扫描式葡萄糖监测系统在1型糖尿病患儿中的应用

Application of the flash glucose monitoring system in children with type 1 diabetes mellitus

目的评估1型糖尿病(T1DM)患儿使用扫描式葡萄糖监测系统(FGM)连续动态血糖监测的效果、成本和不良反应等情况。方法选择2016年5月至2018年2月在深圳市儿童医院就诊且使用FGM并有FGM下载数据的T1DM患儿7例,其中男3例,女4例;年龄9.3~16.3岁。回顾性分析其使用FGM前后4周的糖化血红蛋白(HbA1)、低血糖和高血糖的发生情况、自我血糖监测(SMBG)情况及费用,并记录FGM传感器有效植入时间和不良反应情况。结果使用FGM后HbA1c、高血糖和低血糖的发生率较使用前降低[(8.10±0.14)%比(8.86±0.32)%、(0.27±0.04)次/d比(0.62±0.05)次/d、(0.20±0.02)次/d比(0.37±0.05)次/d],差异均有统计学意义(t=2.727、9.291、2.908,P=0.034、0.001、0.027)。使用FGM后血糖监测频率[(11.09±0.96)次/d]显著高于使用前[(4.02±0.47)次/d],差异有统计学意义(t=-24.398,P=0.001)。使用FGM后血糖监测费用[(814.29±17.71)元]略高于使用前[(758.89±33.42)元],但差异无统计学意义(P>0.05)。使用FGM第1、7、13天时FGM扫描与SMBG测定的血糖值之间差异均无统计学意义(均P>0.05)。T1DM患者使用FGM期间,在不同血糖区间FGM扫描和SMBG测定的血糖值差异均无统计学意义(均P>0.05)。传感器有效植入时间(13.9±0.1) d,未发现不良反应,如皮肤过敏、瘙痒、红肿和感染现象。结论儿童T1DM使用FGM进行连续动态血糖监测安全性高、稳定可靠,对降低HbA1c、减少低血糖和高血糖发生、增加自我血糖监测频率等具有重要作用。

Objective To evaluate the usefulness, cost and side effects of flash glucose monitoring (FGM) in children with type 1 diabetes mellitus (T1DM). Methods Seven children aged 9.3-16.3 years old with T1DM (3 males, 4 females) treated with insulin in Shenzhen Children′s Hospital from May 2016 to February 2018 were enrolled, and they were performed with self-monitoring of blood glucose.All participants were subjected to FGM for 4 weeks and compared for changes in terms of hemoglobin A1c (HbA1c), episodes of hypoglycemia and hyperglycemia, frequency of self-monitoring blood glucose(SMBG) or sensor scanning, costs of glucose monitoring and side effects before and after 4-week implementation of FGM. Results The HbA1c was significantly reduced from (8.86±0.32)% before FGM to (8.10±0.14)% after implementation of FGM, and the difference was statistically significant (t=2.727, P=0.034). Both the frequency of hyperglycemia and hypoglycemia were significantly decreased after the implementation of FGM[(0.27±0.04) times/d vs.(0.62±0.05) times/d,(0.20±0.02) times/d vs.(0.37±0.05) times/d], and the differences were statistically significant(t=9.291, 2.908, P=0.001, 0.027). The average frequency of sensor scanning after the implementation of FGM was significantly higher than SMBG testing before use of FGM[(11.09±0.96) times/d vs.(4.02±0.47) times/d], and the difference was statistically significant(t=-24.398, P=0.001). The cost of FGM was a little higher than that of capillary blood glucose testing while there was no significant difference[(814.29±17.71) yuan vs.(758.89±33.42) yuan, P>0.05]. Comparing the results of the FGM and SMBG on the 1st, 7th and 13th day after FGM, there was no significant difference (all P>0.05). Also there was no significant diffe-rence among the different ranges of blood glucose (all P>0.05). The time with sensor of FGM in the arm was (13.9±0.1) days.There was no side effect to be found during 4 weeks of implementation of FGM. Conclusions FGM has the potential to increase the time of SMBG, decrease the hyperglycemia and hypoglycemia, and improve HbA1c in children with T1DM.Accuracy, safety and stability of the FreeStyle Libre System were demonstrated for the pediatric T1DM.