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在初级保健中接受非胰岛素或基础胰岛素治疗的2型糖尿病成年患者中进行连续血糖监测。

Continuous glucose monitoring among adults with type 2 diabetes receiving noninsulin or basal insulin therapy in primary care.

作者信息

Shields Stephen, Thomas Roy, Durham Joy, Moran Joseph, Clary Jake, Ciemins Elizabeth L

机构信息

Research & Analytics Department of AMGA (American Medical Group Association), Alexandria, VA, USA.

Dexcom, Inc, San Diego, CA, USA.

出版信息

Sci Rep. 2024 Dec 30;14(1):31990. doi: 10.1038/s41598-024-83548-4.

Abstract

Rates of type 2 diabetes (T2D) continue to rise in the United States, with many patients failing to achieve glycemic targets. Primary care providers often serve as the sole clinician managing diabetes. Continuous glucose monitors (CGMs) have shown promise in diabetes management, yet their adoption in primary care settings, especially among patients with T2D not using intensive insulin therapy, remains limited. We sought to evaluate the impact of CGM use on glycemic control in patients with T2D not using insulin and those using basal but not bolus insulin in a primary care setting. CGM use was associated with a significantly greater reduction in HbA1c (-0.62%, p < 0.01) compared with matched controls at 3 months (n = 182). Patients showed improvements in time in range (39.7-61.9%, p < 0.0001), time > 180 mg/dL (60.1-37.9%, p < 0.001), time > 250 mg/dL (27.6-8.5%, p < 0.001), mean estimated glucose value (212 mg/dL to 173 mg/dL, p < 0.001) and glucose management indicator (8.39-7.46%, p < 0.001). CGM use in a primary care setting compared to usual care significantly improved glycemic control in T2D patients not on bolus insulin, irrespective of treatment with non-insulin or basal insulin. This suggests potential for broader CGM integration in primary care.

摘要

在美国,2型糖尿病(T2D)的发病率持续上升,许多患者未能达到血糖目标。初级保健提供者通常是管理糖尿病的唯一临床医生。连续血糖监测仪(CGM)在糖尿病管理中显示出前景,但其在初级保健环境中的应用,尤其是在未使用强化胰岛素治疗的T2D患者中,仍然有限。我们试图评估在初级保健环境中,使用CGM对未使用胰岛素的T2D患者以及使用基础胰岛素但未使用推注胰岛素的患者血糖控制的影响。与匹配的对照组相比,在3个月时(n = 182),使用CGM与糖化血红蛋白(HbA1c)显著更大幅度的降低相关(-0.62%,p < 0.01)。患者在血糖达标时间(39.7 - 61.9%,p < 0.0001)、血糖>180 mg/dL的时间(60.1 - 37.9%,p < 0.001)、血糖>250 mg/dL的时间(27.6 - 8.5%,p < 0.001)、平均估计血糖值(从212 mg/dL降至173 mg/dL,p < 0.001)和血糖管理指标(8.39 - 7.46%,p < 0.001)方面均有改善。在初级保健环境中使用CGM与常规护理相比,显著改善了未使用推注胰岛素的T2D患者的血糖控制,无论其是否接受非胰岛素或基础胰岛素治疗。这表明在初级保健中更广泛地整合CGM具有潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d1e/11686249/74852ccbcb38/41598_2024_83548_Fig1_HTML.jpg

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