Jin Sang-Man, Baek Jong Ha, Suh Sunghwan, Jung Chang Hee, Lee Woo Je, Park Cheol-Young, Yang Hae Kyung, Cho Jae Hyoung, Lee Byung-Wan, Kim Jae Hyeon
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea.
J Diabetes Investig. 2017 Aug 10;9(3):549-57. doi: 10.1111/jdi.12728.
AIMS/INTRODUCTION: We aimed to identify factors independently associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes, in terms of glycemic control and the rate of severe hypoglycemia.
This was a prospective cohort study of 466 adult patients with type 1 diabetes from five tertiary referral hospitals who registered for a national reimbursement program for blood glucose strips and were then followed-up for 12 months. Factors associated with a > 5% reduction in glycated hemoglobin (HbA1c) and decreased rate of severe hypoglycemia (SH) at 12 months from baseline were evaluated.
At the end of the 12 months of follow up, 158 of 466 patients (33.9%) achieved >5% reduction in HbA1c, and 47 of 111 patients (42.3%) had a decreased rate of SH relative to baseline. Higher HbA1c (P < 0.001), lower total daily insulin dose at baseline (P = 0.048) and an increase in self-monitoring of blood glucose (SMBG) frequency during follow up (P = 0.001) were independently associated with >5% reduction in HbA1c. A higher SMBG frequency (P < 0.001), higher rate of SH at baseline (P = 0.029) and lack of hypoglycemic unawareness (P = 0.044) were independently associated with an increase in the frequency of SMBG during follow up. Higher SMBG frequency at baseline (P < 0.001) was independently associated with a decreased rate of SH.
Several factors, including higher SMBG frequency at baseline, were independently associated with reduced HbA1c and a decreased rate of severe hypoglycemia, showing that patients with these characteristics derive the most benefit from reimbursement of blood glucose test strips.
目的/引言：我们旨在确定在血糖控制和严重低血糖发生率方面，与1型糖尿病成年患者血糖试纸国家报销政策更大获益独立相关的因素。
这是一项对来自五家三级转诊医院的466例1型糖尿病成年患者进行的前瞻性队列研究，这些患者登记参加了血糖试纸国家报销计划，随后进行了12个月的随访。评估了与糖化血红蛋白（HbA1c）降低>5%以及与基线相比12个月时严重低血糖（SH）发生率降低相关的因素。
在12个月的随访结束时，466例患者中有158例（33.9%）HbA1c降低>5%，111例患者中有47例（42.3%）SH发生率相对于基线有所降低。较高的HbA1c（P<0.001）、基线时较低的每日总胰岛素剂量（P=0.048）以及随访期间自我血糖监测（SMBG）频率增加（P=0.001）与HbA1c降低>5%独立相关。较高的SMBG频率（P<0.001）、基线时较高的SH发生率（P=0.029）以及无低血糖无意识（P=0.044）与随访期间SMBG频率增加独立相关。基线时较高的SMBG频率（P<0.001）与SH发生率降低独立相关。
包括基线时较高的SMBG频率在内的几个因素与HbA1c降低和严重低血糖发生率降低独立相关，表明具有这些特征的患者从血糖试纸报销中获益最大。
