关键词: 糖尿病, 2型；葡萄糖耐量试验；胰岛素释放试验；急性高血糖；影响因素分析

Abstract: Background　Rapid changes in blood glucose can cause damage to tissues and organs of the body，but at present，domestic and foreign scholars generally pay insufficient attention to the rate of blood glucose change. It is of great significance to study the rate and influencing factors of blood glucose change for the prevention and treatment of diabetes complications. Objective　To investigate the influencing factors of blood glucose elevation rate after 75 g glucose load in newly diagnosed type 2 diabetes mellitus（T2DM） patients. Methods　Participants were 337 initially diagnosed T2DM inpatients who were treated in Department of Endocrinology，Xiaogan Hospital Affiliated to Wuhan University of Science and Technology between January 2016 and April 2019. A retrospective study was preformed on their clinical data，including general demographic information，routine blood test and biochemical parameters，HbA1c，results of a 3-hour 75 g OGTT〔glucose peak value（Gmax），time to peak glucose（Tmax），and mean post-load plasma glucose elevation velocity（Vmean）〕，first-phase insulinogenic index（ΔI30 /ΔG30） measured by insulin response test（IRT），and β-cell function and insulin resistance（IR） assessed by homeostatic model（HOMA）. According to Vmean tertiles，participants were divided into low Vmean group（n=112），medium Vmean group（n=112） and high Vmean group（n=113）. Logistic regression was used to analyze the influencing factors of post-load glucose elevation rate. Results　The age，HbA1c，G120，I120，ΔI30/ΔG30，HOMA-β，neutrophil count，lymphocyte count and serum uric acid differed significantly across Vmean tertile groups（P<0.05）. Spearman's correlation analysis showed that Vmean was positively correlated with HbA1c and G120，and was negatively correlated with age，I120，ΔI30/ΔG30 and HOMA-β（P<0.01）. Ordinal Logistic regression analysis showed that high ΔI30/ΔG30〔OR=0.758，95%CI（0.662，0.867）〕 and older age〔OR=0.966，95%CI（0.949，0.984）〕 were protective factors associated with Vmean delay，while high HbA1c〔OR=1.138，95%CI（1.011，1.280）〕 was associated with increased risk of Vmean delay（P<0.05）. Conclusion　Elevated ΔI30/ΔG30，and high HbA1c and older age were associated with plasma glucose elevation velocity after a 75 g oral glucose load in initially diagnosed T2DM patients. In view of this，improving first-phaseΔI30 /ΔG30，and HbA1c control rate should be considered as an important measure to delay the post-load sharp rise in blood glucose in such patients.

Key words: Diabetes mellitus, type 2；Glucose tolerance test；Insulin release test；Acute hyperglycemic；Root cause analysis