Department of Medicine, NU-Hospital Group, Trollhättan/Uddevalla, Sweden
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Diabetes Care. 2020 Sep;43(9):2017-2024. doi: 10.2337/dc19-2606. Epub 2020 Jul 8.
According to recent guidelines, individuals with type 1 diabetes should spend <4.0% of time per day with glucose levels <3.9 mmol/L (<70 mg/dL) and <1.0% per day with glucose levels <3.0 mmol/L (<54 mg/dL).
In the GOLD randomized crossover trial, 161 individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) were randomized to continuous glucose monitoring (CGM) or conventional therapy with self-monitoring of blood glucose (SMBG) and evaluated over 16 months. We estimated the association between time spent in hypoglycemia and various mean glucose and HbA levels.
Time spent in hypoglycemia (<3.9 mmol/L and <3.0 mmol/L) increased significantly with lower mean HbA and mean glucose levels during both CGM and conventional therapy. During CGM, 24 (57.1%) individuals with HbA <7.5% (<58 mmol/mol) had <1.0% time spent in hypoglycemia <3.0 mmol/L and 23 (54.8%) had <4.0% time spent in hypoglycemia <3.9 mmol/L. During CGM, mean time spent in hypoglycemia for individuals with mean HbA 7.0% (52 mmol/mol) was estimated to be 5.4% for <3.9 mmol/L and 1.5% for <3.0 mmol/L. The corresponding values during SMBG were 9.2% and 3.5%, respectively. Individuals with mean glucose levels of 8 mmol/L spent 4.9% units more time with glucose levels <3.9 mmol/L and 2.8% units more time <3.0 mmol/L during SMBG compared with CGM.
Reaching current targets for time in hypoglycemia while at the same time reaching HbA targets is challenging for patients with type 1 diabetes treated with MDI both with CGM and SMBG monitoring. However, CGM is associated with considerably less time in hypoglycemia than SMBG at a broad range of HbA levels and is crucial for patients with MDI treatment if they are to have a chance to approach hypoglycemia targets.
根据最新指南，1 型糖尿病患者每天应将血糖 <3.9mmol/L（<70mg/dL）的时间控制在<4.0%，血糖 <3.0mmol/L（<54mg/dL）的时间控制在<1.0%。
在 GOLD 随机交叉试验中，161 例接受多次胰岛素注射（MDI）治疗的 1 型糖尿病患者被随机分配至连续血糖监测（CGM）或常规治疗（自我血糖监测，SMBG），并在 16 个月内进行评估。我们估计了低血糖时间与各种平均血糖和 HbA 水平之间的关系。
在 CGM 和常规治疗期间，随着平均 HbA 和平均血糖水平的降低，低血糖时间（<3.9mmol/L 和 <3.0mmol/L）显著增加。在 CGM 期间，24 例（57.1%）HbA<7.5%（<58mmol/mol）的患者 <1.0%时间的血糖<3.0mmol/L，23 例（54.8%）<4.0%时间的血糖<3.9mmol/L。在 CGM 期间，估计平均 HbA 为 7.0%（52mmol/mol）的个体的平均低血糖时间为 5.4%<3.9mmol/L 和 1.5%<3.0mmol/L。SMBG 时的相应值分别为 9.2%和 3.5%。平均血糖水平为 8mmol/L 的个体在 SMBG 时与 CGM 相比，血糖<3.9mmol/L 的时间增加了 4.9%，血糖<3.0mmol/L 的时间增加了 2.8%。
