Glucose kulolerana mayeso kuchuluka, glycated hemoglobin yachibadwa

Kuzindikira matenda ashuga mellitus (DM) pogwiritsa ntchito mayeso a shuga a pakamwa (PHTT) ndi glycated hemoglobin (HbA1c) kunachitika pakati pa odwala 127 omwe ali pachiwopsezo cha matenda a shuga a 2. Kuzindikira matenda a shuga mellitus potengera mulingo wa HbA1c anali otsika kuposa pamaziko a PHTT (31% motsutsana ndi 43%). Mlingo wa HbA1c> 7% nthawi zonse umagwirizana ndi kuzindikira kwa matenda a shuga ndi njira ya PHTT. Komabe, mulingo wa HbA1c wa PHTT.

Kusintha kwa njira yodziwira matenda a shuga oyerekezera zotsatira za kuyamwa kwa glucose mayeso ndi glycated hemoglobin (HbA1c)

Chiwerengero cha owerengeka a odwala 127 omwe ali ndi vuto lachiwiri la matenda a shuga (T2DM) ali pachiwopsezo cha mayeso okhudzana ndi shuga (OGTT) ndi HbA1c pazifukwa zodziwira. HbA1c idawululira odwala ochepa odwala matenda ashuga kuposa OGTT (31% vs 43%). HbA1c> 7% ndi OGTT anali ofanana pakutsimikizira matenda ashuga, koma kuchita kwa HbA1c OGTT kutsimikizira kuzindikiraku.

Zolemba za asayansi pamutu wakuti "Kugwirizana kwa njira yodziwira matenda osokoneza bongo molingana ndi zotsatira za kuyesedwa kwa shuga m'mlomo komanso kuchuluka kwa hemoglobin HbA1c"

Kudziwitsa momwe mungadziwiritsire matenda a shuga mellitus malinga ndi zotsatira za kuyesedwa kwa shuga pakamwa komanso kuchuluka kwa hemoglobin HbA1c

Federal State Budgetary Institution "Endocrinological Science Science Center" ya Unduna wa Zaumoyo ku Russian Federation, Moscow

Kusintha kwa njira yodziwira matenda a shuga oyerekezera zotsatira za kuyamwa kwa glucose mayeso ndi glycated hemoglobin (HbA1c)

Federal state budget budget institution "Endocrinological Research Center", Russian Ministry of Health, Moscow

Kuzindikira matenda ashuga mellitus (DM) pogwiritsa ntchito mayeso a shuga a pakamwa (PHTT) ndi glycated hemoglobin (HbA1c) kunachitika pakati pa odwala 127 omwe ali pachiwopsezo cha matenda a shuga a 2. Kuzindikira matenda a shuga mellitus potengera mulingo wa HbA1c anali otsika kuposa pamaziko a PHTT (31% motsutsana ndi 43%). Mlingo wa HbA1c> 7% nthawi zonse umagwirizana ndi kuzindikira kwa matenda a shuga ndi njira ya PHTT. Komabe, HbA1c 7% ndi OGTT anali ofanana pakutsimikizira matenda ashuga, koma HbA1c sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

kuchuluka kwa ziopsezo zomwe zingayambitse matenda a shuga 2 (T2DM). Zowopsa zake zikuphatikiza zaka> zaka 45, kunenepa kwambiri kapena kunenepa kwambiri (BMI> 25 kg / m2), mbiri ya mabanja ya T2DM (makolo kapena abale ake omwe ali ndi T2DM), zochitika zolimbitsa thupi, kutsika kwambiri kwa glycemia (NGN) kapena kufatsa kwa glucose (NTG) mbiri, matenda a shuga a m'mimba kapena mbiri ya mwana wosabadwa. Phunziroli silinaphatikizepo odwala omwe amalandila chithandizo cha hypoglycemic kapena chithandizo cha zakudya.

Mulingo wa HbAlc unatsimikizika mwa odwala onse, ndipo pasanathe masiku atatu, PHTT yokhazikika idachitidwa ndi 75 g ya glucose motsimikiza kusala shuga ndi 120 min pambuyo ponyamula chakudya. Ntchitoyi idavomerezedwa ndi komiti yamakhalidwe a FSBI ENC. Odwala onse adasaina chilolezo cholembedwa kuti atenge nawo mbali pachipatala.

