1型糖尿病血糖控制评估中八点血糖检测与持续葡萄糖监测系统的比较

Eight-point glucose testing versus the continuous glucose monitoring system in evaluation of glycemic control in type 1 diabetes.

作者信息

Fiallo-Scharer Rosanna

机构信息

Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, Florida 33647, USA.

出版信息

J Clin Endocrinol Metab. 2005 Jun;90(6):3387-91. doi: 10.1210/jc.2004-2510. Epub 2005 Mar 22.

DOI:10.1210/jc.2004-2510

PMID:15784705

Abstract

CONTEXT

Advantages/disadvantages of continuous vs. discrete glucose monitoring are not well documented.

OBJECTIVE

Compare glucose profiles from home meters vs. continuous sensors.

DESIGN

Randomized clinical trial conducted by the Diabetes Research in Children Network (DirecNet) to assess the utility of the GlucoWatch G2 Biographer.

SETTING

Home glucose measurements.

PATIENTS

Two hundred children (age, 7 to < 18 yr) with type 1 diabetes.

INTERVENTION

At baseline, subjects were asked to wear the continuous glucose monitoring system (CGMS) sensor and perform meter tests at eight prespecified times of the day (eight-point testing) each for 3 d (2 d using both, 1 d eight-point testing only, 1 d CGMS only). Hemoglobin A1c was measured in a central laboratory.

MAIN OUTCOME MEASURE

Six-month hemoglobin A1c. This analysis looked at baseline glucose profiles/hemoglobin A1c.

RESULTS

Only 10% of subjects completed full eight-point testing for 3 d, but median CGMS use was 70 h. Mean glucose was lower when measured by the CGMS compared with eight-point testing (183 +/- 37 vs. 188 +/- 41 mg/dl; 10.2 +/- 2.1 vs.10.4 +/- 2.3 mmol/liter; P = 0.009), especially overnight (2400-0400 h; 174 vs. 199 mg/dl; 9.7 vs. 11.1 mmol/liter; P < 0.001). Associations of hemoglobin A1c with mean glucose were similar for eight-point testing [slope 23 mg/dl per 1% (1.3 mmol/liter); correlation 0.40; P < 0.001] and CGMS [slope 19 mg/dl per 1% (1.1 mmol/liter); correlation 0.39; P < 0.001]. Postprandial excursions were lower for eight-point testing vs. CGMS, especially after dinner (mean excursion -17 vs. 63 mg/dl; -1.0 vs. 3.5 mmol/liter; P < 0.001).

CONCLUSIONS

Both methods gave similar mean glucose profiles and associations with hemoglobin A1c. Advantages of the CGMS were higher density of data and better detection of postprandial peaks. However, the CGMS may overestimate the frequency of low glucose levels, especially overnight.

摘要

背景

连续血糖监测与离散血糖监测的优缺点尚无充分文献记载。

目的

比较家用血糖仪与连续血糖传感器的血糖谱。

设计

由儿童糖尿病研究网络（DirecNet）进行的随机临床试验，以评估GlucoWatch G2 Biographer的效用。

设置

家庭血糖测量。

患者

200名1型糖尿病儿童（年龄7至<18岁）。

干预

在基线时，要求受试者佩戴连续血糖监测系统（CGMS）传感器，并在一天中的八个预先指定时间进行血糖仪测试（八点测试），每次测试3天（2天同时使用两种方法，1天仅进行八点测试，1天仅使用CGMS）。在中央实验室测量糖化血红蛋白。

主要观察指标

六个月糖化血红蛋白。该分析观察了基线血糖谱/糖化血红蛋白。

结果

只有10%的受试者完成了为期3天的完整八点测试，但CGMS的中位使用时间为70小时。与八点测试相比，CGMS测量的平均血糖较低（183±37 vs. 188±41 mg/dl；10.2±2.1 vs. 10.4±2.3 mmol/L；P = 0.009），尤其是在夜间（24:00 - 04:（此处原文有误，推测应为04:）00 h；174 vs. 199 mg/dl；9.7 vs. 11.1 mmol/L；P < 0.001）。八点测试和CGMS的糖化血红蛋白与平均血糖的关联相似[斜率为每1%（1.3 mmol/L）23 mg/dl；相关性为0.40；P < 0.001]和CGMS[斜率为每1%（1.1 mmol/L）19 mg/dl；相关性为0.39；P < 0.001]。与CGMS相比，八点测试的餐后血糖波动较低，尤其是晚餐后（平均波动-17 vs. 63 mg/dl；-1.0 vs. 3.5 mmol/L；P < 0.001）。