连续血糖监测系统对比分析

连续血糖监测对于糖尿病的预防和治疗都有重大意义,近年来国内外已经有多款相关产品获批上市.文章从传感器有效期、适用年龄、数据上传频率、校准频率、血糖异常提醒等关键技术指标重点介绍了5款已经上市的连续血糖监测系统.国外厂商的FreeStyle Libre、Dexcom G5和Medtronic Guardian Conne...     

连续血糖监测评价水煮或油煎饺子对糖尿病患者餐后血糖的影响

目的　采用连续血糖监测（CGM)方法评价水煮或油煎饺子对糖尿病患者餐后血糖的影响。方法　纳入10例2011年2至5月在北京协和医院内分泌科住院的2型糖尿病患者,佩戴胰岛素泵平稳控制其空腹与餐前血糖,试验期内第2和第4天午餐分别给予油煎或水煮饺子,试验饮食的营养含量相同。利用抗性淀粉体外消化方法测定试餐的可消化淀粉中快消化淀粉与持续消化淀粉含量,以及抗性淀粉含量。试验阶段佩戴CGM记录全天血糖变化,观察试验餐对餐后各时点(0、15、30、60、90、120、150、180、240 min)血糖、峰值血糖、分时段（0~60 min、63~120 min、123~180 min、183~240 min）血糖曲线下面积(AUC)的影响。结果　体外消化法测定油煎方法的快消化淀粉含量低于水煮方法（30.8%和77.0%）;油煎方法持续消化淀粉含量高于水煮方法（67.3%和20.7%）,两种试餐中抗性淀粉含量均不高 (1.9%和2.3%)。而油煎方法餐后血糖峰值出现时间早于水煮方法 ［（93±53）min比（156±61）min, P=0.02］。各时点血糖均值差异无统计学意义,各时段血糖AUC差异无统计学意义（均P＞0.05）。结论　水煮方法淀粉消化速度快,但餐后血糖峰值却晚于油煎方法,油煎饺子对2型糖尿病患者升高血糖的作用比水煮方法更早。     

持续监测血糖浓度新方法

日本科学家设计了一种有创程度最小的血糖监测装置,当置入小鼠的耳之后,它能够迅速提供对血糖浓度的连续监测。     

连续动态血糖监测护理在妊娠糖尿病产妇中的应用效果

目的探究连续动态血糖监测护理在妊娠糖尿病产妇中的应用效果。方法选取2018年11月至2019年4月于医院接受治疗的妊娠糖尿病产妇50例,按照随机数字表法分为观察组和对照组,各25例。对照组采用常规血糖监测护理,观察组采用连续动态血糖监测护理,持续护理至产妇分娩,比较两组护理前后的血糖(空腹血糖、餐后2h血糖)水平及护理结束后的不良妊娠结局(剖宫产、胎盘早剥、产后出血)、围生儿并发症(早产、胎儿宫内窘迫)情况。结果护理后,两组空腹血糖、餐后2h血糖均降低,且观察组低于对照组,差异有统计学意义(P<0.05);护理后,观察组不良妊娠结局发生率低于对照组,差异有统计学意义(P<0.05);护理后,观察组围生儿并发症发生率略低于对照组,差异无统计学意义(P>0.05)。结论连续动态血糖监测护理能够有效降低妊娠糖尿病产妇的血糖水平,改善妊娠结局,并可在一定程度上减少围生儿并发症的发生。     

血糖监测系统临床试验研究

目的：评价血糖监测系统的有效性和安全性。方法：225例受试者进入临床试验,受试者同时使用试验产品（鱼跃血糖监测系统）和对照产品（强生血糖监测系统）进行血糖检测,分别评价血糖监测系统的临床使用性能、精密度、批间差、准确度、一致性和不良事件。结果：试验和对照产品的临床使用性能合格率均为100％,其精密度、批间差、准确度、一致性均符合国内《GB／T19634--2005》和国际《ISO 15197—2003》标准,2组均无不良事件发生。结论：鱼跃血糖监测系统用于血糖测定安全有效,可代替已上市的同类产品。     

