动态血糖监测期间对糖尿病患者的健康教育

由于住院病人72 h动态血糖监测期间均与医护人员共处,且需要受试者密切配合,详细记录各种生活事件,是进行强化糖尿病(DM)健康教育的理想时期,对于充分利用动态血糖监测系统的优势提高健康教育的效率和血糖控制的精细程度十分有益,但现在的做法还局限在动态血糖监测系统(CGMS)结束后,针对3 d CGMS总的结果对受试者进行生活指导[1],如何在3 d监测期间进行个体化DM教育尚未见报道.为此我们对30 例接受CGMS的本科住院DM患者安排了与3 d动态血糖监测同步的个体化DM健康教育课程,初步显示了其独特的优越性,现报道如下.     

对比分析糖尿病患者动态血糖监测与指尖血糖监测对血糖漂移的评估

目的 通过对血糖控制理想的糖尿病患者进行动态血糖监测系统(CGMS)和指尖血糖监测,分析血糖数据,探讨CGMS是否更有利于血糖控制.方法 选择30例HbA1c达标的短期住院患者,进行72h的CGMS血糖监测,同时用指尖血糖监测3d的FBG、三餐后2hBG、睡前及凌晨3点血糖 ,记录血糖数据.结果 CGMS与指尖血糖监测相比,可以更广泛地监测到血糖最高值、最低值(P＜0.01),提高高血糖、低血糖的检出率.通过调整治疗,可在短时间内使血糖达到24h的全面、平稳控制(P＜0.05).结论 与指尖血糖监测相比,CGMS能够显示全面详细的血糖动态变化情况,较好地评估血糖漂移,为糖尿病患者制订更合理有效的防治策略提供科学依据.     

动态血糖监测系统在胰岛细胞瘤中的应用与护理

总结动态血耱监测系统（CGMS）在胰岛细胞瘤患者中应用的效果与护理体会。CGMS能够连续监测血糖波动，在胰岛细胞瘤患者中应用能够较好的反映血糖的动态变化，对指导临床用药有实际意义。护理要点是：检测前做好宣教，以取得患者的配合；注意探头的保存与安装；CGMS置入后密切观察，及时处理各项报警。     

CSⅡ与CGMS泵联合治疗糖尿病的疗效观察

对64例接受胰岛素泵治疗的糖尿病患者随机分成2组,每组32例。一组采用动态血糖监测系统(CGMS)监测血糖,一组采用血糖仪每日7次监测手指血糖,两组进行比较。结果CGMS组血糖达标时间明显短于血糖仪监测组(P0.01),CGMS组所发现的低血糖及高血糖明显高于血糖仪监测组,两组之间血糖达标后胰岛素剂量无显著差异。结论CGMS联合CSⅡ可使血糖失控的糖尿病患者的血糖更快达标,且安全性优于血糖仪组。     

胰岛素泵联合动态血糖监测系统治疗糖尿病疗效观察

糖尿病患者在胰岛素治疗的过程中,血糖监测尤为重要.我科自2003年9月引进动态血糖监测系统(CGMS),通过对25例糖尿病患者进行胰岛素泵与CGMS联合应用的效果观察,发现其可良好控制患者全天候的血糖水平,现报道如下.     

老年糖尿病患者动态血糖监测阶段式强化教育的效果评价

目的 观察动态血糖监测(CGMS)期间进行阶段式强化健康教育对老年2型糖尿病(T2DM)患者血糖控制水平及健康教育效果的近、中期影响.方法 老年T2DM患者100例,随机分为试验组和对照组各50例,两组均进行72 h CGMS监测,监测前均接受糖尿病知识问卷调查,试验组每日下载血糖数据和图谱并根据结果与生活事件的联系进行针对性健康教育,连续4 d,对照组只在72 h CGMS结束后根据结果进行一次性教育,之后两组均采用快速血糖仪常规测量指尖多点血糖7 d,收集两组患者10 d的血糖值及住院天数.3个月后查两组患者的糖化血红蛋白、体重指数并再次进行糖尿病知识问卷调查.CGMS期间其他控制血糖措施两组间无差别.结果 试验组10 d的血糖均值中空腹血糖、早餐后2 h血糖、中餐前血糖、晚餐后2 h血糖、睡前血糖、凌晨3点血糖均低于对照组(P<0.05或P<0.01);血糖达标时间、低血糖发生次数、3个月后糖化血红蛋白均低于对照组(P<0.05或P<0.01),糖尿病知识问卷得分高于对照组(P<0.001).结论 CGMS期间应用每24 h下载的血糖结果进行阶段式强化教育对老年T2DM患者血糖控制水平及健康教育的近中期效果优于72 h一次性进行的教育.     

