实时动态血糖监测在1型糖尿病门诊管理体系中的应用  

Application of real-time continuous glucose monitoring in outpatient management system for type 1 diabetes mellitus

作　　者：沈艳军[1] 田亚强[1] 李明[1] 李英[1] 段洪刚[1] 彭兰博[1] 卢绍霞 田晓琴 李新晨 

机构地区：[1]聊城市人民医院内分泌科,252000 [2]聊城市国际和平医院内分泌科,252000 [3]聊城市中心医院内分泌科,252000 [4]美敦力(上海)管理有限公司糖尿病业务部,北京100000

出　　处：《中华内分泌代谢杂志》2017年第5期367-371,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：山东省医药卫生科技发展计划项目（2015WS0392）

摘　　要：目的将聊城地区1型糖尿病患者纳入门诊管理体系，评价实时（real—time，RT）动态血糖监测系统（continuous glueosemonitoring system，CGMS）是否有利于改善本地区1型糖尿病控制现状及减少疾病经济负担。方法符合纳入标准的1型糖尿病患者115例，登记其临床资料，随机分配为CGMS组及自我血糖监测（self-monitoring ofblood glucose，SMBG）组。CGMS组每6个月接受1次72hCGMS，SMBG组仅采用自我血糖监测指导胰岛索剂量调整。每6个月门诊随访时测定血糖水平，统计低血糖、酮症酸中毒（DKA）发生次数作为主要观察指标。每12个月评估微血管并发症情况，统计住院次数、治疗总费用作为次要观察指标。结果两组基线资料基本一致。6个月随访时，CGMS组餐后2h血糖（2hPG）及平均血糖（MBG）均低于SMBG组f（10．7±1．9对11．5±2．7）mmol／L，（9．7±0．5对10．6±0．7）mmol／L，均P〈0．05]。人均低血糖次数CGMS组低于SMBG组[（7．9±2．6对9．24-3．4）次，P〈0．05]；12个月再次随访时，空腹血糖（FPG）、2hPG、MBG及HbA1cGMS组均低于SMBG组（t介于4．71—9．75之间，均P〈0．05），低血糖、DKA人均发生次数CGMS组低于SMBG组（t介于3．61～4．37之间，均P〈0．05）。慢性并发症、人均住院次数、年治疗总费用组问比较均未见明显差异。结论实时动态血糖监测应用于1型糖尿病门诊管理，可有效降低患者全天血糖，减少低血糖发生风险，改善控制现状，同时不增加疾病经济负担。Objective To evaluate the effect of continuous glucose monitoring system（CGMS） in improving the cmTent status of type 1 diabetes mellitus （ T1DM ） control and reducing the economic burden of the patients. Methods One hundred and fifteen patients with T1DM were randomly assigned to the CGMS group and the self- monitoring of blood glucose （SMBG） group respectively. The patients in CGMS group were on 72 h CGMS every 6 months, while SMBG group only with SMBG to guide the insulin dose adjustment. The levels of blood glucose and the statistics of the number of hypoglycemia and diabetic ketoacidosis were taken as the main observational indexes every 6 months. The chronic complication and the statistics of the number of hospitalizations and the total cost of treatment were made as the secondary observational index every 12 months. Results 2 h postprandial plasma glucose （2hPG） and mean blood glucose（MBG） in the CGMS group were lower than those in the SMBG group [ （ 10.7 ± 1.9 vs 11.5 ± 2.7） mmol/L, （9.7 ±0.5 vs 10.6 ±0.7） mmol/L, P〈0.05 ] in the clinical follow-up visit after 6 months. The per capita number of hypoglycaemia in the CGMS group was lower than that in the SMBG group [ （ 7.9 ± 2.6 vs 9.2 ± 3.4 ） times, P〈0.05 ]. In the outpatient follow-up re-visit to the patients after 6 months, fasting plasma glucose （ FPG）, 2hPG, MBG, and HbA1c of the patients in the CGMS group were lower than those in the SMBG group （t = 4.71 9.75, P〈0.05 ） , the per capita numbers of hypoglycemia and DKA in the CGMS group were lower than those in the SMBG group （ t = 3.61 - 4.37, P〈0.05 ）. Conclusion The application of real-time continuous glucose monitoring in T1DM outpatient management may reduce the whole-day blood glucose of the patients, decrease the incidence risk of hypoglycemia, and improve the compliance of the treatment while without increasing the economic burden of the disease.

关 键 词：实时动态血糖监测系统 糖尿病 1型 门诊管理体系 控制现状 疾病经济负担 

分 类 号：R587.1[医药卫生—内分泌]