糖尿病患者应用糖皮质激素后的动态血糖特征及降糖方案调整

摘要

目的 观察2型糖尿病患者实施不同类型糖皮质激素治疗后的血糖升高特点,探讨调整控制血糖时胰岛素的用法,为2型糖尿病患者出现的高血糖进行早期监测和干预措施提供依据.方法 选取2014年3月至2016年3月来我院内分泌科、血液病科、皮肤科、风湿免疫科就诊的糖尿病患者共60例,按随机分组原则将入选患者分为甲强龙治疗组(DM1组)、地塞米松治疗组(DM2组)和强的松治疗组(DM3组),每组各20例.所有入选患者均采用雷兰动态血糖监测系统(DGMS)进行连续血糖监测,第2天上午8:00开始给药,其中DM1组静滴甲强龙40 mg,DM2组静滴地塞米松10 mg,DM3组一次口服强的松30 mg.比较三组患者应用糖皮质激素治疗前后的血糖波动特点,即餐后3 h血糖水平、餐后血糖峰值及餐后曲线下面积(AUC)增值.结果 治疗前,三组患者的血糖水平比较差异无统计学意义(P>0.05);经治疗,三组患者餐后3 h的血糖水平均有不同程度的升高,且在治疗的第2 d升高程度更为显著,与治疗前比较差异均有统计学意义(P<0.05);经治疗,DM2组患者的血糖升高最为明显,其次为DM3组,最后为DM1组,且三组患者的血糖升高间比较差异有统计学意义(P<0.05);在应用糖皮质激素治疗后,三组患者中餐、晚餐的血糖峰值及餐后AUC增值均明显高于早餐,增高程度依次为DM2组>DM3组>DM1组,各组间比较差异均有统计学意义(P<0.05).结论 糖尿病患者在应用糖皮质激素治疗后其血糖变化有着自身的特点,大部分患者在中、晚餐后表现出高血糖,而甲强龙对血糖的影响最小,但仍需合理的给予降糖处理以控制血糖.%Objective To observe the characteristics of blood glucose in patients with type 2 diabetes mellitus after treatment with different types of glucocorticoid, to explore the use of insulin in the regulation of blood glucose, and to provide the basis for early monitoring and intervention of hyperglycemia in patients with type 2 diabetes mellitus.Methods From March 2014 to March 2016, 60 patients with diabetes from Department of Endocrinology, Department of Hematology, Department of Rheumatology, Department of Dermatology in our hospital, according to the randomized manner, were divided into methylprednisolone treatment group (DM1 group), dexamethasone treatment group (DM2 group) and prednisone treatment group (DM3 group), with 20 cases in each group. All the patients adopted Reland Dy-namic Glucose Monitoring System (DGMS) for continuous glucose monitoring, and the administration began at 8:00 am on the 2nd day. DM1 group was given methylprednisolone 40 mg, intravenous infusion; DM2 group was treated with dexamethasone 10 mg, intravenous infusion;DM3 group was given prednisone 30 mg, oral. The blood sugar fluctuation characteristics, namely 3-hour postprandial blood glucose, the peak of postprandial glucose, and area under the curve (AUC) value after dinner were compared between the three groups. Results Before treatment, There was no statistical-ly significant difference in blood glucose between the three groups (P>0.05). After treatment, 3-hour postprandial blood glucose of all three groups increased with different degrees, and the increase was more significant on the second day of treatment (P<0.05). The elevation of blood sugar in DM2 group was the most obvious, followed by DM3 group, and fi-nally DM1 group (P<0.05). After application of glucocorticoid, the peak of postprandial glucose, AUC value for lunch and dinner in the three groups of patients were significantly higher than those for breakfast (P<0.05), and the increase de-gree ranked in the order of DM2 group>DM3 group>DM1 group (P<0.05). Conclusion Blood glucose in diabetic pa-tients after the application of glucocorticoid therapy has its own characteristics, and the majority of patients show hyper-glycemia after lunch and dinner. Methylprednisolone exerts the smallest effect on blood sugar, but reasonable hypoglyce-mic treatment is still needed to control blood sugar.