应用动态血糖监测系统评估2型糖尿病患者日内及日间血糖波动幅度

目的 探究动态血糖监测系统应用于评估2型糖尿病患者日内及日间血糖波动的可行性.方法 选择该中心2011年12月-2013年12月该中心收治的98例2型糖尿病患者,标记为实验组;同时,选择100例健康者作为对照组,对两组患者进行动态血糖监测系统进行监测,比较两组患者血糖检测系统(CGMS)显示的平均血糖水平、日内平均血糖波动幅度及日间血糖平均绝对差.结果 CGMS显示,实验组患者平均血糖水平及标准差、日内平均血糖波动幅度及日间血糖平均差均高于对照组,差异无统计学意义(P＞0.05);CGMS显示,平均血糖水平与HBAIC呈正相关关系;2型糖尿病患者日内平均血糖波动幅度及日间血糖平均差与HBAIC不存在相关性.结论 动态血糖检测系统(CGMS)有助于准确的评估2型糖尿病患者日内及日间血糖的波动变化,其显示的日内及日间的血糖血糖波动幅度可以作为评价2型糖尿病患者血糖控制是否达标的重要参数.     

评估动态血糖监测系统在胰岛素泵治疗中的意义

目的观察动态血糖监测系统（CGMS）的临床应用价值及对胰岛素泵（CSII）治疗的指导意义。方法为62例糖尿病患者佩带CGMS72h后分析其血糖波动特点,其中的30例使用CSII治疗（CGMS＋CSII组）,42例使用自我血糖监测（SMBG）的CSII治疗（SMBG＋CSII）结果（1）CGMS记录的探头血糖值和SMBG记录的指血血糖值间有极好的相关性（r=0.92）;（2）62例患者CGMS记录的全部低血糖和高血糖事件为191次,而SMBG记录的全部低血糖和高血糖事件为42次;（3）CGMS＋CSII组患者血糖达标时间与SMBG＋CSII组相比,差异有统计学意义（P〈0.05）;两组低血糖的发生率比较,差异也有统计学意义（P〈0.01）。结论CGMS与CSII联合使用可以使糖尿病患者的血糖在短期内达到理想而稳定的控制目标。     

“双C”方案治疗难治性或脆性糖尿病18例

血糖监测是糖尿病(DM)管理的重要组成部分,动态血糖监测是指通过葡萄糖感应器监测皮下组织间液的葡萄糖浓度而反映血糖水平的技术,可提供连续、全面、可靠的全天血糖信息,了解血糖波动趋势,发现不易被传统方法所探测的高血糖和低血糖,为传统血糖监测方法的有效补充[1],动态血糖监测系统(CGMS)有助于了解血糖变化整体趋势和个体化特征,以指导制定临床个体化治疗方案[2].本文拟观察CGMS和胰岛素泵(CSⅡ)组成的"双C"方案治疗血糖波动大、难治性、脆性DM患者的疗效.     

实时动态血糖监测与胰岛素泵联合应用对2型糖尿病患者血糖控制的效果

目的 评价实时动态血糖监测系统(Guardian~(R) RT CGMS)与持续皮下胰岛素输注(CSII)联合应用对T2DM患者血糖控制的影响. 方法 18例T2DM患者佩戴Guardian~(R)RT CGMS连续3d,并于监测的第2天给予CSII治疗,根据实时血糖情况调整胰岛素用量. 结果各时段血糖、平均血糖及血糖波动幅度均较治疗前显著下降(P均<0.01);高血精、低血糖报警次数及持续时间均较治疗前显著减少. 结论 Guardian~(R) RT CGMS能及时显示血糖变化值,反映血糖变化趋势,以此指导CSII中胰岛素的应用,可平稳有效控制血糖,预防血糖大幅度波动和低血糖的发生.     

