连续血糖监测系统对2型糖尿病患者血液透析相关低血糖的监测效果

Monitoring effect of continuous blood glucose monitoring system on hemodialysis-related hypoglycemia in the patients with type 2 diabetes

目的探讨连续血糖监测系统(CGMS)对2型糖尿病患者血液透析相关低血糖的监测效果。方法选择2018年1月~2019年3月在我院接受透析治疗的23例2型糖尿病患者作为研究对象,应用CGMS系统评估患者72 h内血糖变化和低血糖发生率,观察HbA1c水平与CGMS监测指标的相关性。结果相关性分析显示,CGMS检测的平均血糖水平与HbA1c存在相关性(P<0.05),180 mg/dL以上血糖曲线下面积(AUC180)、平均餐后最高血糖(MPMG,指餐后4 h内最高血糖平均值)也与HbA1c存在相关性(P<0.05),而葡萄糖偏移指数(MAGE)与HbA1c不存在相关性(P>0.05)。减少用药剂量的患者和未减少用药剂量的患者监测24 h、48 h、72 h CGMS检查数据比较,差异均无统计学意义(P>0.05)。23例患者共有13例患者出现24次低血糖发作,18次发生于24 h内,10次发生于透析期间或3 h内。结论 CGMS用于合并T2DM的ESRD患者血液透析期间血糖监测有助于通过对血糖值动态变化分析低血糖发生的规律,为制定个体化方案和降低血糖反应具有指导意义。

Objective To investigate the monitoring effect of continuous blood glucose monitoring system(CGMS) on hemodialysis-related hypoglycemia in the patients with type 2 diabetes. Methods 23 patients with type 2 diabetes who underwent hemodialysis in our hospital from January 2018 to March 2019 were selected as subjects. The CGMS system was used to assess the incidence rate of blood glucose changes and hypoglycemia within 72 hours. The correlation between HbA1c levels and CGMS monitoring indicators was observed. Results Correlation analysis showed that the average blood glucose level detected by CGMS was correlated with HbA1c(P<0.05). The area under the blood glucose curve above 180 mg/dL(AUC180) and the average postprandial maximum blood glucose(MPMG, the mean value of the highest blood glucose within 4 hours after a meal) were also correlated with HbA1c(P<0.05). There was no correlation between mean amplitude of glucose excursion(MAGE) and HbA1c(P>0.05). There was no statistically significant difference in the data of 24 h, 48 h, and 72 h CGMS between the patients who reduced the dose and the patients who did not reduce the dose(P>0.05). Among 23 patients, there were 24 episodes of hypoglycemia in 13 patients, with 18 episodes within 24 hours, and 10 episodes during hemodialysis or within 3 hours. Conclusion CGMS is used in ESRD patients complicated with T2DM. Blood glucose monitoring during hemodialysis can help analyze the regularity of hypoglycemia by dynamic changes in blood glucose levels, which is of guiding significance for the development of individualized protocols and lowering blood glucose response.