Pfützner Andreas, Weissmann Jörg, Mougiakakou Stavroula, Daskalaki Elena, Weis Norbert, Ziegler Ralph
1 Diabetes Center and Practice , Mainz, Germany .
Diabetes Technol Ther. 2015 Jun;17(6):392-7. doi: 10.1089/dia.2014.0278. Epub 2015 Mar 3.
The ProAct study has shown that a pump switch to the Accu-Chek(®) Combo system (Roche Diagnostics Deutschland GmbH, Mannheim, Germany) in type 1 diabetes patients results in stable glycemic control with significant improvements in glycated hemoglobin (HbA1c) in patients with unsatisfactory baseline HbA1c and shorter pump usage time.
In this post hoc analysis of the ProAct database, we investigated the glycemic control and glycemic variability at baseline by determination of several established parameters and scores (HbA1c, hypoglycemia frequency, J-score, Hypoglycemia and Hyperglycemia Indexes, and Index of Glycemic Control) in participants with different daily bolus and blood glucose measurement frequencies (less than four day, four or five per day, and more than five per day, in both cases). The data were derived from up to 299 patients (172 females, 127 males; age [mean±SD], 39.4±15.2 years; pump treatment duration, 7.0±5.2 years).
Participants with frequent glucose readings had better glycemic control than those with few readings (more than five readings per day vs. less than four readings per day: HbA1c, 7.2±1.1% vs. 8.0±0.9%; mean daily blood glucose, 151±22 mg/dL vs. 176±30 mg/dL; percentage of readings per month >300 mg/dL, 10±4% vs. 14±5%; percentage of readings in target range [80-180 mg/dL], 59% vs. 48% [P<0.05 in all cases]) and had a lower glycemic variability (J-score, 49±13 vs. 71±25 [P<0.05]; Hyperglycemia Index, 0.9±0.5 vs. 1.9±1.2 [P<0.05]; Index of Glycemic Control, 1.9±0.8 vs. 3.1±1.6 [P<0.05]; Hypoglycemia Index, 0.9±0.8 vs. 1.2±1.3 [not significant]). Frequent self-monitoring of blood glucose was associated with a higher number of bolus applications (6.1±2.2 boluses/day vs. 4.5±2.0 boluses/day [P<0.05]). Therefore, a similar but less pronounced effect on glycemic variability in favor of more daily bolus applications was observed (more than five vs. less than four bolues per day: J-score, 57±17 vs. 63±25 [not significant]; Hypoglycemia Index, 1.0±1.0 vs. 1.5±1.4 [P<0.05]; Hyperglycemia Index, 1.3±0.6 vs. 1.6±1.1 [not significant]; Index of Glycemic Control, 2.3±1.1 vs. 3.1±1.7 [P<0.05]).
Pump users who perform frequent daily glucose readings have a better glycemic control with lower glycemic variability.
ProAct研究表明，1型糖尿病患者换用Accu-Chek（®）Combo系统（德国曼海姆罗氏诊断公司）后，对于基线糖化血红蛋白（HbA1c）不理想且泵使用时间较短的患者，血糖控制稳定，糖化血红蛋白有显著改善。
在对ProAct数据库的这项事后分析中，我们通过测定几个既定参数和评分（HbA1c、低血糖频率、J评分、低血糖和高血糖指数以及血糖控制指数），研究了不同每日大剂量注射和血糖测量频率（两种情况下均为每天少于4次、每天4或5次以及每天多于5次）参与者的基线血糖控制和血糖变异性。数据来源于多达299名患者（172名女性，127名男性；年龄[平均值±标准差]，39.4±15.2岁；泵治疗持续时间，7.0±5.2年）。
血糖读数频繁的参与者比读数少的参与者血糖控制更好（每天多于5次读数与每天少于4次读数相比：HbA1c，7.2±1.1% 与8.0±0.9%；平均每日血糖，151±22mg/dL与176±30mg/dL；每月读数>300mg/dL的百分比，10±4%与14±5%；目标范围[80 - 180mg/dL]内的读数百分比，59%与48%[所有情况P<0.05]），且血糖变异性更低（J评分，49±13与71±25[P<0.05]；高血糖指数，0.9±0.5与1.9±1.2[P<0.05]；血糖控制指数，1.9±0.8与3.1±1.6[P<0.05]；低血糖指数，0.9±0.8与1.2±1.3[无显著差异]）。频繁的自我血糖监测与更高的大剂量注射次数相关（6.1±2.2次大剂量注射/天与4.5±2.0次大剂量注射/天[P<0.05]）。因此，观察到每日大剂量注射次数增加对血糖变异性有类似但不太明显的有利影响（每天多于5次与每天少于4次大剂量注射：J评分，57±17与63±25[无显著差异]；低血糖指数，1.0±1.0与1.5±1.4[P<0.05]；高血糖指数，1.3±0.6与1.6±1.1[无显著差异]；血糖控制指数，2.3±1.1与3.1±1.7[P<0.05]）。
每日频繁进行血糖读数的泵使用者血糖控制更好，血糖变异性更低。