The accuracy of the CGMS in children with type 1 diabetes: results of the diabetes research in children network (DirecNet) accuracy study

The accuracy of the Continuous Glucose Monitoring System, CGMS (Medtronic MiniMed, Northridge, CA) was assessed in children and adolescents with type 1 diabetes mellitus (T1DM) when compared with reference serum glucose levels during spontaneous fluctuations in glucose levels over 24 h and during acute hyper- and hypoglycemia. Ninety-one subjects with type 1 diabetes (3.5-17.7 years old) wore one or two CGMSs while blood samples were obtained for serum glucose determinations (made at a central laboratory) hourly during the day, every 30 min overnight, and every 5 min during meal-induced hyperglycemia and insulin-induced hypoglycemia tests, resulting in 6778 CGMS-reference glucose pairs. CGMS function was assessed on each of the 3 days of sensor life. The median relative absolute difference (RAD) between the CGMS and reference values was 18% (25th, 75th percentiles = 8%, 34%). Similar results were obtained on each of the 3 days of sensor life. Accuracy was worse during hypoglycemia than during hyperglycemia. Modified sensors that first became available in November 2002 were more accurate than were the original sensors (median RAD = 11% vs. 19%) and had better precision (r = 0.92 vs. r = 0.77) during time periods in which two CGMSs were simultaneously used. The CGMS sensors that have been in clinical use until recently are often inaccurate in quantifying glucose values in children with T1DM. However, recent modifications to the sensor have resulted in substantially better accuracy and reliability. This improved function, if confirmed by additional data, may enhance the clinical utility of the CGMS.     

High frequency of unrecognized hypoglycaemias in patients with Type 2 diabetes is discovered by continuous glucose monitoring.

AIMS: To evaluate the use of a CGMS in the detection of hypoglycaemia in people with type 2 diabetes as an outpatient procedure. METHODS: 31 type 2 diabetic patients underwent glucose monitoring by means of CGMS (Medtronic MiniMed) for up to three days. Patients took part in at least four SMBG (self monitoring blood glucose) tests per day. After three days of monitoring, the CGMS data was downloaded and analysed by a physician to identify the frequency of hypoglycaemias (< or =50 mg/dl) and borderline values (51-70 mg/dl), their duration and distribution. Findings were discussed with the patient and if necessary treatment was adjusted. Eight weeks later, monitoring was repeated to asses the effects of the adjusted treatment. RESULTS: Average duration of sensor wear was 4.19 days. Correlation between the sensor and the SMBG readings was high. A high number of hypoglycaemias and borderline values were detected by the CGMS, most of them unrecognized by the patient. The frequency of hypoglycaemias and borderline values just as the duration could be significantly reduced from first to second monitoring. CONCLUSION: Using the CGMS in type 2 diabetic patients achieved the detection of numerous hypoglycaemias and borderline values both nocturnal and/or unnoticed. The CGMS provides accurate data, which cannot be achieved by conventional SMBG tests. That opens the possibility for treatment adjustment and improvement in metabolic control. For patients it provides a better understanding of the effects of insulin or oral agents, nutrition and exercises to their glucose level.     

Sensors & Algorithms for Continuous Glucose Monitoring: Putative Delays in Interstitial Fluid (ISF) Glucose Kinetics Can Be Attributed to the Glucose Sensing Systems Used to Measure Them Rather Than the Delay in ISF Glucose Itself

Background

Since the advent of subcutaneous glucose sensors, there has been intense focus on characterizing the delay in the interstitial fluid (ISF) glucose response and the effect of insulin to alter the plasma-to-ISF glucose gradient. The Medtronic MiniMed continuous glucose monitoring system (CGMS) has often been used for this purpose; however, many of the studies have used experimental conditions that fall outside its intended use, for example, studies that have assessed the delay during rapid glucose excursions brought about by intravenous infusion of glucose or insulin. Under these conditions, it is possible that the rate of glucose change may exceed that allowed by CGMS filtering routines. If so, the estimated delay may be because of the filter rather than the ISF. Also, sensor characteristics, such as nonspecific offset current or stability, may have been inadvertently attributed to changes in the plasma-to-ISF gradient. The potential for these issues to have confounded the understanding of ISF glucose delay and gradient is investigated.

Methods

An in vitro preparation in which no delay or gradient exists between sensor and measurement solution was used to recreate a rapidly changing glucose profile from a previously published in vivo study. The CGMS system (N = 6 sensors) was then used to estimate any artifactual delay and gradient introduced by the system per se.

Results

One-point calibration resulted in an apparent change in gradient as glucose was lowered from ∼100 to 50 mg/dl. After a two-point calibration, sensor glucose followed the glucose profile as it was decreased slowly from ∼100 to ∼60 mg/dl; however, when the glucose level was subsequently increased rapidly to ∼150 mg/dl, CGMS filtering routines limited the rate of change of sensor glucose and introduced a delay similar to that previously attributed to ISF glucose equilibration delay.

