Giani Elisa, Snelgrove Rebecca, Volkening Lisa K, Laffel Lori M
1 Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
2 Department of Pediatrics, Section on Pediatric Endocrinology, Diabetes and Metabolism, Biomedical and Clinical Science Department, V. Buzzi Children's Hospital, University of Milan, Milan, Italy.
J Diabetes Sci Technol. 2017 May;11(3):476-483. doi: 10.1177/1932296816676280. Epub 2016 Nov 1.
Continuous glucose monitoring (CGM) remains underutilized in youth with type 1 diabetes (T1D). There is a need to investigate factors associated with CGM use.
In 61 T1D youth, CGM use was ascertained by downloads reflecting the 4-week periods preceding 3- and 6-month study visits. Demographic and clinical data were obtained from chart review and interview. Youth and parents completed validated psychosocial surveys at baseline and 6 months.
Youth (52% male, 93% Caucasian, 80% pump treated) were 12.7 ± 2.9 years old, with T1D for 6.3 ± 3.8 years; mean A1c was 7.9 ± 0.9%. Mean CGM use was 4.1 ± 2.1 days/week (median = 4.8) at 3 months and 3.4 ± 2.3 days/week (median = 3.9) at 6 months. At 3 and 6 months, 15% and 20% of youth, respectively, had stopped using CGM. At 6 months, youth using CGM 6-7 days/week had more frequent BG monitoring ( P = .05), less insulin omission ( P = .02), and greater probability of A1c < 7.5% ( P = .01) than youth using CGM less often. Youth using CGM 6-7 days/week consistently over the 6 months demonstrated lower A1c at 3 months compared to baseline ( P = .03) and the improvement was sustained at 6 months ( P = .5, 3 vs 6 months); youth using CGM less often had no significant A1c change. Baseline BG monitoring ≥8 times/day or A1c within target (<7.5%) predicted greater CGM use (6-7 days/week) at 6 months (OR = 4.6, P = .02). There was no deterioration of psychosocial functioning with CGM use.
Consistent and durable CGM use in youth with T1D is associated with treatment adherence and improved glycemic control without increasing psychosocial distress.
持续葡萄糖监测（CGM）在1型糖尿病（T1D）青少年中的应用仍未得到充分利用。有必要研究与CGM使用相关的因素。
在61名T1D青少年中，通过反映3个月和6个月研究访视前4周时间段的下载数据来确定CGM的使用情况。从病历审查和访谈中获取人口统计学和临床数据。青少年和家长在基线和6个月时完成了经过验证的心理社会调查。
青少年（52%为男性，93%为白种人，80%接受胰岛素泵治疗）年龄为12.7±2.9岁，患T1D 6.3±3.8年；平均糖化血红蛋白（A1c）为7.9±0.9%。3个月时CGM的平均使用频率为4.1±2.1天/周（中位数=4.8），6个月时为3.4±2.3天/周（中位数=3.9）。在3个月和6个月时，分别有15%和20%的青少年停止使用CGM。在6个月时，每周使用CGM 6 - 7天的青少年比使用频率较低的青少年血糖监测更频繁（P = 0.05），胰岛素遗漏更少（P = 0.02），糖化血红蛋白<7.5%的概率更高（P = 0.01）。在6个月内持续每周使用CGM 6 - 7天的青少年在3个月时的糖化血红蛋白水平相较于基线有所降低（P = 0.03），且在6个月时仍保持改善（P = 0.5，3个月与6个月比较）；使用CGM频率较低的青少年糖化血红蛋白无显著变化。基线时每日血糖监测≥8次或糖化血红蛋白处于目标范围内（<7.5%）可预测6个月时更高的CGM使用频率（6 - 7天/周）（比值比=4.6，P = 0.02）。使用CGM并未导致心理社会功能恶化。
T1D青少年持续且持久地使用CGM与治疗依从性和血糖控制改善相关，且不会增加心理社会困扰。
