胃旁路术后低血糖患者的连续血糖监测可减少低血糖和血糖变异性。
Continuous glucose monitoring in patients with post-bariatric hypoglycaemia reduces hypoglycaemia and glycaemic variability.
机构信息
Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Diabetes Obes Metab. 2023 Aug;25(8):2191-2202. doi: 10.1111/dom.15096. Epub 2023 May 3.
AIM
To determine whether continuous glucose monitoring (CGM) can reduce hypoglycaemia in patients with post-bariatric hypoglycaemia (PBH).
MATERIALS AND METHODS
In an open-label, nonrandomized, pre-post design with sequential assignment, CGM data were collected in 22 individuals with PBH in two sequential phases: (i) masked (no access to sensor glucose or alarms); and (ii) unmasked (access to sensor glucose and alarms for low or rapidly declining sensor glucose). Twelve participants wore the Dexcom G4 device for a total of 28 days, while 10 wore the Dexcom G6 device for a total of 20 days.
RESULTS
Participants with PBH spent a lower percentage of time in hypoglycaemia over 24 hours with unmasked versus masked CGM (<3.3 mM/L, or <60 mg/dL: median [median absolute deviation {MAD}] 0.7 [0.8]% vs. 1.4 [1.7]%, P = 0.03; <3.9 mM/L, or <70 mg/dL: median [MAD] 2.9 [2.5]% vs. 4.7 [4.8]%; P = 0.04), with similar trends overnight. Sensor glucose data from the unmasked phase showed a greater percentage of time spent between 3.9 and 10 mM/L (70-180 mg/dL) (median [MAD] 94.8 [3.9]% vs. 90.8 [5.2]%; P = 0.004) and lower glycaemic variability over 24 hours (median [MAD] mean amplitude of glycaemic excursion 4.1 [0.98] vs. 4.4 [0.99] mM/L; P = 0.04). During the day, participants also spent a greater percentage of time in normoglycaemia with unmasked CGM (median [MAD] 94.2 [4.8]% vs. 90.9 [6.2]%; P = 0.005), largely due to a reduction in hyperglycaemia (>10 mM/L, or 180 mg/dL: median [MAD] 1.9 [2.2]% vs. 3.9 [3.6]%; P = 0.02).
CONCLUSIONS
Real-time CGM data and alarms are associated with reductions in low sensor glucose, elevated sensor glucose, and glycaemic variability. This suggests CGM allows patients to detect hyperglycaemic peaks and imminent hypoglycaemia, allowing dietary modification and self-treatment to reduce hypoglycaemia. The use of CGM devices may improve safety in PBH, particularly for patients with hypoglycaemia unawareness.
目的
确定连续血糖监测（CGM）是否可以减少减重后低血糖（PBH）患者的低血糖。
材料和方法
在一项开放标签、非随机、前后设计的研究中，采用连续分配方法，在 PBH 患者的两个连续阶段收集 CGM 数据：（i）掩蔽（无法访问传感器血糖或报警）；和（ii）未掩蔽（可访问传感器血糖和低或快速下降的传感器血糖报警）。12 名参与者佩戴 Dexcom G4 设备共 28 天，10 名参与者佩戴 Dexcom G6 设备共 20 天。
结果
与掩蔽 CGM 相比，未掩蔽 CGM 时 PBH 患者 24 小时内的低血糖时间百分比更低（<3.3 mM/L，或 <60mg/dL：中位数[中位数绝对偏差（MAD）]0.7[0.8]% vs. 1.4[1.7]%，P=0.03；<3.9 mM/L，或 <70mg/dL：中位数[MAD]2.9[2.5]% vs. 4.7[4.8]%；P=0.04），夜间也有类似趋势。未掩蔽阶段的传感器血糖数据显示，在 3.9 至 10 mM/L（70-180mg/dL）之间的时间百分比更高（中位数[MAD]94.8[3.9]% vs. 90.8[5.2]%；P=0.004），24 小时内血糖变异性更低（中位数[MAD]平均血糖波动幅度 4.1[0.98] vs. 4.4[0.99]mM/L；P=0.04）。白天，与掩蔽 CGM 相比，未掩蔽 CGM 时参与者的血糖正常时间百分比更高（中位数[MAD]94.2[4.8]% vs. 90.9[6.2]%；P=0.005），这主要是由于高血糖（>10 mM/L，或 180mg/dL：中位数[MAD]1.9[2.2]% vs. 3.9[3.6]%；P=0.02）减少。
结论
实时 CGM 数据和报警与低血糖、高血糖和血糖变异性降低有关。这表明 CGM 可使患者检测到高血糖峰值和即将发生的低血糖，从而进行饮食调整和自我治疗以减少低血糖。CGM 设备的使用可能会提高 PBH 的安全性，特别是对低血糖意识不足的患者。
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