Department of Endocrinology, Nutrition and Metabolic Diseases, University Hospital Sainte Marguerite, APHM, F-13385 Marseille, France.
Aix Marseille Univ, CNRS, CRMBM, F-13385 Marseille, France.
Sensors (Basel). 2021 Sep 13;21(18):6131. doi: 10.3390/s21186131.
The switch from intermittently scanned continuous glucose monitoring (isCGM) to real-time (rt) CGM could improve glycemic management in suboptimal controlled type 1 diabetes patients, but long-term study is lacking. We evaluated retrospectively the ambulatory glucose profile (AGP) in such patients after switching from Free Style Libre 1 (FSL1) to Dexcom G4 (DG4) biosensors over 1 year. Patients ( = 21, 43 ± 15 years, BMI 25 ± 5, HbA1c 8.1 ± 1.0%) had severe hypoglycemia and/or HbA1c ≥ 8%. AGP metrics (time-in-range (TIR) 70-180 mg/dL, time-below-range (TBR) <70 mg/dL or <54 mg/dL, glucose coefficient of variation (%CV), time-above-range (TAR) >180 mg/dL or >250 mg/dL, glucose management indicator (GMI), average glucose) were collected the last 3 months of FSL1 use (M0) and of DG4 for 3, 6 (M6) and 12 (M12) months of use. Values were means ± standard deviation or medians [Q1;Q3]. At M12 versus M0, the higher TIR (50 ± 17 vs. 45 ± 16, = 0.036), and lower TBR < 70 mg/dL (2.5 [1.6;5.5] vs. 7.0 [4.5;12.5], = 0.0007), TBR < 54 mg/dL (0.7 [0.4;0.8] vs. 2.3 [0.8;7.0], = 0.007) and %CV (39 ± 5 vs. 45 ± 8, = 0.0009), evidenced a long-term effectiveness of the switch. Compared to M6, TBR < 70 mg/dL decreased, %CV remained stable, while the improvement on hyperglycemia exposure decreased (higher GMI, TAR and average glucose). This switch was a relevant therapeutic option, though a loss of benefit on hyperglycemia stressed the need for optimized management of threshold alarms. Nevertheless, few patients attained the recommended values for AGP metrics, and the reasons why some patients are "responders" vs. "non-responders" warrant to be investigated.
从间歇性扫描连续血糖监测(isCGM)切换到实时(rt)CGM 可以改善血糖控制不佳的 1 型糖尿病患者的血糖管理,但缺乏长期研究。我们回顾性评估了 21 名患者(43 ± 15 岁,BMI 25 ± 5,HbA1c 8.1 ± 1.0%)在使用 Free Style Libre 1(FSL1)后改用 Dexcom G4(DG4)传感器 1 年以上的动态血糖谱(AGP)。AGP 指标(TIR 70-180mg/dL、TBR<70mg/dL 或<54mg/dL、血糖变异系数(%CV)、TAR>180mg/dL 或>250mg/dL、血糖管理指标(GMI)、平均血糖)在 FSL1 使用的最后 3 个月(M0)和使用 DG4 的第 3、6(M6)和 12 个月(M12)时收集。数值为平均值 ± 标准差或中位数 [Q1;Q3]。与 M0 相比,M12 时的 TIR 更高(50 ± 17 对 45 ± 16,= 0.036),TBR<70mg/dL 更低(2.5 [1.6;5.5] 对 7.0 [4.5;12.5],= 0.0007),TBR<54mg/dL 更低(0.7 [0.4;0.8] 对 2.3 [0.8;7.0],= 0.007),%CV 更低(39 ± 5 对 45 ± 8,= 0.0009),表明转换具有长期效果。与 M6 相比,TBR<70mg/dL 降低,%CV 保持稳定,而高血糖暴露的改善减少(GMI、TAR 和平均血糖更高)。这种转换是一种有效的治疗选择,尽管高血糖的获益丧失强调了需要优化阈值警报的管理。然而,很少有患者达到 AGP 指标的推荐值,需要研究为什么有些患者是“应答者”而不是“非应答者”。