Li Shu-Ying, Guo Hang, Zhang Yi, Li Pei, Zhou Pei, Sun Li-Rong, Li Jing, Chen Li-Ming
Department of Endocrinology, Tianjin Xiqing Hospital, Tianjin, China.
NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin, 300134, China.
Diabetol Metab Syndr. 2021 Apr 9;13(1):39. doi: 10.1186/s13098-021-00657-0.
To investigate the effects of intermittently scanned continuous glucose monitoring (isCGM) on blood glucose control, clinical value of blood glucose monitoring and production of urinary ketone bodies in pregestational diabetes mellitus.
A total of 124 patients with pregestational diabetes mellitus at 12-14 weeks of gestation admitted to the gestational diabetes clinic of our hospital from December 2016 to December 2018 were selected and randomly divided into two groups. Sixty patients adopted self-monitoring of blood glucose (SMBG) were taken as the control group, and the other 64 patients adopted isCGM system by wearing the device for 14 days. Blood sugar control, glycosylated albumin level, ketone production in urine, the maximum and minimum of blood sugar value measured by different monitoring methods and their occurrence time were observed in the two groups.
(1) No statistically significant differences were found between the groups in terms of maternal age, gestational age at first visit, family history, duration of diabetes, education level, total insulin dose, chronic hypertension, abortion history, nulliparity, assisted reproductive technology, history of macrosomia childbirth, pre-pregnancy BMI, and overweight (%) at the first visit and hypoglycemia, (2) the value of Glycated Albumin was lower in the CGM group compared to the control group at 2ed weeks (14.6 ± 2.2 vs. 16.8 ± 2.7, p < 0.001). The women in the CGM group spent increased time in the recommended glucose control target range of 3.5-7.8 mmol/L (69 ± 10% vs. 62 ± 11%, p < 0.001) and reduced time above target compared with those in the control group at 2 weeks (25 ± 7% vs. 31 ± 8%, p < 0.001). In the second week of the study, the positive rate of urinary ketone body in isCGM group was lower than that in the control group (42 ± 5 vs. 54 ± 5, p < 0.001), and (3) the minimum blood glucose of 31.2% (20/64) cases in isCGM group appeared during 0:00-2:59 at night, and 26.6% (17/64) cases appeared during 3:00-5:59 at night. The minimum values of 40.0% (24/60) cases in the control group appeared within the 30 min before lunch, 23.3% (14/60) within the 30 min before breakfast, and 11.7% (7/60) within the 30 min before dinner. The cases of minimum of blood sugar before meals accounted for 75% of all the minimum values, and the cases of minimum at night only accounted for 8.3%.
Intermittently scanned continuous glucose monitoring can reduce hyperglycemia exposure and ketone body formation in pregestational diabetes mellitus. In addition, isCGM is better than SMBG in detecting nocturnal hypoglycemia.
探讨间歇性扫描式动态血糖监测（isCGM）对孕前糖尿病患者血糖控制、血糖监测临床价值及尿酮体产生的影响。
选取2016年12月至2018年12月在我院妊娠糖尿病门诊就诊的124例孕12 - 14周的孕前糖尿病患者，随机分为两组。60例采用自我血糖监测（SMBG）的患者作为对照组，另外64例患者佩戴设备采用isCGM系统14天。观察两组患者的血糖控制情况、糖化白蛋白水平、尿酮体产生情况，以及不同监测方法测得的血糖值的最大值、最小值及其出现时间。
（1）两组患者在母亲年龄、首次就诊孕周、家族史、糖尿病病程、教育程度、胰岛素总剂量、慢性高血压、流产史、未生育、辅助生殖技术、巨大儿分娩史、孕前体重指数及首次就诊时超重（%）和低血糖方面，差异均无统计学意义；（2）CGM组在第2周时糖化白蛋白值低于对照组（14.6±2.2 vs. 16.8±2.7，p＜0.001）。CGM组患者在第2周时处于推荐血糖控制目标范围3.5 - 7.8 mmol/L的时间增加（69±10% vs. 62±11%，p＜0.001），高于目标范围的时间减少（25±7% vs. 31±8%，p＜0.001）。在研究的第2周，isCGM组尿酮体阳性率低于对照组（42±5 vs. 54±5，p＜0.001）；（3）isCGM组31.2%（20/64）的病例最低血糖出现在夜间0:00 - 2:59，26.6%（17/64）的病例出现在夜间3:00 - 5:59。对照组40.0%（24/60）的病例最低值出现在午餐前30分钟内，23.3%（14/60）出现在早餐前30分钟内，11.7%（7/60）出现在晚餐前30分钟内。餐前最低血糖病例占所有最低值的75%，夜间最低值病例仅占8.3%。
间歇性扫描式动态血糖监测可减少孕前糖尿病患者的高血糖暴露和酮体形成。此外，isCGM在检测夜间低血糖方面优于SMBG。