Conclusions

Studies that have previously used the Medtronic MiniMed CGMS system to assess changes in the plasma-to-ISF glucose gradient may need to be reassessed to ensure that the offset current was estimated accurately. Studies that have used the system to assess ISF glucose delay during rapid, unphysiologic changes in glucose and did not remove the CGMS smoothing filters may have attributed CGMS filter delay to ISF glucose equilibration.     

Accuracy, effect on insulin therapy and glycemic control and complications of the continuous glucose monitoring system in type 1 diabetic patients

To evaluate the efficacy, safety and complications of continuous glucose monitoring system (CGMS) in type 1 diabetic patients (DM1), we retrospectively studied 30 patients (25.8 +/- 12.2 years) submitted to 72 hs CGMS (Medtronic; Northridge, CA) and analyzed: mean self monitoring blood glucose (SMBG) and mean CGMS sensors glycemic value; correlation coefficient (%), median absolute percent difference (MAD%), number of sensor reading, glycemic excursions (CGMS vs. SMBG), complications (trauma, local infection, disconnection) and therapeutic management after CGMS. A1c levels were measured 1 month before and 3 months after the study. Mean capillary glucose values were 186.5 +/- 43.3 mg/dl vs. 179.7 +/- 48.1 mg/dl by CGMS sensor, with significant correlation (p = 0.001). An average of 772.4 +/- 254.1 (VR > 680) glucose measurements was recorded for each patient, with 68.7 +/- 19.8 hs of exam. Correlation coefficient was 0.86 +/- 0.21 (VR > 0.79). Median absolute percent difference between sensor and glucometer values was 13.9 +/- 4.7% (VR < 28%). The CGMS was significant more efficient in detection of glycemic excursion related to capillary glycemia (p = 0.009). This data showed important decreased level of A1c in this population 3 months after the CGMS with statistical significance (p = 0.018). No complications were registered in 96.7% of patients. No trauma, local infection or bleeding were registered. The insulin therapeutic regimen was adjusted in 100% of patients. The CGMS showed to be a very safety method, well tolerated, with high accuracy in glycemic values and low complications rate. This method has to be more stimulated by physicians and patients.     

Three-day continuous glucose monitoring for rapid assessment of hypoglycemic events and glycemic variability in type 1 diabetic patients

This study was to determine whether glycemic variability is related to hypoglycemic events in type 1 diabetic patients, and whether the hypoglycemic events during a short-term continuous glucose monitoring system (CGMS) period parallel those measured during a 4-week self-monitoring of blood glucose (SMBG) period. We also evaluated whether glycemic variability indexes from a short-term CGMS correlate with those from a 4-week SMBG. A total of 49 type 1 diabetic patients wore CGMS devices for 3 days. These patients also performed SMBG for 4 weeks. Several indexes from the CGMS data were compared with indexes from the SMBG data. Hypoglycemic events (glucose levels <70 mg/dL) that occurred during the 3-day CGMS and 4-week SMBG periods were evaluated and compared. Hypoglycemic events were detected in 33 patients (67%) during the 3-day CGMS period. The patients with hypoglycemic events had a significantly higher glycemic variability index divided by mean glucose of CGMS, and a higher number of hypoglycemic events during the 4-week SMBG, compared to those with non-hypoglycemic events during the 3-day CGMS period. The percentage of hypoglycemic events using the 3-day CGMS was correlated with that from the 4-week SMBG (r=0.49, P<0.05) and low blood glucose index (r=0.51, P<0.05). The glycemic variability indexes from the 4-week SMBG correlated with the glycemic variability indexes from the 3-day CGMS. The short-term CGMS appears to be clinically useful for rapidly assessing the risk of hypoglycemic events and glycemic variability.     

Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patients

BACKGROUND: To evaluate the efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetes mellitus (DM1) patients. METHODS: We studied 46 patients (43.4%M/56.6%F), average age of 25.9+/-12.8 years, submitted to 72 h CGMS. It were analyzed: capillary glycemia (CG) and CGMS sensor's value, glycemic excursions, postprandial hyperglycemia, asymptomatic hypoglycemia and therapeutic management after CGMS. Correlation coefficient during hypo and hyperglycemia and sensitivity/specificity were determined. RESULTS: The mean capillary glucose values were 191.8+/-46.2mg/dl versus 190.9+/-42.1mg/dl by CGMS sensor, with no statistical difference by T-test (T=-0.6; p=0.79). The CGMS was significantly more efficient in detection of glycemic excursion than CG (p=0.001). The postprandial hyperglycemia was identified in 76.9% of diabetic patients and asymptomatic hypoglycemia was detected in 58.2% of these patients. The correlation coefficient presented no significance (p=0.16) during hypoglycemia versus during hyperglycemia (p=0.002). The CGMS sensor presented low sensitivity (79.1%) to detect hypoglycemia versus hyperglycemia (96.8%). CONCLUSIONS: The CGMS showed to be a good method to identify postprandial hyperglycemia, to improve therapeutics management and confirmed the low sensitivity of CGMS to detect unrecognized hypoglycemia in DM1 patients.     

Subcutaneous glucose sensor values closely parallel blood glucose during insulin-induced hypoglycaemia.

AIMS: To assess the accuracy of the Minimed continuous glucose monitoring system (CGMS) in estimating blood glucose concentration during a controlled reduction in blood glucose. RESEARCH DESIGN AND METHODS: We studied nine adolescent diabetics (age 14 +/- 1.5 years) wearing the CGMS during hyperinsulinaemic hypoglycaemic clamp studies. The glucose values obtained by the CGMS were compared with the venous blood samples taken during the studies and measured at the bedside using a glucose oxidase technique. RESULTS: Blood glucose was lowered from euglycaemia to a mean of 2.8 mmol/l over 120 min and maintained at that level for a further 40 min. A total of 429 paired glucose measurements were available for analysis. Analysis using weighted Deming regression and t-tests revealed small differences between the methods, with blood glucose levels slightly higher than interstitial fluid levels. The mean difference across all values was 0.13 mmol/l. The observed difference was greatest at blood glucose values < 3.3 mmol/l. CONCLUSIONS: This study suggests that during a fall in systemic glucose the subcutaneous glucose sensor provides an accurate reflection of blood glucose. However, a small difference is apparent at blood glucose values < 3.3 mmol/l.     

应用动态血糖监测系统评估2型糖尿病患者日内及日间血糖波动幅度

分析比较38例正常糖调节及39例新诊断2型糖尿病个体动态血糖监测系统（CGMS）显示的平均血糖水平、日内平均血糖波动幅度（MAGE）及日间血糖平均绝对差（MODD）。结果提示，血糖波动幅度应成为评价2型糖尿病患者血糖控制是否达标的重要参数。     

不同HbA1c水平的2型糖尿病患者动态血糖分析

目的利用动态血糖监测系统（CGMS）探讨不同HbA1c水平T2DM患者的血糖特点。方法将178例T2DM患者按HbA1c水平分为3个组,通过CGMS进行血糖监测。结果各组HbA1C与全天平均血糖值（24hMBG）均有相关性（P〈0．05）,与平均血糖漂移幅度（MAGE）无相关性。HbAlc≤7．5％时,餐后血糖与之相关性较好（P〈0．05）。HbA1c〉7．5％时,与三餐前血糖相关性较好（P〈0．05）。结论HbA1c代表血糖的整体水平,但不能反映血糖的稳定性,而CGMS可反映血糖的波动规律。HbA1c和CGMS联合应用更加有利于血糖的综合管理。     

Performance assessment of the Medtronic-MiniMed Continuous Glucose Monitoring System and its use for measurement of glycaemic control in Type 1 diabetic subjects.

AIMS: To assess the accuracy, reliability and measurement of glycaemic control associated with the Medtronic-MiniMed Continuous Glucose Monitoring System (CGMS) in comparison with blood glucose self-monitoring (BGSM) in Type 1 diabetic patients. METHODS: Type 1 diabetic patients (n = 18) underwent glucose monitoring by the CGMS for up to 3 days, when control was also assessed by BGSM performed eight times daily. RESULTS: Ninety-five per cent of paired non calibration samples were in the clinically acceptable zones of the Clarke error grid, and 97% in a consensus grid. The median bias was 0.1 mmol/l and relative bias 15%. The failure rate of sensors was 28% of those initially inserted. The CGMS detected significantly more hypoglycaemia and post-prandial hyperglycaemia, but total duration of hyperglycaemia, blood glucose oscillations and day-to-day variability were similarly assessed by CGMS and BGSM. CONCLUSIONS: The CGMS has acceptable clinical accuracy. Detection by the CGMS of more hypoglycaemia and post-prandial hyperglycaemia than BGSM promises a valuable tool for control assessment and optimization of treatment.