著差异(P0.05)。两组低血糖曲线下面积治疗前后无显著差异(P0.05)。结论:甘精胰岛素并用沙格列汀更能在显著控制2型糖尿病患者血糖的同时,还可使其血糖水平保持持久稳定,且不增加其低血糖的发生风险。     

动态血糖监测在老年2 型糖尿病患者降糖治疗中的应用价值

目的：通过对老年2 型糖尿病患者进行动态血糖监测了解降糖治疗的疗效,评价动态血糖监测系统的应用价值,确定其在 治疗老年2 型糖尿病患者中的地位。方法：选取2008 年8 月至2013 年8 月住院的老年2 型糖尿病患者95 例,随机分为对照组 48 例和观察组47 例,对照组行予常规的指尖血糖监测,观察组行动态血糖监测,比较两组患者血糖的控制情况。结果：观察组患 者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h 血 糖等与治疗前相比较比较,差异均有统计学意义,P＜0.05。对照组患者治疗后平均血糖、高血糖持续时间、低血糖持续时间、血糖 最大波波动幅度、平均血糖波动幅度、血清糖化白蛋白及餐后2h血糖等与治疗前相比较比较,差异均无统计学意义,P＞0.05。两 组患者空腹血糖治疗前、后差异均无统计学意义,P＞0.05。结论：动态血糖监测系统用于监测老年2 型糖尿病患者的降糖治疗疗 效优于常规血糖检测。     

Non-invasive glucose monitoring in patients with diabetes: a novel system based on impedance spectroscopy

The aim of this work was to evaluate the performance of a novel non-invasive continuous glucose-monitoring system based on impedance spectroscopy (IS) in patients with diabetes. Ten patients with type 1 diabetes (mean+/-S.D., age 28+/-8 years, BMI 24.2+/-3.2 kg/m(2) and HbA(1C) 7.3+/-1.6%) and five with type 2 diabetes (age 61+/-8 years, BMI 27.5+/-3.2 kg/m(2) and HbA(1C) 8.3+/-1.8%) took part in this study, which comprised a glucose clamp experiment followed by a 7-day outpatient evaluation. The measurements obtained by the NI-CGMD and the reference blood glucose-measuring techniques were evaluated using retrospective data evaluation procedures. Under less controlled outpatient conditions a correlation coefficient of r=0.640 and a standard error of prediction (SEP) of 45 mg dl(-1) with a total of 590 paired glucose measurements was found (versus r=0.926 and a SEP of 26 mg dl(-1) under controlled conditions). Clark error grid analyses (EGA) showed 56% of all values in zone A, 37% in B and 7% in C-E. In conclusion, these results indicate that IS in the used technical setting allows retrospective, continuous and truly non-invasive glucose monitoring under defined conditions for patients with diabetes. Technical advances and developments are needed to expand on this concept to bring the results from the outpatient study closer to those in the experimental section of the study. Further studies will not only help to evaluate the performance and limitations of using such a technique for non non-invasive glucose monitoring but also help to verify technical extensions towards a IS-based concept that offers improved performance under real life operating conditions.     

Evaluation of the quality of bedside monitoring of the blood glucose level in a teaching hospital.

We evaluated the precision and accuracy of monitoring of the blood glucose level in the laboratory and at the bedside with one of four glucose meters by an experienced operator and by 39 nurses in a teaching hospital. For precision studies aqueous quality control materials were used. A total of 85 blood samples were tested. The precision of the glucose meters (expressed as the coefficient of variation [CV]) in the hands of the experienced operator ranged from 6.7% to 11.1%. The correlation between the values obtained by the experienced operator and the reference values obtained in the laboratory was high (0.95 to 0.98). The precision of the values obtained by the nurses using the meters ranged from 13.7% on medical wards to 45.7% in the intensive care unit (ICU). The correlation between these values and those obtained in the central laboratory ranged from 0.72 to 0.82. Twenty-four percent of the glucose values determined on medical wards and 62% of those determined in the ICU deviated from the reference value by at least 20%. Of the 85 patients 12 (14%) would have received different insulin dosages had the reference value been available at the same time as the glucose meter reading: in 3 of the patients the discrepancy was 6 units of insulin or greater. Continuous quality control of bedside monitoring of the blood glucose level is needed. In addition, personnel who use glucose meters should receive adequate training.