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題名 | Glycemic Control and Association with Metabolic Factors in Hemodialysis Patients with Diabetes Mellitus=糖尿病接受血液透析治療病患之血糖控制及與代謝因子的關係 |
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作者 | 楊堉坤; 郭銘俊; 楊智超; 李建德; 林景坤; 廖上智; 莊峰榮; 陳靖博; 許國泰; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 22:3 2008.09[民97.09] |
頁次 | 頁167-172+209 |
分類號 | 415.668 |
關鍵詞 | 糖尿病; 血液透析; 血糖; 糖化血紅素; 發炎指數; Diabetes mellitus; Hemodialysis; Blood sugar; HbA1C; C-reactive protein; |
語文 | 英文(English) |
中文摘要 | 背景:糖尿病是造成末期腎臟病的重要原因,亦會導致明顯的心血管疾病。良好的血糖控制仍是防止或延遲其併發症的主要方式。但我們很少探討對於接受血液透析的糖尿病病人的血糖控制方式與成效。此研究主要是探討接受血液透析的糖尿病病患之糖尿病的治療方式、治療成效及其與其它代謝因子的關係。方法:我們共收集了123位接受血液透析超過六個月的糖尿病病人,並紀錄其基本資料及生化等數值。我們並比較糖尿病治療方式與血糖控制好壞的關係。我們亦分析血糖控制、發炎指數(high sensitivity CRP)及白蛋白等其他代謝因子問的關係。結果:在123位糖尿病病患中,接受胰島素者有58位(佔47.2%),口服降血糖藥物者有44位(佔35.8%),而同時接受胰島素及口服降血糖藥物者有5位(佔4%)。平均糖化血紅素(HbA1C)是8.2±2.1%。平均糖化血紅素於未接受任何藥物控制者(佔13%)明顯低於其它血糖控制方式(6.1±1.4% v.s. 8.6±19%, p<0.05)。於四個不同治療方式的組別中,白蛋白及血脂並無明顯差異。平均血糖值與自蛋白、糖化血紅素及血脂有相關性;但糖化血紅素與CRP並無相關性。於20個月的追蹤期間,有14位病人死亡(死亡率:11.4%)。糖化血紅素大於及小於9.1%的死亡率分別是20.5%及7.1%,有明顯之差異(p<0.05)。結論:已接受血液透析之糖尿病患的血糖控制並不理想。即使接受胰島素治療者亦然。糖化血紅素與平均血糖值有正相關,但與慢性發炎指數無相關。不同血糖的治療方式之死亡率並無差別,但血糖控制較差者死亡率較高。 |
英文摘要 | Background: Diabetes mellitus is the leading cause of end-stage renal disease and is associated with significant cardiovascular morbidity and mortality. Good glycemic control remains the key to prevent or delay its complication. We conducted a cross-sectional study to assess the regimens of diabetes treatment and effect of therapy, and examine the relationship between clinical features and metabolic factors. Methods: Adult diabetic patients on chronic hemodialysis were investigated. Their demographic and biochemical data were reviewed and recorded. Treatments for diabetes were compared and glycemic control was assessed by average random blood sugar and glycated hemoglobin (HbA1C) levels. The association between blood sugar levels, high sensitivity C-reactive protein (hsCRP), and other metabolic factors were examined. Results: In 123 enrolled patients, 107 patients (87%) were on insulin injection or anti-diabetic agents (ADA). The average HbA1C was 82±2.1% (4.2-13.1%). The HbA1C level was lower in patients without the need of medication than in other treatment regiment groups (6.1±1.4% vs. 8.6±1.9%, p<0.05). Neither albumin level. nor lipid profile showed significant difference among treatment groups. Average random glucose level showed a negative correlation with albumin (r=-0.237, p<0.01), and was directly related to HbA1C (r=0.745, p<0.001), and triglyceride (r=0.225, p<0.05). No association was found between HbA1C and hsCRP level, in a follow-up period of 20 months, there were 14 deaths in this study cohort (11.4%). Patients with HbA1C greater than 9.1% had significantly increased mortality (20.5% vs. 7.1% in HbA1C less than 9.1%, p<0.05). Conclusion: Glycemic control in diabetic HD patients is not adequate even under insulin treatment. The HbA1C level correlated well with average random sugar level but was not related to chronic inflammatory marker. Poor glycemic control was associated with poor outcome. |
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