血糖监测技术及管理指标的临床应用进展

Clinical application progress of blood glucose monitoring technology and management indicators

我国是全球糖尿病(DM)患者数最多的国家,且DM患者的血糖控制达标率偏低。血糖监测是DM管控的重要组成部分,目前血糖监测技术飞速发展,检测标本从尿液、静脉血、末梢血发展到组织间液、呼出气体等;监测手段从频繁地末梢取血到无创血糖监测;监测时点从传统的点时血糖发展到长达14 d的动态葡萄糖图谱(AGP)。床旁即时检验(POCT)应用于血糖管理逐步规范化、信息化,临床操作中应注意避免某些影响因素干扰检测结果;持续葡萄糖监测(CGM)因可提供葡萄糖连续瞬间波动及变化规律而成为血糖监测的新趋势,在DM及危重症患者治疗中发挥重要作用;目标范围内时间(TIR)和糖化血红蛋白(HbA1c)联合应用成为血糖监测和治疗效果评估的关键参考指标。该文就目前临床常用的几种血糖监测技术、血糖管理指标以及未来发展方向进行综述。

Though the number of diabetes mellitus(DM)patients in China is the largest in the world,the compliance rate of blood glucose control of the overall DM patients is relatively low.Nowadays,rapid developments in blood glucose detection technology have been observed.Testing specimens have extended from urine,venous blood and peripheral blood to interstitial fluids and exhaled gas.Testing methods have ranged from frequent peripheral blood sampling to noninvasive blood glucose monitoring.The time of monitoring has been improved from the traditional fixed-time sampling to the up-to-14-day ambulatory glucose profile(AGP).Certain influencing factors that may interfere with the clinical test results should be avoided to meet the recent standardization and informatization of the blood glucose point-of-care testing(POCT)system.Continuous glucose monitoring(CGM)is predicted to become an emerging trend benefited from features of continuous monitoring of blood glucose fluctuations and analyzing changes,and to play a crucial role in the treatment of DM and critical patients.The combination of time in range(TIR)and glycated hemoglobin A1c(HbA1c)is a key reference indicator for blood glucose monitoring and treatment assessment.This article summarizes several blood glucose monitoring technologies,blood glucose management indicators and future development directions.