Šumník Zdeněk, Pavlíková Markéta, Pomahačová Renata, Venháčová Petra, Petruželková Lenka, Škvor Jaroslav, Neumann David, Vosáhlo Jan, Konečná Petra, Čížek Jindřich, Strnadel Jiří, Průhová Štěpánka, Cinek Ondřej
Department of Pediatrics, Motol University Hospital and Charles University, 2nd Faculty of Medicine, Prague, Czech Republic.
Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic.
Pediatr Diabetes. 2021 May;22(3):439-447. doi: 10.1111/pedi.13184. Epub 2021 Feb 17.
Increased access to modern technologies is not always accompanied by a decrease in HbA1c. The aim of this study was to identify changes in the proportion of continuous glucose monitoring (CGM) users since 2017, when general reimbursement for CGM became effective in Czechia, and to test whether HbA1c is associated with the percentage of time spent on CGM.
All T1D children in the Czech national ČENDA registry (3197 children) were categorized according to their time spent on CGM and associations with age, sex, center size, and HbA1c were tested with calendar year as a stratification factor.
The proportion of children with any CGM use increased from 37.9% in 2017 to 50.3% in 2018 and 74.8% in 2019. Of the CGM users, 16%, 28%, and 41% of the children spent >70% of their time on CGM over the 3 years of the study period, with an overrepresentation of children in the <10 years age group versus the older age groups (p < 0.001). The proportion of CGM users differed among centers and was positively associated with a large center size (>100 patients) (p < 0.001). HbA1c was negatively associated with the time spent on CGM (p < 0.001).
A rapid increase in CGM use was reported over the 3 years after general reimbursement. HbA1c was associated with time spent on CGM, a continuing decrease was observed in the >70% category. Reimbursement for CGM likely contributes to the improvement of T1D control at the population level.
获得现代技术的机会增加并不总是伴随着糖化血红蛋白（HbA1c）的降低。本研究的目的是确定自2017年（当时连续血糖监测（CGM）在捷克共和国开始普遍报销）以来CGM使用者比例的变化，并测试HbA1c是否与CGM使用时间百分比相关。
捷克国家ČENDA登记处的所有1型糖尿病儿童（3197名儿童）根据其CGM使用时间进行分类，并以日历年作为分层因素，测试其与年龄、性别、中心规模和HbA1c的关联。
使用过任何CGM的儿童比例从2017年的37.9%增加到了2018年的50.3%和2019年的74.8%。在CGM使用者中，在研究期间的3年里，分别有16%（2017年）、28%（2018年）和41%（2019年）的儿童CGM使用时间超过其总时间的70%，10岁以下年龄组的儿童占比高于年龄较大的组（p<0.001）。CGM使用者的比例在各中心之间存在差异，并且与大型中心规模（>100名患者）呈正相关（p<0.001）。HbA1c与CGM使用时间呈负相关（p<0.001）。
在普遍报销后的3年里，CGM的使用迅速增加。HbA1c与CGM使用时间相关，在使用时间超过70%的类别中持续下降。CGM报销可能有助于在人群水平上改善1型糖尿病的控制。
