接受透析的糖尿病合并终末期肾病患者应用连续血糖监测的疗效：系统评价。
Efficacy of continuous glucose monitoring in people living with diabetes and end stage kidney disease on dialysis: a systematic review.
机构信息
Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
出版信息
BMC Nephrol. 2024 Oct 25;25(1):379. doi: 10.1186/s12882-024-03763-z.
BACKGROUND
Patients with diabetes on dialysis experience wide variations in glucose levels and an increased risk of hypoglycaemia. Due to the inaccuracies of HbA1c in dialysis patients, JBDS-IP and KDIGO recommend the use of continuous glucose monitoring (CGM). We conducted a systematic review to examine the current evidence for CGM use and its impact on clinical outcomes in patients with diabetes on dialysis.
METHODS
A search of MEDLINE(R) ALL, Ovid Emcare, Journals@Ovid Full Text and Embase databases were conducted. Clinical or observational trials in adults with Type 1(T1D) or Type 2 (T2D) diabetes on dialysis and CGM intervention reporting on glycaemic outcomes were included.
RESULTS
Of the 936 citations identified, 49 duplicates were removed. 887 citations were screened by title and abstract. 9 full texts were reviewed and a further 7 excluded due to duplications or failure to meet to selection criteria. Data was extracted for 2 studies, both prospective before-and-after interventional studies with no control group. Joubert et al. (2015) showed results for 15 participants with T1D. Mean CGM glucose level decreased from 8.37mmol/L at baseline to 7.7mmol/L at the end of the CGM period (p < 0.05) while HbA1c decreased from 6.9 to 6.5% (p < 0.05) during the same period. Mean CGM was lower on dialysis days (7.68mmol/L vs. 7.8mmol/L, p < 0.05). Képénékian et al. (2014) reported on data from 29 T2D patients. Following a 3 month CGM-adapted insulin regimen, HbA1c decreased from 8.4% at baseline to 7.6% (p < 0.01) by the end of study. Mean CGM values decreased from 9.9mmol/L to 8.9mmol/L (p = 0.05) and the frequency of glucose values > 10mmol/L decreased from 41 to 30% (p < 0.05), without a significant increase in hypoglycaemia frequency. Both studies were deemed to be of 'good' quality.
CONCLUSION
Evidence demonstrating the benefits of CGM in patients with diabetes receiving dialysis is lacking. There is a need for well-designed randomised controlled trials to ascertain the benefits of this technology in this patient group.
TRAIL REGISTRATION
PROSPERO registration number: CRD42023371635, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371635 .
背景
接受透析治疗的糖尿病患者血糖水平波动较大，且低血糖风险增加。由于 HbA1c 在透析患者中的准确性不足，JBDS-IP 和 KDIGO 建议使用连续血糖监测（CGM）。我们进行了一项系统评价，以评估 CGM 在透析患者中的应用现状及其对临床结局的影响。
方法
检索 MEDLINE(R) ALL、Ovid Emcare、Journals@Ovid Full Text 和 Embase 数据库。纳入成人 1 型（T1D）或 2 型（T2D）糖尿病接受透析和 CGM 干预并报告血糖结局的临床或观察性试验。
结果
在 936 条引文中共发现 49 条重复引文，887 条引文经标题和摘要筛选，9 篇全文进行了回顾，另外 7 篇由于重复或不符合入选标准而被排除。对 2 项研究的数据进行了提取，这两项研究均为前瞻性、干预前后研究，没有对照组。Joubert 等人（2015 年）的研究结果显示了 15 名 T1D 参与者的数据。CGM 平均血糖水平从基线时的 8.37mmol/L 降至 CGM 期结束时的 7.7mmol/L（p<0.05），同时 HbA1c 从 6.9%降至 6.5%（p<0.05）。CGM 在透析日的平均值较低（7.68mmol/L 与 7.8mmol/L，p<0.05）。Képénékian 等人（2014 年）报告了 29 名 T2D 患者的数据。在接受 3 个月 CGM 调整胰岛素治疗后，HbA1c 从基线时的 8.4%降至研究结束时的 7.6%（p<0.01）。CGM 平均血糖值从 9.9mmol/L 降至 8.9mmol/L（p=0.05），血糖值>10mmol/L 的频率从 41%降至 30%（p<0.05），低血糖频率无显著增加。这两项研究均被认为质量较好。
结论
目前缺乏 CGM 在接受透析治疗的糖尿病患者中获益的证据。需要进行精心设计的随机对照试验，以确定该技术在该患者群体中的获益。
试验注册
PROSPERO 注册号：CRD42023371635，https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=371635 。
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