Kesavadev Jothydev, Vigersky Robert, Shin John, Pillai Pradeep Babu Sadasivan, Shankar Arun, Sanal Geethu, Krishnan Gopika, Jothydev Sunitha
Jothydev's Diabetes Research Centre, Konkalam Road, Mudavanmugal, Trivandrum, Kerala, 695032, India.
Medtronic Diabetes, 950 F St. NW, Washington, DC, 20004, USA.
Adv Ther. 2017 Aug;34(8):1918-1927. doi: 10.1007/s12325-017-0576-x. Epub 2017 Jun 30.
There have been few large studies that have analyzed the effect of professional (masked) continuous glucose monitoring (P-CGM) on glycemic control in patients with type 2 diabetes (T2DM) who were on a broad spectrum of baseline therapies.
We performed a retrospective, blinded evaluation of glycemic control in 296 T2DM adults for 6 months following a 6- to 7-day study of their glycemic profile using masked P-CGM. At baseline, 91% of the patients were on some form of insulin treatment with oral hypoglycemic agents (OHA), while 7% were on one or more OHAs without insulin, and the remaining 2% were on GLP-1RAs. On the basis of the masked CGM profile, patients were counselled on diet and exercise change(s) in their baseline diabetes therapy by our professionally trained diabetes team. They also continued to receive regular treatment advice and dose titrations through our Diabetes Tele-Management System (DTMS). The baseline changes in hemoglobin A1C (A1C) observed in these patients after 6 months of undergoing P-CGM was compared to a matched control group.
P-CGM revealed that the predominant pattern of hyperglycemia was postprandial while previously unknown hypoglycemia was found in 38% of the patients; over half of the cases of hypoglycemia were nocturnal. The mean A1C of the P-CGM group dropped from 7.5 ± 1.4% at baseline vs. 7.0 ± 0.9% at 6 months (p < 0.0001). The frequency of performing self-monitoring of blood glucose (SMBG) was also found to be significantly increased in these patients from the baseline. Meanwhile, no significant improvement in A1C was noted in the control group during the same time frame (7.7 ± 1.1% at baseline vs. 7.4 ± 1.1% at 6 months; p = 0.0663) and frequency of SMBG remained almost unchanged.
P-CGM can provide actionable data and motivate patients for diabetes self-care practices, resulting in an improvement in glycemic control over a wide range of baseline therapies.
很少有大型研究分析专业（隐蔽式）连续血糖监测（P-CGM）对接受广泛基线治疗的2型糖尿病（T2DM）患者血糖控制的影响。
我们对296例T2DM成年患者进行了回顾性、盲法血糖控制评估，在使用隐蔽式P-CGM对其血糖谱进行6至7天研究后的6个月内进行。基线时，91%的患者接受某种形式的胰岛素联合口服降糖药（OHA）治疗，7%的患者仅接受一种或多种不含胰岛素的OHA治疗，其余2%的患者接受胰高血糖素样肽-1受体激动剂（GLP-1RAs）治疗。根据隐蔽式CGM结果，我们专业训练的糖尿病团队就患者基线糖尿病治疗中的饮食和运动变化给予建议。他们还通过我们的糖尿病远程管理系统（DTMS）继续接受常规治疗建议和剂量调整。将这些患者接受P-CGM 6个月后观察到的糖化血红蛋白（A1C）基线变化与匹配的对照组进行比较。
P-CGM显示，高血糖的主要模式是餐后高血糖，38%的患者发现了以前未知的低血糖；超过一半的低血糖病例发生在夜间。P-CGM组的平均A1C从基线时的7.5±1.4%降至6个月时的7.0±0.9%（p<0.0001）。这些患者自我血糖监测（SMBG）的频率也从基线时显著增加。同时，对照组在同一时间段内A1C无显著改善（基线时为7.7±1.1%，6个月时为7.4±1.1%；p=0.0663），SMBG频率几乎保持不变。
P-CGM可以提供可采取行动的数据，并激励患者进行糖尿病自我护理，从而在广泛的基线治疗范围内改善血糖控制。
