Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, GA.
Rollins School of Public Health, Emory University, Atlanta, GA.
Diabetes Care. 2020 Nov;43(11):2730-2735. doi: 10.2337/dc19-2073. Epub 2020 Jul 8.
We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care capillary glucose testing (POC) among insulin-treated hospitalized patients with type 2 diabetes (T2D).
This was a prospective study in adult patients with T2D admitted to general medicine and surgery wards. Patients were monitored with POC before meals and bedtime and with CGM during the hospital stay. Study end points included differences between POC and CGM in mean daily blood glucose (BG), hypoglycemia <70 and <54 mg/dL, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), ±15%/15 mg/dL, ±20%/20 mg/dL, and ±30%/30 mg/dL and error grid analysis between matched glucose pairs.
Mean daily glucose was significantly higher by POC (188.9 ± 37.3 vs. 176.1 ± 46.9 mg/dL) with an estimated mean difference of 12.8 mg/dL (95% CI 8.3-17.2 mg/dL), and proportions of patients with glucose readings <70 mg/dL (14% vs. 56%) and <54 mg/dL (4.1% vs. 36%) detected by POC BG were significantly lower compared with CGM (all < 0.001). Nocturnal and prolonged CGM hypoglycemia <54 mg/dL were 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4% and 16.7% for glucose values between 70 and 250 mg/dL and higher for 51-69 mg/dL (MARD 28.0%). The percentages of glucose readings within ±15%/15 mg/dL, ±20%/20 mg/dL, and ±30%/30 mg/dL were 62%, 76%, and 91%, respectively. Error grid analysis showed 98.8% of glucose pairs within zones A and B.
Compared with POC, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM's accuracy was lower in the hypoglycemic range.
我们比较了接受胰岛素治疗的 2 型糖尿病（T2D）住院患者使用 FreeStyle Libre Pro 连续血糖监测（CGM）和即时毛细血管血糖检测（POC）的性能。
这是一项在普通内科和外科病房住院的 T2D 成年患者中进行的前瞻性研究。患者在餐前和睡前接受 POC 监测，在住院期间接受 CGM 监测。研究终点包括 POC 和 CGM 在平均每日血糖（BG）、<70mg/dL 和 <54mg/dL 的低血糖、夜间低血糖方面的差异。我们还计算了匹配血糖对之间的平均绝对相对差异（MARD）、±15%/15mg/dL、±20%/20mg/dL 和 ±30%/30mg/dL 以及误差网格分析。
POC 测量的平均每日血糖明显较高（188.9 ± 37.3 与 176.1 ± 46.9mg/dL），估计平均差值为 12.8mg/dL（95%CI 8.3-17.2mg/dL），POC 检测到的血糖读数<70mg/dL（14%与 56%）和 <54mg/dL（4.1%与 36%）的患者比例明显低于 CGM（均<0.001）。夜间和长时间 CGM 低血糖<54mg/dL 的比例分别为 26%和 12%。总体 MARD 为 14.8%，70-250mg/dL 之间的血糖值范围为 11.4%-16.7%，51-69mg/dL 时更高（MARD 28.0%）。血糖读数在±15%/15mg/dL、±20%/20mg/dL 和 ±30%/30mg/dL 范围内的百分比分别为 62%、76%和 91%。误差网格分析显示，98.8%的血糖对位于 A 和 B 区。
与 POC 相比，FreeStyle Libre CGM 显示出较低的平均每日血糖和更高的低血糖事件检出率，特别是在 T2D 住院患者中，夜间和长时间低血糖。CGM 在低血糖范围内的准确性较低。
