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肺移植术后高血糖患者连续血糖监测的可行性及性能

Feasibility and performance of continuous glucose monitoring in hyperglycemia after lung transplantation.

作者信息

Munoz Pena Juan M, Algarra Kimberly, Kennedy Hannah, Leong Man Chong, Salloum Ramzi G

机构信息

Division of Endocrinology, Diabetes & Metabolism, University of Florida, Gainesville, FL, United States.

Department of Biostatistics, University of Florida, Gainesville, FL, United States.

出版信息

Front Transplant. 2024 Jan 4;2:1282215. doi: 10.3389/frtra.2023.1282215. eCollection 2023.

Abstract

BACKGROUND

Post-Transplant Diabetes Mellitus (PTDM) affects 20%-40% of lung transplant recipients within five years, impacting rejection, infection, cardiovascular events, and mortality. Continuous glucose monitoring (CGM) is used in diabetes but not well-studied in PTDM.

OBJECTIVE

This study assessed CGM performance in detecting hypoglycemia and hyperglycemia post-lung transplantation, compared to self-monitoring blood glucose.

METHODS

A prospective pilot study included 15 lung transplant patients (mean age 58.6 years; 53.3% men; 73.3% with pre-transplantation diabetes) managing hyperglycemia with insulin. Patients used a blinded CGM and self-monitored glucose for ten days. Data were categorized (% time in range, % high, % very high, % low, % very low) and compared using paired t-tests.

RESULTS

CGM showed superior hyperglycemia detection. Mean differences for "% very high", "% high", and "% high and % very high" were 7.12 (95% CI, 1.8-12.4), 11.1 (95% CI, 3.5-18.8), and 18.3 (95% CI: 7.37-29.24), respectively. No significant difference was found for "% low and % very low". All patients reported a positive CGM experience.

CONCLUSION

CGM use post-lung transplantation seems feasible and offers advantages in detecting hyperglycemia and in optimizing glucose management. Study limitations include a small sample size, requiring larger studies to assess glycemic control, hypoglycemia detection, and transplant outcomes.

摘要

背景

移植后糖尿病(PTDM)在五年内影响20%-40%的肺移植受者,对排斥反应、感染、心血管事件及死亡率产生影响。持续葡萄糖监测(CGM)用于糖尿病患者,但在PTDM中的研究尚不充分。

目的

本研究评估了CGM在肺移植后检测低血糖和高血糖方面的性能,并与自我血糖监测进行比较。

方法

一项前瞻性试点研究纳入了15例肺移植患者(平均年龄58.6岁;53.3%为男性;73.3%有移植前糖尿病),这些患者使用胰岛素治疗高血糖。患者使用盲法CGM并自我监测血糖10天。数据进行分类(血糖在目标范围内的时间百分比、高血糖百分比、极高血糖百分比、低血糖百分比、极低血糖百分比),并使用配对t检验进行比较。

结果

CGM在检测高血糖方面表现更优。“极高血糖百分比”“高血糖百分比”以及“高血糖百分比与极高血糖百分比之和”的平均差异分别为7.12(95%CI,1.8-12.4)、11.1(95%CI,3.5-18.8)和18.3(95%CI:7.37-29.24)。“低血糖百分比与极低血糖百分比之和”未发现显著差异。所有患者对CGM体验均呈阳性评价。

结论

肺移植后使用CGM似乎可行,在检测高血糖及优化血糖管理方面具有优势。研究局限性包括样本量小,需要更大规模的研究来评估血糖控制、低血糖检测及移植结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bbf8/11235312/591f0228ad03/frtra-02-1282215-g001.jpg

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