Serum glucose idatsimikizika pa Architect c4000 biochemical analyzer (Abbott Diagnostics, Abbott Park, IL, USA) pogwiritsa ntchito zida zapamwamba zaopanga. Glycated hemoglobin (HbA1c) imatsimikiziridwa ndi kuthamanga kwamadzimadzi amadzimadzi pa chosanthula cha D10 (Bio-Rad) molingana ndi muyezo

Tebulo 1. Kuzindikira momwe matenda a shuga amawonongera komanso matenda ena a glycemic (WHO, 1999-2006)

Carbohydrate kagayidwe

Madzi am'madzi a m'magazi a glycemia (mmol / L)

Norm SD NTG NGN

7.0 6.1 ndi 11.1> 7.8 ndipo sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Gulu lowopsa la matenda ashuga

Sanatchulidwe Osatchulidwa> 6.5

Kutsatira ndi njira zowonetsera kusokonezeka kwa kagayidwe kazakudya ka PHTT ndi mulingo wa HbA1c (kuchuluka kwa odwala).

Todike. Njira imatsimikiziridwa ndi NGSP (The National Glycohemoglobin Standartization Program).

Kutengera ndi zotsatira za HRTT komanso kuchuluka kwa HbAlc, mituyi idagawika m'magulu atatu: anthu omwe alibe zovuta za carbohydrate metabolism (zabwinobwino), gulu lomwe lili ndi chiopsezo chachikulu cha T2DM, komanso gulu lomwe lili ndi T2DM yatsopano. Gulu lomwe lili pachiwopsezo chachikulu cha T2DM linaphatikizapo odwala omwe ali ndi NGN, NTG, kapena ophatikiza onse awiri. Odwala adapatsidwa gulu lomwe linali ndi T2DM molingana ndi zotsatira za PHTT pansi pa chimodzi mwazinthu izi: kukhalapo kwa chiwonetsero cha glycemia nthawi imodzi mu diabetic osiyanasiyana mu anamnesis + kuwonjezeka kwa glycemia munthawi ya odwala omwe ali ndi matenda ashuga panthawi ya PHTT. Odwala adapatsidwa gulu lomwe linali ndi T2DM mu HbA1c pamlingo wotsatira: kukhalapo kwa glycemia kolemba nthawi imodzi mdziko la ashuga mu mbiri ya + HbA1 mu diabetes

osiyanasiyana> 6.5%, kuwonjezeka kumodzi kwa glycemia pa PHTT + HL1c pazosowa shuga.

Pa tebulo. 1 ndi 2, njira zowunikira za zovuta za carbohydrate metabolism zimaperekedwa.

Zotsatira ndi zokambirana

Kupenda koyerekeza kupezeka kwa zovuta zamatenda a carbohydrate pogwiritsa ntchito PGTT ndi mulingo wa HL1c kunawonetsa kusamvana pakati pazotsatira za mayesowa (onani chithunzi).

Mwa anthu odwala omwe adawerengedwa, kuchuluka kwa HL1c kudalosera kupezeka kwa matenda ashuga poyerekeza ndi PGTT (31% motsutsana ndi 43%).

Zomwe zalembedwa zikuwonetsa kuti kupezeka kwa matenda a shuga ndi mulingo wa HL1c sikuwulula kwambiri monga kuchuluka kwa odwala omwe ali ndi matenda ashuga poyerekeza ndi PGTT. Zotsatira za kafukufuku yemwe wachitika ku Denmark, UK, Australia,

Greenland, Kenya ndi India zikuwonetsa chisokonezo chachikulu pakuwunika kumeneku malinga ndi zotsatira za PHTT ndi mulingo wa HL1c. Pafupipafupi mwazomwe zachitika pakupezeka kwa matenda a PHTT komanso mulingo wa НЛЛ1с m'maphunzirowa anali osiyana ndi 17 mpaka 78%. Mabungwe ambiri a anthu odwala matenda ashuga sawalimbikitsa kugwiritsa ntchito mulingo wa HL1c ngati njira yodziwira matenda ashuga chifukwa chosagwirizana ndi njira komanso kusowa kwa chidziwitso cha mitundu ya hemoglobin glycation.

