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基于持续葡萄糖监测的干预措施在2型糖尿病各阶段的应用前景

Perspective of Continuous Glucose Monitoring-Based Interventions at the Various Stages of Type 2 Diabetes.

作者信息

Ajjan R A, Seidu S, Riveline J P

机构信息

Leeds Institute for Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.

St James's University Hospital, Leeds Teaching Hospitals Trust, Leeds, LS9 7TF, UK.

出版信息

Diabetes Ther. 2024 Aug;15(8):1657-1672. doi: 10.1007/s13300-024-01607-5. Epub 2024 Jun 22.

DOI:10.1007/s13300-024-01607-5
PMID:38907936
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11263446/
Abstract

Continuous glucose monitoring (CGM) is now advocated for the clinical management of individuals with type 1 diabetes (T1D). However, this glucose monitoring strategy is not routinely used in type 2 diabetes (T2D), given the large population, significant cost implications and relatively limited supporting evidence. T2D is a more heterogenous condition compared with T1D with various glucose lowering therapies that do not necessarily require CGM to ensure within target glucose levels. While all individuals with T2D may benefit from CGM at certain time points, the whole T2D population does not necessarily require this technology continuously, which should be prioritized based on patient benefit and cost effectiveness. In this pragmatic opinion piece, we describe the rationale and evidence for CGM use in different subgroups of individuals with T2d, divided according to the stage of the condition, glycemic therapies, presence of diabetes complications, or associated co-morbidities. We discuss a total of 16 T2D subgroups and provide a clinical view on CGM use in each, based on current evidence while also highlighting areas of knowledge gaps. This work provides health care professionals with a simple guide to CGM use in different T2D groups and gives suggestion for future studies to justify expansion of this technology.

摘要

目前,连续血糖监测(CGM)被推荐用于1型糖尿病(T1D)患者的临床管理。然而,鉴于2型糖尿病(T2D)患者数量众多、成本影响巨大且支持证据相对有限,这种血糖监测策略在T2D中并未得到常规应用。与T1D相比,T2D是一种更为异质性的疾病,有多种降糖疗法,不一定需要CGM来确保血糖水平达标。虽然所有T2D患者在某些时间点可能从CGM中获益,但并非整个T2D人群都需要持续使用这项技术,应根据患者获益和成本效益来确定优先次序。在这篇务实的观点文章中,我们描述了在不同T2D亚组中使用CGM的基本原理和证据,这些亚组根据病情阶段、血糖治疗方法、糖尿病并发症的存在情况或相关合并症进行划分。我们共讨论了16个T2D亚组,并根据当前证据对每个亚组中CGM的使用提供临床观点,同时也突出了知识空白领域。这项工作为医疗保健专业人员提供了一份在不同T2D组中使用CGM的简易指南,并为未来研究提出建议,以证明扩大这项技术应用的合理性。

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Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial.多针胰岛素注射治疗的 2 型糖尿病成人患者的连续血糖监测与结构化教育:一项多中心随机对照试验。
Diabetologia. 2024 Jul;67(7):1223-1234. doi: 10.1007/s00125-024-06152-1. Epub 2024 Apr 19.
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Continuous glucose monitoring for the routine care of type 2 diabetes mellitus.实时血糖监测用于 2 型糖尿病的常规护理。
Nat Rev Endocrinol. 2024 Jul;20(7):426-440. doi: 10.1038/s41574-024-00973-1. Epub 2024 Apr 8.
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Diabetes Mellitus in Acute Coronary Syndrome.
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Life (Basel). 2023 Nov 19;13(11):2226. doi: 10.3390/life13112226.
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2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes.2023年欧洲心脏病学会糖尿病患者心血管疾病管理指南
Eur Heart J. 2023 Oct 14;44(39):4043-4140. doi: 10.1093/eurheartj/ehad192.
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Continuous glucose monitoring for inpatient diabetes management: an update on current evidence and practice.住院糖尿病管理中的持续血糖监测:当前证据与实践的最新进展
Endocr Connect. 2023 Sep 25;12(10). doi: 10.1530/EC-23-0180. Print 2023 Oct 1.
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Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital.在一家保障性医院的住院重症和非重症护理环境中,CGM 的真实世界准确性。
Diabetes Care. 2023 Oct 1;46(10):1825-1830. doi: 10.2337/dc23-0089.
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Continuous Glucose Monitoring Use in Older Adults for Optimal Diabetes Management.老年人连续血糖监测在优化糖尿病管理中的应用。
Diabetes Technol Ther. 2023 Jun;25(S3):S56-S64. doi: 10.1089/dia.2023.0111.
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Management of type 1 diabetes in pregnancy: update on lifestyle, pharmacological treatment, and novel technologies for achieving glycaemic targets.妊娠合并 1 型糖尿病的管理:生活方式、药物治疗以及实现血糖目标的新技术更新。
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