血糖监测的现状与未来

糖尿病是由于体内胰岛素缺乏，引起的代谢紊乱性疾病或内分泌疾病，病症最初表现为体内血糖失控。长期研究证明，如果能确实将血糖值控制在正常范围内即110±25mg／dL，即可控制糖尿病。为了将血糖值控制在正常范围内，了解患者体内血糖水平是必需的，有时一日可能要对患者进行数次血糖值测定。因此，血糖值监测成了糖尿病治疗的一个重要组成部分。目前已研究出多种方法和装置供在实验条件下、自然条件下对体液中葡萄糖含量进行监测。这些方法和装置的研究开发，目的是在以下几个方面有所突破。（1）相应速度一根据不同需要能在1～5min内测…     

血压连续监测记录系统的开发

根据容积补偿法连续血压测量的工作原理,构建了一个小型化的实验系统。经初步的试验结果表明,该系统能有效采集桡动脉血压信号,采用的数字PID算法能跟踪血压的变化,连续血压检测的精度达到同类产品的水平。     

自我监测血糖仪的发展现状

糖尿病是一种常见的内分泌代谢病,血糖的监控对于糖尿病患者的诊断和治疗具有重要意义。本文不但对微损式、无创式和连续式血糖检测仪的检测原理和研究现状进行了综述和分析,并且为自我检测型血糖仪的选购和研制提供了参考依据。     

糖尿病人如何进行自我血糖监测

如何确定血糖监测的时间和频率 这要根据患者病情的实际需要来决定。     

2型糖尿病动态血糖监测系统监测的临床意义

我们对45例治疗中的2型糖尿病患进行了动态血糖监测系统监测,旨在能更好的了解2型糖尿病患血糖波动的情况,利于调整,达到血糖控制的目标。     

连续性实时葡萄糖监测系统在危重症病人血糖管理中的作用

目的:评价连续性实时葡萄糖监测系统(RTCGM)在危重症病人血糖监测中的准确性和指导性。方法:2010年7月收住我院中心ICU,拟住ICU>3 d,APACHEⅡ>10分的危重症病人16例,应用统一的血糖管理方案控制血糖,比较RTCGM血糖检测方法与床旁血糖检测仪、动脉血气、静脉血实验室检测的血糖值之间的相关性和一致性。结果:①RTCGM血糖值与床旁血糖监测仪血糖值比较:共597对配对资料,相关性r=0.90(P<0.01);绝对误差0.38 mmol/L(-0.48～1.32)mmol/L;相对误差4.2%(-5.9～14.8)%;Clarke误差栅格分析显示,99.3%的结果在A区和B区。②RTCGM血糖值与动脉血气血糖值比较:共146对配对资料,相关性r=0.72(P<0.01);绝对误差0.10 mmol/L(-0.99～0.96)mmol/L;相对误差1.7%(-15.8～13.3)%;Clarke误差栅格分析显示,97.3%的结果在A区和B区。③RTCGM血糖值与静脉血实验室检测的血糖值比较:共57对配对资料,相关性r=0.80(P<0.01);绝对误差0.38 mmol/L(-0.54～1.49)mmol/L;相对误差5.2%(-5.9～19.4)%;Clarke误差栅格分析显示,100%的结果在A区和B区。但有约25%的组织葡萄糖值超出ISO标准,与国外相关报道相近。结论:连续性葡萄糖检测结果准确性较高,能较好地反映血糖的动态变化,及时发现严重的高血糖与低血糖事件,是危重症病人应激性高血糖管理的安全保证。     

动态血糖监测系统在妊娠期糖代谢异常患者中的应用

目的评估动态血糖监测系统（CGMS）在妊娠期糖代谢异常患者中的应用价值。方法采用CGMS对6例妊娠糖尿病（GDM）患者和6例妊娠期糖耐量受损（GIGT）患者进行连续3d的皮下组织葡萄糖监测,计算血糖波动系数、高血糖时间比和低血糖时间比。结果两组患者的血糖波动系数、葡萄糖平均值、高血糖时间比、低血糖时间比、空腹血糖平均值、餐后血糖平均值差异均无统计学意义（P均〉0．05）。两组患者早、中、晚餐3餐达到餐后血糖峰值的时间及峰值浓度差异无统计学意义（P均〉0．05）,达峰时间均为餐后90～120min。未发生与探头置入相关的不良反应。结论在妊娠妇女中使用CGMS感应器是安全的,GDM和GIGT患者经CGMS监测血糖水平没有显著差异,GIGT的治疗应该和GDM同样严格。     

Low-glycaemic index sweetener-based beverages reduce 24-h glucose profiles in healthy adults