Pakafukufuku wathu, zotsatira zakupezeka kwa matenda ashuga m'mayeso awiri zimangopezeka pa HL1c> 7%. Pa 6.5 7%, kuchuluka kwa odwala omwe amadziwika kuti ali ndi matenda a shuga kumagwirizana kwathunthu ndi zomwe amagwiritsa ntchito golide wodziwika bwino - PHT. Komabe, pamlingo wa НЛЛ1с

Mayankho 15

Mudawona kuti "0,1 peresenti chabe mwazonse"? Kodi mwaphwanya zonse glucose kulolerana mayeso. Ndipo anatcha insulin kukana. Komanso, malinga ndi mapuloteni amakono, aliyense, ngakhale mwangozi, kupezeka kwa glycemia pamtunda wa 11.1 mmol / l ndi nthawi yokhazikitsa matenda a shuga.

M'malo mwake, ndibwino kuyamba ndikuchotsa zolakwa zasayansi. Bwerezani, ngati nkotheka, mayeso onse awiri mu labotale ina.

Elena, ndiye mosakayikira - shuga. Mwina sanawonetsetse kale kwambiri, ndipo hemoglobin wa glycosylated sanakhalepo ndi nthawi yochita. Ndikufuna ndikulimbikitseni posachedwa kuti ndikwaniritse kuyesa kwa magazi kwa insulin, C-peptide ndi index ya NOMA (zolemba za pancreatic functional and insulin resistance) ndikuthana ndi endocrinologist pamaso panu kuti mupeze chithandizo.

Tsopano yambani kutsatira zakudya No. 9 (chidziwitso chake chimapezeka kwambiri pa intaneti, kotero sindingachite izi), sankhani zomwe zili ndi index ya glycemic yomwe ili pansipa 50.
Muthanso kumwa phytosborne Arfazetin theka lagalasi 3 pa tsiku kwa mphindi 30 musanadye chakudya malinga ndi chiwembu "masiku 14 kudya + masiku 14 yopuma".

Ndichite chiyani ngati ndikadakhala ndi funso lofananalo koma losiyana?

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Matenda a shuga

Matenda a shuga (omwe amadziwikanso kuti "prediabetes"), prediabetes - chikhalidwe chomwe chimayambitsa chitukuko cha matenda a shuga, omwe nthawi zambiri amakhala a 2. Dongosolo la prediabetesic limadziwika ndi shuga wokwanira wamagazi (glucose), koma osakwera kwambiri kuti apezeka ndi mtundu wachiwiri wa matenda a shuga.

Matenda a shuga nthawi zambiri amakhala asymptomatic, koma ludzu (lakukulitsa) kwambiri, kukoka pafupipafupi, kugona ndi njala nthawi zonse komanso chisonyezo chooneka bwino ndi chododometsa chomwe chimafuna chisamaliro chachipatala kuchokera kwa endocrinologist.

Kukhalapo kwa prediabetes sikutanthauza kufalikira kwa mkhalidwewu kukhala mtundu wa matenda a shuga 2, komabe, kumafunikira miyeso yofunikira kuchepetsa chiopsezo, makamaka: kuchepetsa thupi, kusiya zizolowezi zoyipa, kuwonjezera zolimbitsa thupi, ndipo nthawi zina, kugwiritsa ntchito mankhwala osokoneza bongo.

Dongosolo la shuga limapezeka ndi chimodzi mwazoyeserera zitatu (zomwe takambirana m'nkhaniyi): shuga wamagazi (glucose) (GKN), mayeso a glucose kulolerana (GTT) ndi glycated hemoglobin A1c.

Ngati matenda a prediabetes sapezeka munthawi yake, izi zitha osasinthika Zotsatira: chitukuko cha matenda a shuga 2, komanso zovuta zina mwanjira yamatenda a mtima ndi mitsempha yayikulu yamatenda, matenda amanjenje ndi impso, kuwonongeka kwa m'mitsempha.

Pakadali pano, European Journal of Endocrinology yasindikiza ndemanga yokhudza matenda a mafupa amtundu 1 shuga.

