Albisser A M, Wright C E, Sakkal S
Shared Diabetes Data Center, Hollywood, FL 33019, USA.
Diabetes Res Clin Pract. 2007 May;76(2):207-14. doi: 10.1016/j.diabres.2006.09.007. Epub 2006 Oct 4.
Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis.
Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months.
Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P<0.0001) and insulin therapy by just -9 U/day (P<0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers' interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia.
Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.
低血糖是所有胰岛素治疗共有的风险因素。假设是，减少或预防这种不良副作用的努力可能会失败，因为医疗服务提供者通常缺乏预测未来血糖水平以及未来低血糖风险的资源。这种不足已得到弥补。开展了一项对照研究以验证该假设。
22名胰岛素依赖型受试者参与了本研究，他们每周发生低血糖事件超过1次，胰岛素治疗方案、糖尿病教育和自我管理培训情况相似。对于所有受试者，使用远程监测资源（登记处和数据库）来获取每日自我血糖监测数据，并为医疗服务提供者的干预和决策支持提供反馈途径。采用相同的远程医疗方法，仅在医疗服务提供者端有所不同，预测组会在屏幕上直观显示预测血糖值和预测低血糖风险，而对照组则没有。研究持续了2个月。
从基线到随访的平均41天内，在使用血糖预测资源时，预测组的医疗服务提供者干预更为有效，低血糖发生率降低了9倍（P<0.0001），胰岛素治疗量仅减少了-9 U/天（P<0.01）。餐前平均血糖水平未受影响。从基线到最终随访的61天内，对照组未进行血糖预测，医疗服务提供者的干预效果较差，低血糖发生率、每日胰岛素治疗量或餐前平均血糖水平均无净变化。
鉴于了解未来血糖水平和未来低血糖风险，临床实践中的医疗服务提供者现在可以在不到2个月的时间内避免医源性低血糖。提供远程数据采集和决策支持的共享糖尿病数据中心是将此作为糖尿病新临床程序实施的基础。
