门诊2型糖尿病患者行动态血糖监测的临床价值及影响因素

Clinical value and influencing factors of continuous glucose monitoring on glycemic control in outpatients with type 2 diabetes mellitus

目的评价动态血糖监测(CGM)系统应用于门诊T2DM患者的临床价值及影响因素。方法采用iPro--2 CGM对2016年3月至2017年2月于我院内分泌科门诊就诊的246例患者行72 h连续CGM。根据平均血糖波动幅度(MAGE)及治疗方法不同对患者进行2次分组。结果 HbA_1c与多个动态血糖参数无相关性。高MAGE患者年龄更大、病程更长、HbA_1c更高。使用预混胰岛素患者无症状低血糖发生率(23.2%)及平均MAGE最高;使用非胰岛素促泌剂类药物患者无症状低血糖发生率(9.1%)及MAGE最低。药物不合理使用是无症状低血糖最常见诱因。多元逐步回归分析显示,病程、FPG、HbA_1c是MAGE水平的影响因素。结论 CGM适合门诊使用,是HbA1c的重要补充。高龄、长病程、高HbA_1c或使用预混胰岛素的门诊患者,更应使用CGM。

Objective To evaluate the clinical value and influencing factors of continuous glucose monitoring(CGM)on glycemic control in outpatient with type 2 diabetes(T2DM).Methods 72 h blood glucose of 246 patients were conducted in department of endocrinology of our hospital from March 2016 to February 2017,using the medtronic iPro-2 continuous glucose monitoring system.Patients were grouped twice according to the mean amplitude of glycemic excursions(MAGE)and the treatment method.Results HbA1c had no correlation with several CGM parameters. High MAGE patients had older age,longer duration and higher HbA1c.The incidence of symptomatic hypoglycemia and average MAGE were highest in patients treated with premixed insulin(23.2%)and were lowest in patients treated with non - insulin secretagogue(9.1%). Improper use of drugs was the most common cause of asymptomatic hypoglycemia. Multiple step-wise regression showed that the duration of T2DM and the levels of FPG and HbA1c were independent factors for MAGE.Conclusion CGM is suitable for outpatient T2DM,which is an important complement of HbA1c,especially for patients with older age,long duration,high HbA1c or premixed insulin treatment.