扫描式葡萄糖监测系统结合胰岛素泵对1型糖尿病儿童青春期血糖控制的效果观察

Effect of flash glucose monitoring system combined with insulin pump on adolescence with type 1 diabetes mellitus

目的:探讨扫描式葡萄糖监测系统(flash glucose monitoring system, FGM)结合持续性皮下胰岛素输注(continuous subcutaneous insulin infusion, CSII)或每天多次胰岛素注射(multiple daily injections, MDI)不同治疗方式对1型糖尿病患儿青春期血糖控制的疗效。方法:2014年5月-2019年1月在南通大学附属医院小儿内分泌专科门诊随访的1型糖尿病患儿46例,其中采用FGM+CSII治疗20例,采用FGM+MDI治疗26例,疗程均>3个月,比较两组患儿动态血糖监测指标及对青春期血糖控制疗效。结果:FGM+CSII和FGM+MDI两组患儿糖化血红蛋白[(7.39±0.66)%vs (7.87±0.69)%,P=0.02]、平均血糖值[(7.32±0.80) mmol/L vs (7.84±0.85) mmol/L, P=0.04]、低血糖持续时间[(2.51±0.49) h vs (3.02±0.42) h,P<0.001]、平均血糖波动幅度[(5.39±0.93) mmol/L vs (6.62±1.10) mmol/L,P<0.001]、血糖目标范围时间[(16.41±1.41) h vs(15.12±1.66) h, P=0.008]比较差异均有统计学意义。结论:FGM是发现血糖异常波动的有效工具,该技术结合CSII技术更易使青春期1型糖尿病患儿血糖达标。

Objective : To investigate the efficacy of flash glucose monitoring system(FGM) combined with continuous subcutaneous insulin infusion(CSII) or multiple daily injections(MDI) on adolescent blood glucose in type 1 diabetes mellitus patients. Methods : A total of 46 children with type 1 diabetes were followed up in the pediatric endocrine clinic from May 2014 to January 2019 at Affiliated Hospital of Nantong University. Among them, 20 children were treated with FGM+CSII and 26 children were treated with FGM+MDI for more than three months. Results : The glycosylated hemoglobin between FGM+CSII and FGM+MDI was [(7.39±0.66)% vs(7.87±0.69)%, P=0.02]. The average blood glucose were [(7.32±0.80) mmol/L vs(7.84±0.85) mmol/L, P=0.04]. The duration of hypoglycemia were [(2.51±0.49) h vs(3.02±0.42) h, P<0.001]. The average fluctuation range were [(5.39±0.93) mmol/L vs(6.62±1.10) mmol/L, P<0.001] and time in range were [(16.41±1.41) h vs(15.12±1.66) h, P=0.008]. There was significant difference in HbA1 c, average blood glucose, duration of hypoglycemia, average fluctuation range, and time in range between the two groups. Conclusion : FGM is an effective tool to detect blood glucose in adolescent children with type 1 diabetes mellitus. FGM in combination with CSII technology is more effective to control the blood glucose of adolescent children with type 1 diabetes mellitus.