Noor Nudrat, Norman Gregory, Sonabend Rona, Chao Lily, Kamboj Manmohan, Golden Lauren, Bekx M Tracy, Hseih Susan, Levy Carol, Sanchez Janine, Rapaport Robert, Ebekozien Osagie
T1D Exchange, Boston, MA, USA.
Dexcom, San Diego, CA, USA.
J Diabetes Sci Technol. 2025 Jan;19(1):63-71. doi: 10.1177/19322968231178017. Epub 2023 Jun 1.
We used real-world electronic health record (EHR) data to examine HbA1c levels among children and adults with type 1 diabetes (T1D) who are classified as continuous glucose monitor (CGM) users after T1D diagnosis and switch to self-monitoring of blood glucose (SMBG) during follow-up, versus people who opt for SMBG after T1D diagnosis and switch to CGM during follow-up visits.
We conducted an observational, case-crossover study using electronic medical record (EMR) data from the T1D Exchange Quality Improvement Collaborative. The primary outcome in this study was HbA1c. Baseline HbA1c levels were taken at the index date, corresponding to initial device classification, and compared with HbA1c value recorded at the clinic visit following device switch.
Of all patients classified in the SMBG group, 7,706 switched to CGM use within the 5-year study time frame, and 5,123 of all initial CGM users switched to SMBG within the study time frame and were included in this analysis. At baseline, median (interquartile range [IQR]) HbA1c for SMBG use was 8.1 (2.4), whereas postcrossover to CGM use, there was a decline in median (IQR) levels to 7.7 (1.9) ( < .001). For baseline CGM users, median (IQR) HbA1c levels were 7.9 (2.0), and postcrossover to SMBG, median (IQR) HbA1c levels increased to 8.0 (2.9) ( < .001).
We found that people who switched to CGM use had significantly improved HbA1c levels compared to those who switched to glucose monitoring with SMBG.
我们使用真实世界的电子健康记录（EHR）数据，研究1型糖尿病（T1D）儿童和成人的糖化血红蛋白（HbA1c）水平。这些患者在T1D诊断后被归类为持续葡萄糖监测（CGM）使用者，并在随访期间转为自我血糖监测（SMBG），并与那些在T1D诊断后选择SMBG并在随访期间转为CGM的人进行比较。
我们使用来自T1D交换质量改进协作组的电子病历（EMR）数据进行了一项观察性病例交叉研究。本研究的主要结局是HbA1c。在对应于初始设备分类的索引日期获取基线HbA1c水平，并与设备切换后诊所就诊时记录的HbA1c值进行比较。
在所有归类于SMBG组的患者中，7706人在5年研究时间范围内转为使用CGM，所有初始CGM使用者中有5123人在研究时间范围内转为SMBG，并纳入本分析。基线时，使用SMBG的HbA1c中位数（四分位间距[IQR]）为8.1（2.4），而转为使用CGM后，中位数（IQR）水平降至7.7（1.9）（P<0.001）。对于基线CGM使用者，HbA1c中位数（IQR）水平为7.9（2.0），转为SMBG后，HbA1c中位数（IQR）水平升至8.0（2.9）（P<0.001）。
我们发现，与转为使用SMBG进行血糖监测的人相比，转为使用CGM的人的HbA1c水平有显著改善。
