AIM：实时动态血糖监测仪和胰岛素泵可优化1型糖尿病患者的血糖控制

2012-07-16 段梦爱唯医学网

  　　《内科学文献》7月10日在线发表的一项系统综述显示，与常规血糖监测和胰岛素给药方法相比，实时动态血糖监测仪(rt-CGM)和胰岛素泵(CSII)可更有效地优化一些1型糖尿病患者的血糖控制。此外，这些昂贵的新技术还可改善治疗满意度和生活质量。　　约翰?霍普金斯大学的Hsin-Chieh Yeh博士及其同事对入选1型或2型糖尿病儿童、青少年或成人患者的试验进行了评价。排除胰

　　《内科学文献》7月10日在线发表的一项系统综述显示，与常规血糖监测和胰岛素给药方法相比，实时动态血糖监测仪(rt-CGM)和胰岛素泵(CSII)可更有效地优化一些1型糖尿病患者的血糖控制。此外，这些昂贵的新技术还可改善治疗满意度和生活质量。

　　约翰•霍普金斯大学的Hsin-Chieh Yeh博士及其同事对入选1型或2型糖尿病儿童、青少年或成人患者的试验进行了评价。排除胰岛素泵即连续皮下胰岛素输注(CSII)组使用胰岛素的试验，因为这不是临床首选治疗方法。纳入每日多次注射(MDI，每日至少注射3次)胰岛素组使用长效及速效类似物和(或)中性鱼精蛋白锌胰岛素及常规胰岛素的试验，因为这两种方法均为临床现行方法。纳入评价了过程指标、中期预后、生活质量或重度低血糖的试验及设有评价微血管或大血管预后或死亡率的同期对照组的随机对照试验和观察性试验。由2名研究者独立对试验纳入标准进行评价。最终纳入33项随机对照试验，其中19项对CSII与MDI进行比较，10项对实时动态血糖监测(rt-CGM)与自我监测血糖(SMBG，每日手指采血至少3次)进行比较，4项对传感器增强型胰岛素泵与MDI和SMBG进行比较。

　　分析结果显示，与MDI相比，CSII有助于改善1型糖尿病成人患者的血糖控制，并且这两种方法预防低血糖的效果一样好。结果还显示，rt-CGM(与SMBG相比)和传感器增强型胰岛素泵(与MDI/SMBG相比)均可改善血糖控制，并且不增加低血糖风险。

　　在1型糖尿病儿童和青少年患者中，随访≥16周后CSII组HbA1c相对基线的改变与MDI组无差异。同样，在2型糖尿病成人患者中，这两个给药组的血糖控制情况和重度低血糖发生率也相似。在1型糖尿病成人患者中，CSII控制血糖的效果较好，但研究者认为该结果受到以下因素的影响，即在一项研究中受试者入组时的HbA1c较高，导致观察到的HbA1c降幅大于受试者入组时HbA1c接近目标值的其他研究中观察到的降幅。

　　比较rt-CGM和SMBG的疗效发现，rt-CGM组HbA1c降幅达到统计学意义，但无临床意义。在传感器依从性≥60%的研究中，这一效应稍大。此外，在年龄≤18岁的患者中，rt-CGM组的HbA1c水平低于MDI组，这在一定程度上支持了近期对8岁以上儿童应用rt-CGM的建议。

　　在1型糖尿病患者中，与MDI/SMBG组相比，传感器增强型胰岛素泵组HbA1c降幅更大，且具有统计学和临床意义，但没有充分证据支持得出有关重度低血糖或生活质量的明确结论。

　　该系统评价存在一些局限性：各对比较的试验数量较少，并且作者可能遗漏了未发表的试验。此外，评价结果不能外推至所有糖尿病患者，因为CSII和rt-CGM治疗通常仅限于大型医疗机构和积极性高的患者。该系统综述也未探讨可获得性、费用和医保范围等可能妨碍新技术应用的因素。

　　尽管MDI和以速效类似物为基础的CSII强化胰岛素治疗在降低1型糖尿病患者HbA1c水平方面的有效性相似，并且低血糖发生率也相似，但rt-CGM降低1型糖尿病患者HbA1c 水平的作用优于SMBG，且不增加重度低血糖风险，在依从使用rt-CGM监测仪的患者中尤其如此，这一结果提示，在SMBG和强化胰岛素治疗基础上增加这种监测方法有助于该患者人群血糖达标。

　　该系统综述获卫生保健研究与质量管理局(AHRQ)支持。

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2013-05-04 millore

#1型糖尿病患者#

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2012-12-09 baoya

#胰岛#

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2013-03-09 wgsun

#动态血糖监测#

34 0
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2012-07-18 whlxd

#血糖控制#

29 0
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2012-07-18 xue8604

#糖尿病患者#

34 0
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2012-07-18 jktdtl

#血糖监测#

31 0
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2012-07-18 12498a1cm71暂无昵称

#胰岛素泵#

37 0

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AIM：实时动态血糖监测仪和胰岛素泵可优化1型糖尿病患者的血糖控制

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