【摘要】 目的 评价2型糖尿病（type 2 diabetes mellitus，T2DM）患者动态血糖监测（continuous glucose monitoring，CGM）的准确性及其相关因素。 方法 2009年1月—2010年1月共纳入患者530例，其中口服降糖药治疗者和胰岛素强化治疗者各265例。应用动态血糖监测系统（美国Medtronic MiniMed公司）连续监测3 d，同时每天输入4次指尖血糖值（self-monitoring of blood glucose，SMBG）进行校正。用直线回归分析CGM值与SMBG的相关性，用Clarke误差表格分析一致性，用平均绝对差（mean absolute relative difference，MAD）评价准确性，并分析MAD的相关因素。 结果 ①共收集到6 350对CGM值[（9.66±3.54） mmol/L]与SMBG值[（9.64±3.38） mmol/L]，两者差异无统计学意义（Pgt;0.05）。Pearson相关性分析显示，两者呈正相关（r=0.959，Plt;0.001）。②Clarke误差表格分析显示:99.89%的点位于A区和B区，其中92.37%血糖值位于A区，7.72%位于B区，其余7对（0.11%）位于D区。③总体MAD值为7.2%（5.5%~9.5%），通过分析每天的MAD值见到，随着监测时间的延长，CGM结果的MAD值逐渐降低，而准确性逐渐升高。 ④胰岛素强化治疗组患者MAD值高于口服药治疗组患者（Plt;0.05），多元逐步回归分析显示，MAD值与糖化血清白蛋白水平呈独立负相关（β=-0.134， Plt;0.01），与胰岛素强化治疗呈独立正相关（β=0.117， Plt;0.05）。 结论 ①动态血糖与毛细血管血糖具有良好的相关性、一致性及准确性。 ②CGM结果的准确性除了受监测时间的影响外，还可能与患者的降糖治疗方案有关。【Abstract】 Objective To assess the accuracy of continuous glucose monitoring (CGM) for patients with type 2 diabetes mellitus (T2DM), and its correlated factors. Methods From January 2009 to January 2010, 530 patients with T2DM were enrolled in this study, including 265 subjects taking oral hypoglycemic agents and the other 265 subjects taking intensive insulin treatment. All the subjects underwent CGM (American Medtronic MiniMed) for three days. Meanwhile, capillary glucose values through self-monitoring of blood glucose (SMBG) were inputted four times a day for adjustment. The correlation of CGM value and capillary glucose value was analyzed by linear regression method. The consistency was analyzed by Clarke error grid. Mean absolute relative difference (MAD) was used to assess accuracy and correlated factors of MAD were also analyzed. Results ① A total of 6 350 pairs of CGM and SMBG values were collected [(9.66±3.54) mmol/L vs. 9.64±3.38) mmol/L,Pgt;0.05]. Pearson correlation analysis showed that CGM value was positively correlated with SMBG value (r=0.959,Plt;0.001). ② Clarke error grid demonstrated that 99.89% of paired SMBG-CGM values were located in zone A and zone B and the remaining seven pairs (0.11%) of glucose values were located in zone D. ③ The overall MAD value was 7.2% (5.5%-9.5%). According to the analysis of daily MAD value, MAD value decreased, while accuracy elevated gradually with monitoring time. ④ MAD value of intensive insulin treatment group was higher than that of the oral hypoglycemic agent treatment group (Plt;0.05). And stepwise multiple regression analysis indicated that MAD value had negative correlation with glycated albumin level (β=-0.134, Plt;0.01) and positive correlation with intensive insulin treatment (β= 0.117,Plt;0.05). Conclusions ① The results of CGM are accurate, and have good correlation and consistency with capillary glucose. ② Besides monitoring time, the accuracy of continuous glucose monitoring may be also associated with hypoglycemic treatment strategy.
