| The main method of delaying or preventing the chronic diabetic complications is intensively controlling hyperglycemia. Because of the ineffectively monitoring glycemia, the hyperglycemia has often not been detected and well controlled. Recently, the improvement of continuous glucose monitoring system (CGMS) has offered valuable assistant for investigating the blood glucose profile of diabetes patients, especially for detecting asymptom hypoglycemia and postprandial hyperglycemia. Up to now, there have few reports in below fields. First, the characters and differences of daily glucose profiles in various glucose tolerance subjects by CGMS. Second, the efficacy of repaglinide on daily blood glucose profile in newly diagnosed type 2 diabetes mellitus(T2DM) patients, especially on postprandial hyperglycemia. Third, the effects of glargine on 24h blood glucose profiles and noctual hypoglycemia events in T2DM patients, and the superiority of glargine as basal insulin replacement in T2DM.Objective1.To evaluate the accuracy of MiniMed CGMS in blood glucose measurement, compared with blood glucose self-monitoring (BGSM).2.To investigate the characteristic and difference of daily glucose profiles in various glucose tolerance subjects by CGMS.3. To observe the efficacy of repaglinide in newly diagnosed T2DM patients by CGMS.4.To compare the effects of glargine with NPH on 24-h blood glucose profiles and hypoglycemia events in type 2 diabetic patients, whose blood glucose were not well controlled with sulphanylureas by CGMS, and to evaluate the superiority of glargine as basal insulin replacement in T2DM..Methods1.Totally 46 CGMS data of 37 diabetic patients were analysized with correlation analysis and error grid analysis to assess the correlation and coincidence between CGMS glucose values and BGSM glucose values.2.Totally 6 NGT.IO IGT, and 20 newly diagnosed T2DM subjects, diagnosed by 75g oral glucose tolerance test (OGTT), were enrolled. CGMS were carried out in these subjects with daily customs fixted.3.20 newly diagnosed T2DM patients were randomly assigned to repaglinide group(0.5mg tid) or glibenclamide group(2.5mg bid), treated for 4 weeks. To evaluate the daily change of blood glucose, CGMS was carried out before and after treatment.4. 24 cases with T2DM, whose blood glucose was not well controlled with sulphanylureas, were enrolled. At first, they were treated with extended-release glipizide (glucotrol XL) 5mg before breakfast daily for 2 weeks, then randomized to glargine combined with glucotrol XL group(16 cases) or NPH combined with glucotrol XL group(8 cases) and treated for 12 weeks. CGMS were carried at the 2nd week after treatment with glucotrol XL, and at 12th week after randomization. The differences of blood glucose profiles and nocturnal hypoglycemia events between two groups were compared.Resultsl.?The CGMS examination was well accepted in all patients. ?The correlation and coincidence between CGMS glucose values and SGMS glucose values were favorable in all blood glucose levels. ?Error grade analysis showed that 99.8% CGMS glucose values failed in A and B zones.2.?The average blood glucose, TpG&7.8mmOi/L%, and standard deviation (SD)of blood glucose were all significantly correlated with glycosylated albumin(HA)(r=0.86,0.89 or 0.76 respectively, p =0.000) . ?From NGTJGT to newlydiagnosed T2DM subjects, the average blood glucose, standard deviation of bloodglucose, Tpos7.8mmoi/L, the increasment of blood glucose after meals gradually elevated (P<0.05,respectively) , and the CGMS blood glucose profile excursion were also more and more fluctuant. ?In IGT group, the moment of PG reaching 7.8mmol/L and peak were 105.0±26.2min #1 109.1±31.5min after meals, respectively, and the average postprandial TpG^7.8mmol/L was 60.1±15.2 min; In newly diagnosed T2DM group, the moment of PG reaching 1 l.lmmol/L and peak were 78.3±20.4min and 65.1±14.2min after meals, respectively, and the average postprandial Tpg ^ 11.1 mmol/L was 251.5±25.4 min. The blood glucose increased more quikly, more sharply, and continued for more time after breakfast.3.?The average blood glucose, blood glucose SD of were all decreased after treatment in both repaglinide and glibenclamide groups ( P<0.05, respectively) . The blood glucose in various times of the overall day were decreased (P<0.05,respectively) in repaglinide group, and the blood glucose in most time of the overall day except post-lunch were also decreased (P<0.05, respectively) in glibenclamide group. ?The average blood glucose, blood glucose SD, 2h postprandial blood glucose and peak postprandial blood glucose in repaglinide group were decreased more than that in glibenclamide group, while the blood glucose at 3:00am decreased less (P<0.05) . The preprandial and bedtime blood glucose in both groups were comparable(P>0.05).4. ?The HbAlc levels were significantly reduced in both groups with glargine or NPH treatment compared with patients treated only with glucotrol XL(from 8.77 ±1.18% to 7.62 ± 0.98% in glargine group, and from 8.75 ± 1.24 % to 7.43 ±0.73% in NPH group)(P<0.05).(2)WhenFPG were well controlled in both groups (glargine group vs NPH group: 6.0 ± 1.0 vs 5.8 ± 1.3mmol/L), the blood glucose level at pre-supper (6.0 ± 0.7 vs 7.1 ± 1.0 mmol/L) and bedtime(7.8 ± 1.2 vs 9.2 ± 2.0 mmol/L) were lower (P <0.05,respectively), the blood glucose at 3:00am (5.1 ± 0.9 vs 4.2 ± 0.8 mmol/L) were higher (P<0.05) , the rate of nocturnal hypoglycemia (1/16 vs 4/8) were less (P=0.028) ,...
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