长期护理机构居民指尖血糖与连续血糖监测指标之间的一致性
Agreement Between Fingerstick Blood Glucose and Continuous Glucose Monitor Measures Among Long-Term Care Facility Residents.
作者信息
Khan Marzan A, Munshi Medha N, Slyne Christine, Joyce Nina R, Zullo Andrew R
机构信息
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
出版信息
J Am Geriatr Soc. 2025 Aug 2. doi: 10.1111/jgs.70024.
BACKGROUND
Long-term care facility (LTCF) residents with diabetes are at high risk of hypoglycemia. Continuous glucose monitoring (CGM), which measures interstitial glucose at 5-min intervals over 10-14 days, and fingerstick blood glucose (FBG) which analyzes glucose from a drop of blood, are both used to monitor glucose levels. Observational studies using electronic health record (EHR) data containing FBG measures could help to identify ways to reduce hypoglycemia risk. We first need to understand the validity of such data. Our objective was to compare EHR-based FBG measures against reference-standard CGM measures of hypoglycemia.
METHODS
We studied two cohorts of residents with diabetes in parallel. In Cohort 1, we analyzed linked CGM and Long-Term Care Data Cooperative EHR-based FBG data collected in 2023. In Cohort 2, we analyzed linked CGM and EHR-based FBG data obtained directly from LTCFs between 2022 and 2023. We defined hypoglycemia as glucose < 70 mg/dL and assessed the sensitivity and specificity of FBG versus CGM measures to detect hypoglycemia. The unit of analysis was each pair of contemporaneous FBG-CGM measures.
RESULTS
In Cohort 1, two White female residents with a mean (standard deviation [SD]) age of 81 [12.7] years generated 25 daily hypoglycemia measurements. The sensitivity and specificity were 14% and 100%, respectively, for FBG-measured hypoglycemia. Cohort 2 included 40 residents (mean [SD] age 68 [11] years, 45% females, 60% White race) who generated 425 daily measurements of hypoglycemia. The sensitivity and specificity were 13% and 99%, respectively.
CONCLUSION
EHR FBG measures of hypoglycemia had high specificity but failed to identify four out of every five hypoglycemic events among LTCF residents. Researchers and healthcare providers should assume hypoglycemia is measured with substantial errors in EHRs and account for this in their research and clinical practice.
背景
患有糖尿病的长期护理机构（LTCF）居民发生低血糖的风险很高。连续血糖监测（CGM）可在10 - 14天内每隔5分钟测量一次组织间液葡萄糖，而指尖血糖（FBG）则通过一滴血来分析葡萄糖，二者均用于监测血糖水平。利用包含FBG测量值的电子健康记录（EHR）数据进行的观察性研究，有助于确定降低低血糖风险的方法。我们首先需要了解此类数据的有效性。我们的目标是将基于EHR的FBG测量值与低血糖的参考标准CGM测量值进行比较。
方法
我们同时研究了两组糖尿病居民队列。在队列1中，我们分析了2023年收集的关联CGM数据以及基于长期护理数据合作组织EHR的FBG数据。在队列2中，我们分析了2022年至2023年期间直接从长期护理机构获得的关联CGM数据和基于EHR的FBG数据。我们将低血糖定义为血糖<70mg/dL，并评估FBG与CGM测量值检测低血糖的敏感性和特异性。分析单位是每对同期的FBG - CGM测量值。
结果
在队列1中，两名平均（标准差[SD]）年龄为81[12.7]岁的白人女性居民产生了25次每日低血糖测量值。FBG测量的低血糖的敏感性和特异性分别为14%和100%。队列2包括40名居民（平均[SD]年龄68[11]岁，45%为女性，60%为白人），他们产生了425次每日低血糖测量值。敏感性和特异性分别为13%和99%。
结论
基于EHR的FBG低血糖测量具有高特异性，但未能识别出长期护理机构居民中每五起低血糖事件中的四起。研究人员和医疗保健提供者应假定在EHR中测量低血糖存在重大误差，并在他们的研究和临床实践中考虑到这一点。
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