Objective To investigate the accuracy of continuous glucose monitoring (CGM) system in emergency critically ill patients. Methods Critically ill patients admitted to the Intensive Care Unit of Department of Emergency Medicine, West China Hospital of Sichuan University between August 2022 and February 2023 were continuously enrolled. Blood glucose monitoring was performed using CGM system, while blood glucose in the patient’s fingertips was monitored every 4 hours. The correlation and consistency of blood glucose values between CGM system and fingertip glucose detection were compared. Results A total of 52 patients were included, and 1 504 matching blood glucose pairs were formed with fingertip blood glucose values. The overall correlation coefficient was 0.874 (P<0.001), the mean absolute relative difference was 14.50%, and the highest mean absolute relative difference (31.76%) was observed in the hypoglycemic range (<3.9 mmol/L). The percentage of CGM system blood glucose within ±15%, ±20% and ±30% of fingertip blood glucose was 56.65%, 75.56% and 94.75%, respectively. The intra-group correlation coefficient between CGM system blood glucose and fingertip blood glucose was 0.85 on the consistency test, and the Bland-Altman plot showed acceptable clinical accuracy. Conclusions The overall accuracy of the application of CGM system in critically ill patients is reasonable, but the accuracy in the range of low blood glucose values is poor. Whether the auxiliary use of CGM system can improve the blood glucose management of critically ill patients and reduce medical costs needs to be further studied.
On December 11, 2023, the American Diabetes Association (ADA) promulgated the Standards of Care in Diabetes (2024). For a long time, the ADA promulgated the Standards of Care in Diabetes had been regarded as the international guide in the field of diabetes, which has a great reference value for the diagnosis and treatment of diabetes in various countries. The new standard continues to emphasize the transformation of the diagnosis and treatment model from the glucose reduction to the patients, highlighting the importance of reasonable control of glucose, weight management, and improvement of cardiac and renal prognosis as the comprehensive management of diabetes patients, meanwhile continues to affirm the advantages of new hypoglycemic drugs such as glucagon like peptide-1 receptor agonist and metabolic surgery in the comprehensive management of type 2 diabetes mellitus.
Objective To investigate the current situation of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) in Sichuan province, and to analyze the influencing factors of SMBG, so as to provide evidence for improving the level of SMBG. Methods By the convenience sampling method, 410 patients with T2DM for more than 1 year were selected from 17 hospitals and community health service centers in 7 cities across Sichuan province, and their SMBG was investigated with a questionnaire. Results Among 410 eligible patients, the average frequency of SMBG was 7.3 times per month. There were 268 patients (65.4%) performed SMBG less than 4 times per month, 94 (22.9%) performed 4-15 times per month, 29 (7.1%) performed 6-29 times per month, and 19 (4.6%) performed over 30 times per month. Just 234 patients (57.1%) monitored the HbA1c in the past 6 months. FPG, 2-hour PPG and HbA1c were negatively correlated with the frequency of SMBG. The influencing factors of SMBG were insulin treatment and education. Conlusion The SMBG status in D2TM patients is relatively poor in Sichuan province, and the compliance of SMBG is expected to be improved by enhancing diabetic education.
目的 探讨护理行为对重症急性胰腺炎患者在实时强化血糖控制和治疗中的效果与影响。 方法 选择2010年7月－2011年7月15例采用强化血糖控制研究的急性重症胰腺炎患者，对其实时24 h动态血糖监测的护理方法及要点进行回顾分析。 结果 15例患者顺利完成强化血糖控制的临床研究，血糖值达到目标监测范围（6.1～8.3 mmol/L）的百分比例78.3%，未出现严重并发症。 结论 实时动态的血糖监测、严格执行的强化血糖控制方案及针对性护理措施可为重症胰腺炎患者的血糖强化控制提供安全有效的保证。
Blood glucose monitoring has become the weakest point in the overall management of diabetes in China. Long-term monitoring of blood glucose levels in diabetic patients has become an important means of controlling the development of diabetes and its complications, so that technological innovations in blood glucose testing methods have far-reaching implications for accurate blood glucose testing. This article discusses the basic principles of minimally invasive and non-invasive blood glucose testing assays, including urine glucose assays, tear assays, methods of extravasation of tissue fluid, and optical detection methods, etc., focuses on the advantages of minimally invasive and non-invasive blood glucose testing methods and the latest relevant results, and summarizes the current problems of various testing methods and prospects for future development trends.
Diabetes and its complications pose a serious threat to human life and health. It has become a public health problem of wide concern worldwide. Currently, diabetes is mainly treated with insulin injection in clinic. However, manual insulin injection still has many shortcomings. In recent years, with the deepening of research, it has been found that an automated insulin delivery system (AID), which combines a continuous glucose monitoring device with an insulin pump, can significantly improve the effectiveness of diabetes treatment and reduce the incidence of complications in patients. This paper firstly introduces the composition of the AID system and its working principle, and then details the development history and current status of the related technologies from the aspects of continuous glucose monitoring technology, insulin pumps and the development of closed-loop control algorithms, etc. Finally, this paper looks forward to the application prospect and future development of AID system in the field of diabetes treatment, providing theoretical reference for further research.