实时动态血糖监测在骨科围手术期2型糖尿病患者中的应用价值

Application value of real-time continuous glucose monitoring in orthopedic patients with type 2 diabetes mellitus during perioperative period

目的探讨在骨科围手术期2型糖尿病(T2DM)患者中实时动态血糖监测(RT-CGM)的应用及其效果。方法本研究为单中心、前瞻性、随机对照研究。纳入2023年1月至5月于南京鼓楼医院就诊的骨科围手术期T2DM患者40例,采用动态随机化法中的最小随机分组法分为试验组(RT-CGM+胰岛素皮下泵组20例)和对照组(胰岛素皮下泵组20例)。比较两组患者葡萄糖目标范围内时间(TIR)、高于葡萄糖目标范围内时间(TAR)、低于葡萄糖目标范围内时间(TBR)、平均血糖(MBG)、术前等待时间、术后住院时间等指标的差异。结果试验组TIR[(62.56±13.55)%vs(44.60±15.14)%,t=3.953,P<0.01]明显高于对照组,TAR[(37.26±13.44)%vs(55.21±15.20)%,t=3.957,P<0.01]明显低于对照组,两组TBR相比差异无统计学意义(P>0.05)。试验组MBG[(9.81±1.54)mmol/L vs(12.06±1.96)mmol/L,t=4.036,P<0.01]明显低于对照组。试验组术前等待时间[(3.25±1.74)d vs(4.60±1.96)d,t=2.303,P=0.027]、术后住院时间[(4.90±2.36)d vs(6.65±2.80)d,t=2.139,P=0.039]低于对照组。结论RT-CGM可以更好地控制患者的血糖水平,降低住院时间,对骨科围手术期T2DM患者有较好的临床应用价值。

Objective To explore the application and effect of real-time continuous glucose monitoring(RT-CGM)in orthopedic perioperative patients with type 2 diabetes mellitus(T2DM).Methods As a single-center,prospective,randomized controlled trail,40 orthopedic patients with T2DM during perioperative period in the Department of Othopedics of Nanjing Drum Tower Hospital from January to May 2023 were selected and assigned to the experimental group(RT-CGM with insulin subcutaneous pump group,n=20)and the control group(insulin subcutaneous pump group,n=20)by minimum random grouping method in dynamic randomization method.The differences in time in range(TIR),time above range(TAR),time below range(TBR),mean blood glucose(MBG),preoperative waiting time,and postoperative hospital stay were compared between the two groups.Results The TIR of the experimental group was significantly higher than that of the control group[(62.56±13.55)%vs(44.60±15.14)%,t=3.953,P<0.01],and the TAR was significantly lower than that of the control group[(37.26±13.44)%vs(55.21±15.20)%,t=3.957,P<0.01],and there was no significant difference in the TBR between the two groups(P>0.05).The MBG level in the experimental group was significantly lower than that in the control group[(9.81±1.54)mmol/L vs(12.06±1.96)mmol/L,t=4.036,P<0.01].The preoperative waiting time of the experimental group were lower than that of the control group[(3.25±1.74)d vs(4.60±1.96)d,t=2.303,P=0.027],and the postoperative hospital stay was lower than that of the control group[(4.90±2.36)d vs(6.65±2.80)d,t=2.139,P=0.039].Conclusion RT-CGM can better control the blood glucose level of patients,reduce the hospitalization time,which has a higher clinical application value for orthopedic perioperative patients with T2DM.