动态血糖监测系统和扫描式血糖监测系统判断2型糖尿病患者黎明现象的一致性研究

目的探讨基于动态血糖监测系统(CGMS)评价扫描式血糖监测系统判断2型糖尿病(T2DM)患者黎明现象的有效性。方法采用便利抽样法,选取2019年6月-2020年6月于新乡市中心医院内分泌科住院的45例T2DM患者为研究对象。患者入院后先佩戴扫描式动态血糖监测系统,48 h后再佩戴CGMS行连续血糖监测,再过72 h后同时取下扫描式动态血糖监测系统和CGMS,核对同时间段的血糖分析报告,判断是否发生黎明现象。采用Kappa检验分析CGMS与扫描式血糖监测系统判断黎明现象的一致性,以CGMS判断结果为标准,绘制扫描式血糖监测系统判断黎明现象的ROC曲线,评定夜间血糖预测黎明现象及次日空腹血糖评估黎明现象的最佳切点值。结果 CGMS判断55.56%(25/45)的患者、扫描式血糖监测系统判断46.67%(21/45)的患者发生黎明现象,两者比较差异无统计学意义(χ2=0.711,P>0.05)。CGMS和扫描式血糖监测系统判断黎明现象的一致性良好(Kappa=0.895,95%CI为1.130~4.883,P<0.01)。夜间血糖预测黎明现象的最佳切点值为8.31 mmol/L,次日空腹血糖评估黎明现象的最佳切点值为7.25 mmol/L,两者的ROC曲线下面积分别为0.729、0.803。结论扫描式血糖监测系统可以准确地判断黎明现象,当夜间血糖值为8.31 mmol/L时提示可能会发生黎明现象,次日空腹血糖值为7.25 mmol/L时提示可能发生了黎明现象。

Consistency of continuous glucose monitoring system and scanning blood glucose monitoring system in predicting dawn phenomenon in patients with type 2 diabetes mellitus

Objective To investigate the effectiveness of scanning glucose monitoring system in dawn phenomenon of patients with type 2 diabetes mellitus(T2DM)based on continuous glucose monitoring system(CGMS).Methods A total of 45 patients with T2DM hospitalized in the Endocrine Department of Xinxiang Central Hospital from June 2019 to June 2020 were selected as the research subjects by convenience sampling method.All selected patients were asked to wear the scanning glucose monitoring system after admission,and then the CGMS for continuous glucose monitoring after 48 hours.The scanning glucose monitoring system and the CGMS were taken off at the same time after 72 hours.The blood glucose analysis report of the same period was checked to determine whether the dawn phenomenon occurred.The consistency to determine dawn phenomenon was analyzed between CGMS and scanning blood glucose monitoring hy Kappa test.According to the CGMS judgment results,the receiver operating characteristic curve(ROC)of the scanning blood glucose monitoring system was drawn to evaluate the optimal tangent value of the night blood glucose for predicting dawn phenomenon and the next day fasting blood glucose for evaluating dawn phenomenon.Results Among the 45 study subjects,there was no statistical difference in determining the incidence of dawn phenomena between CGMS and scanning glucose monitoring system55.56%(25/45)vs.46.67%(21/45),x²=0.711,P>0.05].Consistency analysis shower that Kappa value was 0.895,and the consistency of CGMS and scanning glucose monitoring system in judging dawn phenomenon was good(Kappa=0.895,95%C I 1.130-4.883,P<0.01).The optimal tangent value of night blood glucose for predicting dawn phenomenon was 8.31 mmol/L,and the optimal tangent value of the next day fasting blood glucose for evaluating dawn phenomenon was 7.25 mmol/L.The value of the area under the ROC curve were 0.729 and 0.803 respectively.Conclusions Scanning blood glucose monitoring can accurately judge the dawn phenomenon.When the night blood glucose value is 8.31 mmol/L,it indicates that the dawn phenomenon may occur.When the next day s fasting blood glucose value is 7.25 mmol/L,it indicates that the dawn phenomenon may already occur.