扫描式葡萄糖监测系统对1型糖尿病患者血糖控制的影响

Impact of flash glucose monitoring on glycemic control in type 1 diabetic patients

目的评估扫描式葡萄糖监测系统(FGM)对1型糖尿病患者血糖控制的影响。方法选取2017年12月至2018年7月在南京医科大学第一附属医院内分泌科就诊的70例符合标准的1型糖尿病患者为研究对象,并详细收集人口学资料、HbA1C值和FGM使用情况。根据患者就诊前3个月是否佩戴及连续佩戴扫描式葡萄糖监测系统,将患者分为使用FGM组(n=25)和未使用FGM组(n=45)。采用多因素回归模型分析FGM使用与否对HbA1C的影响。统计采用双侧检验,以P<0.05为差异具有统计学意义。结果使用FGM组和未使用FGM组相比,年龄、性别、体重指数(BMI)、受教育程度、低血糖发生率、胰岛素注射方式无显著差异(P>0.05)。相较于没有使用FGM组,使用FGM组的每日胰岛素用量低[(0.562±0.059)U/kg和(0.772±0.049)U/kg,P=0.008],病程短[2.0(0.8~6.0)和6.0(2.5~10),P=0.013],HbA1C低[6.8%(6.2%~7.7%)对8.0%(6.9%~9.4%),P=0.001]。多因素回归分析发现在校正了年龄、性别、BMI、病程、受教育程度、低血糖发生率、基础和餐时胰岛素剂量、胰岛素注射方式因素后,使用FGM组HbA1C显著低于未使用组(P=0.034),提示是否使用FGM是HbA1C的独立相关因素。结论使用FGM可能有助于1型糖尿病患者血糖控制,但仍需前瞻性研究进一步证实其对血糖控制水平如HbA1C的影响。

Objective The application of flash glucose monitoring (FGM) in type 1 diabetes could diminish the frequency of hypoglycaemia, however, how FGM improving the glycaemic control target (e.g. HbA1C) is waited to be investigated. Methods Seventy type 1 diabetic patients were recruited from December 2017 to July 2018 in the First Affiliated Hospital of Nanjing Medical University. Their demographic data, use of FGM and HbA1C level were collected. Results We observed that type 1 diabetic patients wearing the FGM showed lower insulin dose [(0.562±0.059)U/kg vs (0.772±0.049)U/kg, P=0.008)], shorter diabetic duration[2.0(0.8-6.0) vs 6.0(2.5-10), P=0.013], lower HbA1C value [6.8%(6.2%-7.7%) vs 8.0%(6.9%-9.4%), P=0.001]. Nevertheless, after adjusting the potential confounders, the level of HbA1C in patients wearing FGM was significantly lower than those without FGM. Moreover, it was independent of other factors, such as the dose of insulin and the insulin delivery method. Conclusion Type 1 diabetic patients wearing FGM had lower HbA1C value but it needs further follow-up to confirm the improvement of glycaemic control in type 1 diabetes with the use of FGM.