Calliari Luis Eduardo P, Krakauer Marcio, Vianna Andre Gustavo Daher, Ram Yashesvini, Barbieri Douglas Eugenio, Xu Yongjin, Dunn Timothy C
1Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil.
Centro de Pesquisa Clínica do Grupo Leforte, São Paulo, Brazil.
Diabetol Metab Syndr. 2020 Jan 7;12:3. doi: 10.1186/s13098-019-0513-z. eCollection 2020.
New technologies are changing diabetes treatment and contributing better outcomes in developed countries. To our knowledge, no previous studies have investigated the comparative effect of sensor-based monitoring on glycemic markers in developing countries like Brazil. The present study aims to evaluate the use of intermittent Continuous Glucose Measurements (iCGM) in a developing country, Brazil, regarding (i) frequency of glucose scans, (ii) its association with glycemic markers and (iii) comparison with these findings to those observed in global population data.
Glucose results were de-identified and uploaded to a dedicated database when Freestyle Libre™ readers were connected to an internet-ready computer. Data between September 2014 and Dec 2018, comprising 688,640 readers and 7,329,052 sensors worldwide, were analysed (including 17,691 readers and 147,166 sensors from Brazil). Scan rate per reader was determined and each reader was sorted into 20 equally-sized rank ordered groups, categorised by scan frequency. Glucose parameters were calculated for each group, including estimated A1c, time above, below and within range identified as 70-180 mg/dL.
In Brazil, reader users performed an average of 14 scans per day, while around the world, reader users performed an average of 12 scans per day (p < 0.01). In Brazil dataset, those in the lowest and in the highest groups scanned on average 3.6 and 43.1 times per day had an estimated A1c of 7.56% (59 mmol/mol) and 6.71% (50 mmol/mol), respectively (p < 0.01). Worldwide, the lowest group and the highest groups scanned 3.4 times/day and 37.8 times/day and had an eA1c of 8.14% (65 mmol/mol) and 6.70% (50 mmol/mol), respectively (p < 0.01). For the scan groups in both populations, the time spent above 180 mg/dL decreased as the scan frequency increased. In both Brazil and around the world, as scan frequency increased, time in range (TIR) increased. In Brazil, TIR increased from 14.15 to 16.62 h/day (p < 0.01). Worldwide, TIR increased from 12.06 to 16.97 h/day (p < 0.01).
We conclude that Brazilian users have a high frequency of scans, more frequent than global data. Similarly to the world findings, increased scan frequency is associated with better glycemic control.
新技术正在改变糖尿病治疗方式，并在发达国家带来更好的治疗效果。据我们所知，此前尚无研究调查过像巴西这样的发展中国家基于传感器的监测对血糖指标的比较效果。本研究旨在评估在巴西这个发展中国家间歇性连续血糖监测（iCGM）的使用情况，具体涉及：（i）血糖扫描频率；（ii）其与血糖指标的关联；（iii）将这些结果与全球人群数据中的观察结果进行比较。
当FreeStyle Libre™血糖仪与联网电脑连接时，血糖检测结果被匿名化并上传至专用数据库。分析了2014年9月至2018年12月期间的数据，包括全球688,640台血糖仪和7,329,052个传感器（其中来自巴西的有17,691台血糖仪和147,166个传感器）。确定了每台血糖仪的扫描率，并将每台血糖仪按扫描频率分为20个大小相等的排序组。计算了每组的血糖参数，包括估计的糖化血红蛋白（A1c）、高于、低于及处于70 - 180mg/dL范围内的时间。
在巴西，血糖仪使用者平均每天进行14次扫描，而全球范围内血糖仪使用者平均每天进行12次扫描（p < 0.01）。在巴西的数据集中，扫描次数最少组（平均每天3.6次）和最多组（平均每天43.1次）的估计糖化血红蛋白分别为7.56%（59mmol/mol）和6.71%（50mmol/mol）（p < 0.01）。在全球范围内，扫描次数最少组（每天3.4次）和最多组（每天37.8次）的估计糖化血红蛋白分别为8.14%（65mmol/mol）和6.70%（50mmol/mol）（p < 0.01）。对于两个群体中的扫描组，随着扫描频率增加，血糖高于180mg/dL的时间减少。在巴西和全球范围内，随着扫描频率增加，血糖处于目标范围内的时间（TIR）均增加。在巴西，TIR从每天14.15小时增加到16.62小时（p < 0.01）。在全球范围内，TIR从每天12.06小时增加到16.97小时（p < 0.01）。
我们得出结论，巴西使用者的扫描频率较高，高于全球数据。与全球研究结果类似，扫描频率增加与更好的血糖控制相关。
