“沉默殺手”PPG:積極管理意義重大 PPG目標(biāo)值:避免低血糖,“量體裁衣” 從點(diǎn)到面,血糖管理呼喚精細(xì)化 ◆ 阿卡波糖有效降糖、改善血糖波動(dòng):治療12周后,與基線相比,阿卡波糖組和二甲雙胍組均有效降低空腹血糖、餐后2小時(shí)血糖和HbA1C,阿卡波糖組對(duì)于餐后2小時(shí)血糖(-8.6±4.9mmol/L vs. -4.5±3.7mmol/L,P<0.001)和C肽(-1.3±1.5ng/ml vs. -0.2±1.3ng/ml,P<0.001)和血糖波動(dòng)的改善均顯著優(yōu)于二甲雙胍組[24]。 ◆ 阿卡波糖顯著提高TIR:阿卡波糖100mg顯著提高TIR達(dá)28.56%,延長(zhǎng)血糖達(dá)標(biāo)時(shí)間(圖1)[24]。 PPG對(duì)HbA1C貢獻(xiàn)大,與糖尿病大血管并發(fā)癥息息相關(guān),其管理是T2DM治療的重要環(huán)節(jié)。PPG的控制目標(biāo)值應(yīng)在避免低血糖的基礎(chǔ)上,量體裁衣。然而,PPG等血糖監(jiān)測(cè)指標(biāo)無法精細(xì)反映全天血糖的波動(dòng)變化,存在一定局限性。TIR作為血糖的評(píng)估指標(biāo)之一,開啟了血糖精細(xì)化管理的時(shí)代。AIM研究不僅表明阿卡波糖100mg在控制PPG及改善血糖波動(dòng)方面優(yōu)于二甲雙胍,還證實(shí)阿卡波糖顯著提高TIR達(dá)28.56%,延長(zhǎng)血糖達(dá)標(biāo)時(shí)間,為中國(guó)精細(xì)化管理時(shí)代的糖尿病治療策略提供重要依據(jù)。 參考文獻(xiàn): 1. 母義明, 紀(jì)立農(nóng), 楊文英,等.中國(guó)2型糖尿病患者餐后高血糖管理專家共識(shí)[J]. 中國(guó)糖尿病雜志, 2016, 024(005):385-392. 2. 中華醫(yī)學(xué)會(huì)糖尿病學(xué)分會(huì). 中國(guó)2型糖尿病防治指南(2013年版). 中國(guó)糖尿病雜志, 2014, 22:附錄. 3. Jia W P , Pang C , Chen L , et al. Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross-sectional 3-year follow-up study in Shanghai urban communities[J]. Diabetologia, 2007, 50(2):286-292. 4. Ji L , Lu J , Weng J , et al. China type 2 diabetes treatment status survey of treatment pattern of oral drugs users[J]. Journal of Diabetes, 2015, 7(2):166-173. 5. Monnier L , Colette C , Dunseath G J , et al. The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes[J]. Diabetes Care, 2007, 30(2):263-269. 6. Monnier L , Lapinski H , Colette C . Contributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients: Variations with increasing levels of HbA1c[J]. Diabetes Care, 2003, 26(3):881-885. 7. Kang X , Wang C , Chen D , et al. Contributions of Basal Glucose and Postprandial Glucose Concentrations to Hemoglobin A1c in the Newly Diagnosed Patients with Type 2 Diabetes-The Preliminary Study[J]. Diabetes Technology & Therapeutics, 2015, 17(7):445-448. 8. Nakagami T . Screen-detected diabetes, hypertention and hyperchoresterolemia as predictors origin : the DECODA study[J]. Eur J Cardiovasc Prev Rehabil, 2006, 13:555-561. 9. Saydah S H , Miret M , Sung J , et al. Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults[J]. Diabetes Care, 2001, 24(8):1397-1402. 10. Jieli Lu, Jiang He, Mian Li, et al. Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults[J]. Diabetes Care, 2019, 42(8):1539-1548. 11. Ceriello A, Colagiuri S, Gerich J, et al. Guideline for management of postmeal glucose in diabetes[J]. Nutr Metab Cardiovasc Dis, 2008, 18(4):S17-S33. 12. IDF. Guideline for management of postmeal glucose in diabetes[J]. Diabetes Research & Clinical Practice, 2014, 103(2):256-268. 13. 賈偉平等. 中國(guó)2型糖尿病防治指南(2017版). 中華糖尿病雜志. 2018;10(1): 4-67. 14. American Diabetes Association. Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S1-S212. 15. Woerle H J , Neumann C , Zschau S , et al. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes: Importance of postprandial glycemia to achieve target HbA1c levels[J]. diabetes res clin pract, 2007, 77(2):0-285. 16. 侯新國(guó). 血糖監(jiān)測(cè)從點(diǎn)到曲線的路,我們有哪些誤區(qū) [J] . 中華糖尿病雜志, 2019, 11( 8 ):562-564. 17. 司一鳴, 應(yīng)令雯, 周健. 持續(xù)葡萄糖監(jiān)測(cè)臨床應(yīng)用國(guó)際專家共識(shí)解讀[J]. 中華糖尿病雜志, 2018, 010(006):386-389. 18. 戴冬君. 持續(xù)葡萄糖監(jiān)測(cè)新指標(biāo):葡萄糖在目標(biāo)范圍內(nèi)時(shí)間的臨床意義解析[J]. 中華糖尿病雜志, 2019, 11(2):139-142. 19. Vigersky RA, et al. Going beyond HbA1c to understand the benefits of advanced diabetes therapies[J]. J Diabetes, 2019, 11(1)23-31. 20. Beck RW, et al. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials[j]. Diabetes Care, 2019, 42(3):400-405. 21. Lu J, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes[J]. Diabetes Care. 2018, 41(11):2370-2376. 22. Qingyu Guo, Pu Zang, Shaoying Xu, et al. ime in Range, as a Novel Metric of Glycemic Control, Is Reversely Associated With Presence of Diabetic Cardiovascular Autonomic Neuropathy Independent of HbA1c in Chinese Type 2 Diabetes[J]. J Diabetes Res, 2020 , 2020: 5817074. 23. Battelino T , Danne T , Bergenstal R M , et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range[J]. Diabetes Care, 2019, 42(8):1593-1603. 24. Fei Gao, Xiaojing Ma, Jiahui Peng, et al. The Effect of Acarbose on Glycemic Variability in Patients With Type 2 Diabetes Mellitus Using Premixed Insulin Compared to Metformin (AIM): An Open-Label Randomized Trial[J]. Diabetes Technol Ther. 2020, 22(4):256-264. |
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