Zelada Henry, Recklein Carol L, McGill Janet B
Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham Heersink School of Medicine, United States.
Division of Endocrinology Metabolism and Lipid Research, Washington University School of Medicine in St Louis, United States.
J Family Med Prim Care. 2023 Jul;12(7):1412-1416. doi: 10.4103/jfmpc.jfmpc_2172_22. Epub 2023 Jul 14.
Achieving glucose and glycosylated hemoglobin (HbA1c) targets have been shown to reduce long-term microvascular complications of diabetes; however, suboptimal glucose control is common. We tested whether glucose control could be improved within 8 weeks by employing structured blood glucose monitoring (BGM) qid in addition to seven times per day prior to visits for diabetes education and medication management that occurred every 2-4 weeks.
This single-center, prospective study was conducted on 78 adults with either type 1 diabetes (T1D) or type 2 diabetes (T2D), HbA1c >8%, and serum creatinine (sCr) <2.0 mg/dl. HbA1c was checked at baseline, Week 2, Week 4, and at Week 8. Patients were evaluated by a physician and a certified diabetes educator (CDE) at baseline, Week 2, and Week 4 for treatment adjustments and lifestyle advice based on a review of BGM done qid plus 7-point profiles conducted before Weeks 2, 4, and 8. Study outcomes were change in HbA1c from baseline to Week 8 and change in mean glucose on the 7-point profile from Week 2 to Week 8. These were compared using one-way repeated measures ANOVA.
Of the 78 patients, 64.1% had T2D, 50% were women, and 72% were Caucasian. Mean age (±SD) was 51.3.5 ± 11.1 years, and median diabetes duration was 9 (5-17) years. The percentage of patients using insulin increased from 58.9% at baseline to 67.9% at Week 8. The mean (±SD) HbA1c was 9.53% (±1.71) at baseline, declined -1.38% from baseline to week 8 (CI -1.62 to -0.14, < 0.001). The mean (±SD) glucose on the 7-point profile was 187 (±52) mg/dl at Week 2, and 157 (±5) mg/dl at Week 8. ( < 0.01).
An intensive glucose optimization program using structured BGM qid plus 7-point profiles, diabetes education, and conventional anti-diabetic therapies was successful in reducing HbA1c by 1.38% over 8 weeks in patients with poor glucose control.
已证实实现血糖和糖化血红蛋白（HbA1c）目标可减少糖尿病的长期微血管并发症；然而，血糖控制欠佳的情况很常见。我们测试了在每2 - 4周进行糖尿病教育和药物管理就诊前，除每日7次血糖监测外，采用每日4次的结构化血糖监测（BGM），能否在8周内改善血糖控制。
这项单中心前瞻性研究纳入了78例1型糖尿病（T1D）或2型糖尿病（T2D）患者，HbA1c>8%，血清肌酐（sCr）<2.0mg/dl。在基线、第2周、第4周和第8周检查HbA1c。在基线、第2周和第4周，由医生和认证糖尿病教育者（CDE）根据每日4次的BGM检查结果以及第2周、第4周和第8周前进行的7点血糖谱评估，对患者进行治疗调整和生活方式建议。研究结局为从基线到第8周HbA1c的变化以及从第2周到第8周7点血糖谱上平均血糖的变化。使用单向重复测量方差分析进行比较。
78例患者中，64.1%患有T2D，50%为女性，72%为白种人。平均年龄（±标准差）为51.3±11.1岁，糖尿病病程中位数为9（5 - 17）年。使用胰岛素治疗患者的比例从基线时的58.9%增至第8周时的67.9%。基线时HbA1c的平均值（±标准差）为9.53%（±1.71），从基线到第8周下降了 - 1.38%（可信区间 - 1.62至 - 0.14，P<0.001）。7点血糖谱上的平均血糖在第2周时为187（±52）mg/dl，在第8周时为157（±5）mg/dl（P<0.01）。
对于血糖控制不佳的患者，使用每日4次的结构化BGM加7点血糖谱、糖尿病教育和传统抗糖尿病治疗的强化血糖优化方案在8周内成功使HbA1c降低了1.38%。