Matenda a shuga

Matenda a shuga, matenda ashuga, matenda a shuga (mellitus) (malinga ndi ICD-10 - E10-E14) - gulu la matenda amtundu wa metabolic amadziwika ndi shuga (shuga) m'magazi chifukwa chazovuta zonse (mu DM 1) kapena wachibale (mu DM 2) kuperewera kwa mahomoni a pancreatic gland ya insulin. Matenda a shuga amaphatikizidwa ndi vuto mitundu yonse kagayidwe: protein, mafuta, chakudya, mchere wamchere ndi mchere.

Matenda a shuga a shuga amawonetsedwa ndi zizindikiro zotsatirazi: ludzu (DM 1 ndi DM 2), kununkhira kwa acetone kuchokera mkamwa ndi matupi a acetone mu mkodzo (DM 1), kuchepa kwa thupi (DM 1, mu DM 2 - kumapeto kwa magawo), komanso kukodza kwambiri, zilonda zam'miyendo, machiritso olakwika.

Anzanu okhazikika a shuga mellitus ndi: kuchuluka kwa shuga mkodzo (glycosuria, glucosuria), ketonuria (acetonuria, matupi a acetone mu mkodzo), nthawi zambiri mapuloteni amkodzo (albuminuria, proteinuria) ndi hematuria (magazi apambuyo mkodzo). Kuphatikiza apo, momwe mkodzo wa shuga umayendera nthawi zambiri umasunthira kumbali ya asidi.

Mtundu woyamba wa matenda ashuga a mtundu 1 a shuga (mtundu 1 wa matenda ashuga, wodalira insulin, mwana, malinga ndi ICD-10 - E10) ndi matenda a autoimmune a endocrine system yodziwika ndi mtheradi kusowa kwa insulini, chifukwa chakuti chitetezo cha mthupi, pazifukwa zosamveka lero, chikuukira ndikuwononga maselo a pancreatic beta omwe amapanga insulin. Matenda a shuga amtundu woyamba amathanso kukhudza munthu wazaka zilizonse, koma matendawa amakula mwa ana, achinyamata ndi achikulire osakwana zaka 30.

Mtundu wa matenda a shuga a mtundu wachiŵiri (mtundu wachiwiri wa matenda ashuga, osadalira insulini, malinga ndi ICD-10 - E11) ndi nthenda yopanda autoimmune yodziwika ndi wachibale insulin akusowa chifukwa kuphwanya mogwirizana kwa insulin ndi maselo minofu. Matenda a shuga a Type 2 nthawi zambiri amakhudza anthu azaka zopitilira 40. Zomwe zimayambitsa matendawa sizimamvekanso bwino, koma anthu omwe ali ndi kunenepa kwambiri ali pachiwopsezo.

Mayeso atatu amagwiritsidwa ntchito kuti adziwe matenda a shuga:

1. Kuthamanga magazi
2. Mayeso a kulolera a glucose
3. Kuyesa kwa hemoglobin wa glycated.

Kuthamanga magazi

Kuthamanga shuga wa plasma, FPG ndi mayeso omwe ndi mtundu wa kuyezetsa magazi komwe kumagwiritsidwa ntchito pomaliza shuga. Kuyesaku kumachitika pamimba yopanda kanthu, wodwalayo sayenera kudya zakudya ndi zakumwa (kupatula madzi) kwa maola 8-12 pasanayambike phunzirolo. Kuyesaku kutha kuchitika modziyimira palokha, pogwiritsa ntchito mbali ziwiri zamiyeso ya shuga kapena zingwe zamayeso a glucose, komanso mu labotale. Kuyesedwa kwa shuga kwa magazi ndi gawo limodzi la mayeso a glucose kulolerana.

Mayeso a kulolera a glucose

Kuyesererana kwa glucose, mayeso a shuga a pakamwa, GTT, kuyesa kwa glucose pakamwa, OGTT - kuyesedwa kochitika kokha mkati mwa chipatala chachipatala.

M'masiku atatu chisanachitike mayeso, wodwalayo ayenera kudya zakudya zabwino, osadziletsa pakumupatsa chakudya. M'pofunikanso kupewa kumwa mankhwala, kumwa mowa, kulimbitsa thupi kwambiri.

