1型糖尿病血糖监测现状及其对血糖控制的影响:一项单中心调查研究  

Status of blood glucose monitoring in patients with type 1 diabetes and its association with glycemic control:a single-center survey

作　　者：戴刘宴 李雨潇 黄玫 魏倩影 秦瑶[1] 王洪[1] 于健 徐晶晶[1] 杨涛[1] 张梅[1] Dai Liuyan;Li Yuxiao;Huang Mei;Wei Qianying;Qin Yao;Wang Hong;Yu Jian;Xu Jingjing;Yang Tao;Zhang Mei(Department of Endocrinology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,南京210029

出　　处：《中华糖尿病杂志》2023年第6期509-516,共8页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(81974103);2021年度“临床能力提升工程”医疗项目立项(JSPH-MA-2021-3);江苏省科教能力提升工程江苏省医学重点学科/实验室(ZDXK202202)。

摘　　要：目的探讨1型糖尿病(T1DM)患者血糖监测现状及其对血糖控制的影响。方法为横断面研究,选取2021年10至12月于南京医科大学第一附属医院内分泌科就诊的T1DM患者作为研究对象。通过问卷形式调查患者年龄、糖尿病病程、目前治疗方案、教育程度以及持续葡萄糖监测(CGM)和自我血糖监测(SMBG)情况,检测患者糖化血红蛋白(HbA_(1c))。依据《中国1型糖尿病诊治指南(2021版)》,将HbA_(1c)<7.0%定义为HbA_(1c)达标。根据血糖监测方式将患者分为CGM组和SMBG组。采用Mann‐Whitney U检验、χ^(2)检验进行组间比较,采用多因素logistic回归分析法分析HbA_(1c)达标以及不同血糖监测方式的影响因素。结果共纳入197例患者,年龄27.0(18.2,41.0)岁,病程5.0(2.0,9.8)年。CGM和SMBG使用率分为61.4%(121/197)和38.6%(76/197)。CGM组的HbA_(1c)低于SMBG组[分别为6.6%(6.1%,7.5%)和7.5%(6.4%,9.5%),Z=3.19,P<0.001],2组的HbA_(1c)达标率分别为62.1%(59/95)和40.0%(24/60),差异具有统计学意义(χ^(2)=7.22,P<0.01)。多因素logistic回归分析结果显示,调整年龄、糖尿病病程、目前治疗方案等影响因素后,CGM的使用(OR=2.028,95%CI 1.012~2.042,P<0.05)和教育程度(OR=1.571,95%CI 1.209~2.042,P<0.01)均与HbA_(1c)达标相关。结论现实生活中61.4%的T1DM患者选择CGM作为血糖监测方式,且CGM的使用可显著改善患者血糖控制。Objective To investigate the current situation of blood glucose monitoring in type 1 diabetes mellitus(T1DM)patients and its impact on glycemic control.Methods The study was a cross-sectional survey.T1DM patients or their guardians who visited the Department of Endocrinology,First Affiliated Hospital of Nanjing Medical University from October to December 2021 were selected as the research subjects.The patients′age,course of diabetes,current treatment plan,education level,continuous glucose monitoring(CGM)and self-monitoring blood glucose(SMBG)were assessed by questionnaire.The glycated hemoglobin A1c(HbA_(1c))was measured.According to the Guidelines for the diagnosis and treatment of type 1 diabetes mellitus in China(2021 edition),HbA_(1c)<7.0%is defined as HbA_(1c) meeting the standard.Patients were divided into CGM group and SMBG group based on blood glucose monitoring methods.Mann-Whitney U test,chi-square test were used for inter-group comparison,and multivariate logistic regression analysis was used to analyze the influencing factors of HbA_(1c) compliance and different blood glucose monitoring methods.Results A total of 197 patients with T1DM were included,with an average age of 27.0(18.2,41.0)years and a course of disease of 5.0(2.0,9.8)years.The utilization rates of CGM and SMBG were 61.4%(121/197)and 38.6%(76/197),respectively.The HbA_(1c) in the CGM group was lower than that in the SMBG group[6.6%(6.1%,7.5%)and 7.5%(6.4%,9.5%),Z=3.19,P<0.001],and the compliance rates of HbA_(1c) in the 2 groups were 62.1%(51/95)and 40.0%(24/60),respectively.The difference was statistically significant(χ^(2)=7.22,P<0.01).After adjustment for age,diabetes course and current treatment,logistic regression analysis showed that the use of CGM(OR=2.028,95%CI 1.012-2.042,P<0.05)and education level(OR=1.571,95%CI 1.209-2.042,P<0.01)were correlated with HbA_(1c) standard.Conclusion In our real-world data,61.4%of the patients with T1DM were using a CGM device,which was associated with improved glycemic control.

关 键 词：糖尿病 1型 血糖监测 持续葡萄糖监测 自我血糖监测 血糖控制 

分 类 号：R587.1[医药卫生—内分泌]