随着生活水平的提高，“三高”综合征现在是越来越多，糖尿病（DM）是其中一个十分不好治疗也不好控制的综合征之一，对于DM的患者，都需要定期复查血糖及相关指标，经常有朋友问，血糖是测量空腹血糖，餐后血糖还是糖化血红蛋白，哪个更重要？
空腹血糖指的是进食后8~10小时，不再有热量摄入，然后测定的血糖值，一般在清晨7-9点空腹的状态下来测量，对于大多数朋友来说，空腹血糖是必检的项目。要注意测量空腹血糖前不要剧烈的运动，另外，空腹时间不要太长，也不要太短，空腹血糖的参考值3.9~6.1mmol/L。
餐后2小时血糖指的是从第一口饭开始计时，两个小时后测的血糖值，餐后血糖受食物的种类，胃肠蠕动，以及餐后运动量等多种因素的影响，其参考值为4.4~7.8mmol/L。
糖化血红蛋白（HbA1c）是红细胞中的血红蛋白（Hb）与血清中的糖类相结合形成的产物。它是通过缓慢、持续及不可逆的糖化反应形成，其含量多少取决于血糖浓度以及血糖与Hb接触时间，而与抽血时间、患者是否空腹、是否使用胰岛素等因素无关，HbA1c 正常参考范围：4%~6%。
与随机血糖相比，HbA1c检测不受抽血时间、是否空腹、是否使用降糖药物等因素的影响，因而稳定性更好，可有效反映糖尿病患者过去2~3个月内血糖控制的情况。而血糖能反映即时情况，尤其通过多点血糖监测（血糖谱）可反映患者全天血糖波动及控制情况。
糖化血红蛋白（HbA1c）虽是临床上判断血糖控制达标情况的重要指标，但不是唯一指标，空腹（餐前）血糖和餐后2小时血糖检测结果是否达标也同样重要，各有优势。初诊糖尿病患者需要检测HbA1c；治疗方案改变或血糖控制不达标的患者，最好每3个月测定一次HbA1c；血糖控制平稳并达标的患者每年测定两次即可。当然仅HbA1c正常，血糖也不一定就控制好了，日常监测血糖非常重要。只有空腹（餐前）血糖、餐后2小时血糖以及HbA1c都达标，才能说糖尿病患者血糖控制真正达标了。
血糖高的人应遵循低糖、低脂、高纤维的饮食原则，尽量不吃或少吃高糖、高脂的食物，如糖果、蛋糕、巧克力、油炸食品等。相反，应多吃蔬菜、水果、全麦面包等富含纤维的食物，这有助于稳定血糖水平。此外，合理安排餐次，保持定时定量的饮食习惯，避免暴饮暴食，也是控制血糖的重要步骤。
运动能增加身体能量消耗，提高胰岛素敏感性，减轻胰岛负担。选择适合自己的有氧运动方式，如快走、慢跑、骑车等，并坚持每周进行至少150分钟的中等强度运动，能有效提升身体代谢水平，降低血糖。
糖尿病患者应定期监测血糖水平，及时调整治疗方案。同时，按照医生的建议和用药方案，合理使用胰岛素注射、口服药物等进行治疗。日常的血糖监测和记录也是帮助了解病情并及时调整饮食、运动和用药的重要手段。
四、保持良好的生活习惯对控制血糖也有积极影响
戒烟限酒，保证充足的睡眠，避免熬夜和过度疲劳。保持良好的心态，避免情绪波动和压力过大，都能有助于维持血糖的稳定。
参考文献：
[1]中华医学会糖尿病学分会.中国2型糖尿病防治指南（2021年版）
宜宾市第五人民医院检验科是宜宾市第五人民医院（三级乙等公立医院）下属的专业实验室，实验室包括6个专业组：临床检验、临床生化、临床微生物、临床免疫、临床分子生物学、输血与血库。科室现有高级职称3人，中级职称8人，初级职称15人。现已开展检验技术项目200余项。常规开展血糖、OGTT（葡萄糖耐量试验）、糖化血红蛋白（根据中华人民共和国卫生行业标准WS/T 461-2015，测定糖化血红蛋白采用国际化公认的高压液相色谱法，检测结果更为准确）等与血糖监测相关的多个项目。
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供稿：任宴梅 核稿：曹 芳 审稿：徐风万
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2024-03-20 下一篇中共宜宾市第五人民医院委员会召开2023年度中层干部述职会
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