Selvan Chitra, Thukral Anubhav, Dutta Deep, Ghosh Sujoy, Chowdhury Subhankar
Department of Endocrinology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India.
Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India.
Indian J Endocrinol Metab. 2017 May-Jun;21(3):382-386. doi: 10.4103/ijem.IJEM_342_16.
Logbooks of self-monitoring of blood glucose (SMBG) are useful in the modulation of insulin regimens, which aid in achieving glycemic control in type 1 diabetes mellitus (T1DM). However, discrepancies in SMBG charting may impede its utility. This study aimed to assess the accuracy of log entries and its impact on long-term glycemic control.
SMBG in logbooks was compared with readings in glucometer memory and discrepancies between the two were evaluated in 101 children with T1DM. The relationship between these discrepancies and glycated hemoglobin (HbA1c) over 44 months was assessed.
Errors in glucose charting were observed in 32.67% children. The most common observed error was omission (42.42%), followed by fabrication (27.27%), erroneous (18.18%), and others (12.12%). Age was not significantly different among children having accurate versus inaccurate SMBG logs. During follow-up of 44 months, children with accurate SMBG logs consistently had lower HbA1c as compared to children having inaccurate logs, which was statistically significant at 4, 16, 20, and 28 months' follow-up. The same was reflected in the proportion of children achieving HbA1c <7% and 7%-9%. Of the 14 children who had omissions, 9 had omission of high values only, 3 patients had omission of low values only, 1 had omission of both high and low values, and 1 had omission of normal values. Among logs with fabrication, parents were responsible in 2 of 9 incidents. In the remaining 7, it was the child himself/herself. Children with fabrication consistently had the highest HbA1c values among the different types of inaccurate blood glucose chartings, which was statistically significant at 32 and 36 months of follow-up.
Reliability of SMBG logs is a significant problem among children with T1DM at our center. Children with accurate logs of SMBG readings were more likely to have better glycemic control on long-term follow-up.
血糖自我监测（SMBG）日志有助于调整胰岛素治疗方案，从而有助于实现1型糖尿病（T1DM）患者的血糖控制。然而，SMBG记录中的差异可能会妨碍其效用。本研究旨在评估日志记录的准确性及其对长期血糖控制的影响。
将101例T1DM儿童日志中的SMBG与血糖仪内存中的读数进行比较，并评估两者之间的差异。评估了这些差异与44个月内糖化血红蛋白（HbA1c）之间的关系。
32.67%的儿童存在血糖记录错误。最常见的错误是遗漏（42.42%），其次是伪造（27.27%）、错误记录（18.18%）和其他（12.12%）。SMBG日志准确与不准确的儿童之间年龄无显著差异。在44个月的随访期间，SMBG日志准确的儿童与日志不准确的儿童相比，HbA1c持续较低，在随访4、16、20和28个月时具有统计学意义。这也反映在HbA1c<7%和7%-9%的儿童比例上。在14例有遗漏记录的儿童中，9例仅遗漏了高值，3例仅遗漏了低值，1例同时遗漏了高值和低值，1例遗漏了正常值。在伪造记录的日志中，9起事件中有2起是家长所为。其余7起是孩子自己所为。在不同类型的不准确血糖记录中，伪造记录的儿童HbA1c值始终最高，在随访32和36个月时具有统计学意义。
在我们中心，T1DM儿童中SMBG日志的可靠性是一个重要问题。SMBG读数记录准确的儿童在长期随访中更有可能实现更好的血糖控制。
