Martin S, Schneider B, Heinemann L, Lodwig V, Kurth H-J, Kolb H, Scherbaum W A
German Diabetes Clinic, German Diabetes Centre at the Heinrich-Heine-University, Dusseldorf, Auf'm Hennekamp 65, 40225 Dusseldorf, Germany.
Diabetologia. 2006 Feb;49(2):271-8. doi: 10.1007/s00125-005-0083-5. Epub 2005 Dec 17.
AIMS/HYPOTHESIS: The aim of this study was to obtain epidemiological data on self-monitoring of blood glucose (SMBG) in type 2 diabetes and to investigate the relationship of SMBG with disease-related morbidity and mortality.
The German multicentre Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and 1999 until the end of 2003. Endpoints were diabetes-related morbidity (non-fatal myocardial infarction, stroke, foot amputation, blindness or haemodialysis) and all-cause mortality. SMBG was defined as self-measurement of blood glucose for at least 1 year.
During a mean follow-up period of 6.5 years, 1,479 patients (45.3%) began SMBG prior to an endpoint and an additional 64 patients started SMBG after a non-fatal endpoint. Interestingly, many patients used SMBG while being treated with diet or oral hypoglycaemic drugs (808 of 2,515, 32%). At baseline, the SMBG cohort had higher mean fasting blood glucose levels than the non-SMBG cohort (p<0.001), suggesting that insufficient metabolic control was one reason for initiating SMBG. This was associated with a higher rate of microvascular endpoints. However, the total rate of non-fatal events, micro- and macrovascular, was lower in the SMBG group than in the non-SMBG group (7.2 vs 10.4%, p=0.002). A similar difference was found for the rate of fatal events (2.7 vs 4.6%, p=0.004). Cox regression analysis identified SMBG as an independent predictor of morbidity and mortality, with adjusted hazard ratios of 0.68 (95% CI 0.51-0.91, p=0.009) and 0.49 (95% CI 0.31-0.78, p=0.003), respectively. A better outcome for both endpoints was also observed in the SMBG cohort when only those patients who were not receiving insulin were analysed.
CONCLUSIONS/INTERPRETATION: SMBG was associated with decreased diabetes-related morbidity and all-cause mortality in type 2 diabetes, and this association remained in a subgroup of patients who were not receiving insulin therapy. SMBG may be associated with a healthier lifestyle and/or better disease management.
目的/假设：本研究旨在获取2型糖尿病患者血糖自我监测（SMBG）的流行病学数据，并调查SMBG与疾病相关发病率和死亡率之间的关系。
德国多中心回顾性研究“2型糖尿病患者的血糖自我监测与结局”（ROSSO）对1995年至1999年间诊断为2型糖尿病的3268例患者进行随访，直至2003年底。观察终点为糖尿病相关发病率（非致命性心肌梗死、中风、足部截肢、失明或血液透析）和全因死亡率。SMBG定义为至少1年的自我血糖测量。
在平均6.5年的随访期内，1479例患者（45.3%）在观察终点前开始进行SMBG，另有64例患者在非致命性终点后开始SMBG。有趣的是，许多患者在接受饮食或口服降糖药物治疗时使用SMBG（2515例中的808例，32%）。在基线时，SMBG队列的平均空腹血糖水平高于非SMBG队列（p<0.001），这表明代谢控制不佳是启动SMBG的一个原因。这与微血管终点发生率较高相关。然而，SMBG组的非致命事件（微血管和大血管）总发生率低于非SMBG组（7.2%对10.4%，p=0.002）。在致命事件发生率方面也发现了类似差异（2.7%对4.6%，p=0.004）。Cox回归分析确定SMBG是发病率和死亡率的独立预测因素，调整后的风险比分别为0.68（95%CI 0.51-0.91，p=0.009）和0.49（95%CI 0.31-0.78，p=0.003）。当仅分析未接受胰岛素治疗的患者时，在SMBG队列中也观察到两个观察终点都有更好的结局。
结论/解读：SMBG与2型糖尿病患者糖尿病相关发病率和全因死亡率降低相关，并且这种关联在未接受胰岛素治疗的患者亚组中仍然存在。SMBG可能与更健康的生活方式和/或更好的疾病管理有关。
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