Poyesedwa, wodwala poyamba amayesa kuchuluka kwa kusala kwa magazi, pambuyo pake amapatsidwa madzi akumwa okhala ndi magalamu 75 a shuga (magalamu 1.75 pa kilogalamu imodzi ya kulemera kwa ana). Pambuyo pa shuga wamlomo wam'magazi, shuga wa m'magazi amayezedwa mphindi 30 zilizonse (kupanga dongosolo lofananira) kwa maola awiri. Kutalika kwa maphunzirowa kumasinthidwa ndikufika mpaka maola 6 (monga adokotala amafotokozera).

Mkulu wama glucose osakwana 7.0 mmol / L maola 2 atayamba kuyesedwa kwa glucose amadziwika kuti ndi wabwinobwino. Pamlingo woposa 7.0, koma osakwana 11.0 mmol / l, zotsatira zoyesedwa zimawonedwa ngati kuphwanya kulekerera kwa glucose, zikuwonetsa prediabetes. Kupeza zotsatira ndi index ya glucose woposa 11.0 mmol / L kumawerengeredwa ngati kupezeka kwa matenda a shuga.

Dinani ndikugawana nkhaniyi ndi anzanu:

Glycated hemoglobin mayeso

Glycated hemoglobin, glycosylated hemoglobin, glycogemoglobin, hemoglobin A1c, Hb_A1c - chizindikiro chamagazi owonetsa kuchuluka kwa glucose kwa nthawi yayitali (mpaka masiku 90) asanafike mayeso.

Glycated hemoglobin imapangidwa chifukwa cha kupendekeka kwapang'onopang'ono kosapanga enzymatic ku hemoglobin A (Mayar reaction) yomwe ili m'maselo ofiira a m'magazi. Momwe izi zimachitikira komanso kuchuluka kwa hemoglobin yopangidwa kuchokera kwa glycated kumadalira kuchuluka kwa glucose m'magazi pamoyo wamaselo ofiira a magazi (mpaka masiku 120, komabe, maselo ofiira ammagazi omwe amayenderera m'magazi amakhala ndi nthawi yosiyana ndi moyo, mtengo wotsika umatengedwa pamawerengeredwe).

Chifukwa cha zomwe Maillard adachita, mitundu yambiri ya hemoglobin imapangidwa, kuphatikiza Hb_A1c, yomwe imakhala yolimba kwambiri komanso imapereka lingaliro lolondola kwambiri lakuopsa kwa matenda a shuga (ngati alipo).

Chifukwa chake, Hb_A1c kuwonetsera kuchuluka hemoglobin A m'mwazi womwe osasinthika olumikizidwa ndi mamolekyulu a shuga. Mokulira kuchuluka kwa glucose m'magazi, kuchuluka kwakukulu kwa hemoglobin kudzakhala glycated.

Gome la ubale pakati pa glycated hemoglobin (%) ndi shuga wamagazi ambiri (mmol / l).

Magazi a m'magazi (mmol / l)

Kwa mayeso, kukonzekera kwapadera sikofunikira, magazi athunthu amagwiritsidwa ntchito kusanthula, kafukufukuyu amachitika pogwiritsa ntchito capillary electrophoresis.

Zolemba

Zolemba ndi kumveketsa bwino nkhani "Kuphatikiza kuyesa kwa shuga m'magazi kudzapangitsa kuti matenda a prediabetes adziwe."

Georgia State University, Georgia State University, GSU ​​ndi yunivesite yaku America yofufuzira anthu yomwe ili ku Atlanta, Georgia, USA. Yakhazikitsidwa mu 1913, Georgia State University lero ndi amodzi mwa mayunivesite anayi ofufuza ku Georgia, omwe kuyambira Meyi 2017 akuphunzira

25,000 ophunzira. Yunivesiteyo ili ndi masukulu asanu ndi atatu ndi makoleji, komwe Sukulu ya Nursing and Medical Workers ndi Sukulu ya Public Health ndizogwirizana ndi mankhwala. Omaliza maphunziro odziwika bwino ku Georgia State University ndi a William Duvall (woimba patsogolo wa Alice ku Chains), wojambula mafilimu waku America a Julia Roberts, Ken Lewis (wamkulu director of Bank of America), ena andale ndi aboma, olemba ndakatulo, ochita masewera olimbitsa thupi komanso oimba.