JAMA:实时连续血糖监测对胰岛素依赖性糖尿病患者预后的影响

2021-06-09 MedSci原创 MedSci原创

在这项包含I型糖尿病和II型糖尿病患者的回顾性队列研究中,实时连续血糖监测有助于改善患者糖化血红蛋白水平,降低急诊就诊和低血糖住院风险

传统的糖尿病患者自我血糖监控通常是某一点的指尖血糖,是一种间歇性的血糖监测手段。近年来,连续血糖监测(CGM)设备取得了显著进步,实时CGM设备使用皮下传感器来测量血液中葡萄糖水平,并向患者提供有关葡萄糖水平和趋势的反馈,可实现胰岛素剂量的自我管理低血糖警报,并可与医护团队实施共享数据,以提高糖尿病患者自我血糖管理的安全性。先前在I型糖尿病患者中的临床试验表明,实时CGM可降低患者的低血糖风险,与间断性自我监测相比具有成本效益。近日研究人员考察实时CGM对所有类型糖尿病患者的临床效果

41753名接受胰岛素治疗的糖尿病患者参与研究,其中5673名I型糖尿病患者,36080名II型糖尿病患者,患者进行自我血糖水平监测,并且之前没有使用过CGM。随机立即接受实时CGM或对照。研究的主要终点为基线前12个月和基线后12个月10个终点事件差异,包括糖化血红蛋白、低血糖、高血糖、HbA1c 水平低于7%、HbA1c 水平低于8%、HbA1c 水平高于9%、全因急诊、全因住院以及门诊和电话就诊次数。

3806例患者接受实时CGM(平均年龄42.4岁,51%为女性。I型糖尿病占91%),对照组包括37947 名患者(平均年龄63.4岁,49%为女性,I型糖尿病占6%)。实时CGM组基线前平均HbA1c低于对照组,但基线前低血糖和高血糖发生率较高。干预后,实时CGM组平均糖化血红蛋白水平从8.17%下降到7.76%,对照组从8.28%下降到8.19%(调整后差异估计为-0.40%)。实时CGM组的低血糖率从5.1%下降到3.0%,对照组的低血糖率从1.9%上升到2.3%(差异为-2.7%)。组间HbA1c水平低于7%(调整后差异:9.6%)、低于8%(13.1%)和高于9%的患者比例(-7.1%)有显著差异,实时CGM组占优势,实时CGM组门诊和电话就诊量下降。组间高血糖率、全因急诊就诊或全因住院风险差异不显著。

在这项包含I型糖尿病和II型糖尿病患者的回顾性队列研究中,实时连续血糖监测有助于改善患者糖化血红蛋白水平,降低急诊就诊和低血糖住院风险

原始出处:

Andrew J. Karter et al. Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes. JAMA. June 02,2021.

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    2021-11-24 baoya
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    2021-06-09 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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    2021-06-09 misszhang

    谢谢MedSci提供最新的资讯

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