Background:  Previous research has shown that substitution of high-glycaemic index (GI) bread for low-GI bread can favourably alter the 24-h glucose profile. Given the high beverage consumption in the UK, the present study aimed to evaluate the impact of consuming a beverage containing a low-GI, natural sweetener at mealtimes compared to a sucrose-based beverage, on the 24-h glucose profile.
Methods:  In a randomized crossover design, six subjects (aged 41 ± 16 years; body mass index = 25.8 ± 4.1 kg m⁻²) were provided with a diet including low-GI or control (sucrose) beverages on two nonconsecutive days. On each study day, subjects consumed the low-GI or control beverage at breakfast, lunch and dinner. Interstitial glucose concentrations were measured over 24 h using a continuous glucose monitoring system.
Results:  Compared to the control beverage, the low-GI beverage significantly reduced mean glucose concentration over 24 h ( P  < 0.05). Similarly, 24-h and daytime incremental area under the curves for glucose were significantly lower ( P  = 0.001).
Conclusions:  The substitution of a sucrose-based beverage for a beverage containing a low-GI, natural sweetener at mealtimes is a simple dietary change that can significantly reduce 24-h glucose levels and may be beneficial for many individuals.     

双相门冬胰岛素30和预混人胰岛素30/70短期疗效的动态血糖监测比较

目的 比较每日2次注射双相门冬胰岛素30(BIAsp 30)和预混人胰岛素30/70(BHI 30)治疗老年2型糖尿病(T2DM)的血糖控制和血糖波动情况.方法 选择52例口服降糖药效果不佳的老年T2DM患者随机分为两组,分别每日早、晚餐前皮下注射BIAsp 30和BHI 30,三餐前及睡前指尖血糖达标后进行动态血糖监测,比较两组整体血糖控制水平、血糖波动系数、餐后血糖漂移、低血糖发生等情况.结果 两组三餐前、午餐后及平均血糖水平的差异无统计学意义(均P＞0.05).BIAsp 30组较BHI 30组血糖波动系数减小[(1.69±0.42)mmol/L vs.(2.07±0.51)mmol/L,t=-3.013,P＜0.01];早、晚餐后血糖漂移幅度减小,分别为[(2.89±1.32)mmol/L vs.(3.83±1.18)mmol/L,t=-2.705,P＜0.01]、[(2.69±1.37)mmol/L vs.(3.55±1.40)mmol/L,t=-2.232,P＜0.05];血糖漂移至11.1 mmol/L以上的时间百分数减低[(621±6.04)% vs.(10.0l±6.80)%,t=-2.132,P＜0.05].BIAsp 30组较BHI 30组低血糖频率减少,但两组差异无统计学意义(P＞0.05).结论 对于老年T2DM患者,每日2次注射BIAsp 30和BHI 30同样有效,但前者能更明显降低餐后血糖和减少血糖波动,减少低血糖风险.

Abstract：

Objective To compare the blood glucose levels and variability of premixed insulin aspart (BIAsp 30) with human insulin premix (BHI 30) used in a twice a day injection regimen in elderly type 2 diabetes patients. Methods 52 cases of inadequate glycemia controlled by oral anti-diabetic drugs were randomly divided into two groups, treated on a twice-daily regimen with BIAsp 30 (n=26) and BHI 30 (n=26) respectively. After achieving the target goal, a continuous glucose monitoring system (CGMS) was used to compare the blood glucose levels, blood glucose fluctuant coefficient (BGFC), postprandial glucose excursion (PPGE), and occurrence of hypoglycemia.Results BIAsp 30 was as effective as BHI 30 in controling glycaemia. Detected by CGMS, there was no statistical differences in blood glucose levels among pre-three main meals, post-lunch and the mean blood glucose (MBG) (all P＞0.05). The BGFC levels were significantly lower in the BIAsp 30 group than in the BHI 30 group [(1.69±0.42) mmol/L vs. (2.07 ±0.51)mmol/L,t=-3.013,P＜0.01]. The blood glucose increment over breakfast, dinner and the percentage of time at hyperglycaemia (BG ＞11.1 mmol/L) were lower in the BIAsp 30 group than in the BHI 30 group[(2.89± 1.32) mmol/Lvs.(3.83 ± 1.18) mmol/L, t=-2.705, P＜0.01; (2.69 ± 1.37) mmol/L vs. (3.55 ± 1.40) mmol/L, t=-2.232, P＜0.05; (6.21 ± 6.04)% vs. (10.01 ± 6.80)%, t=-2.132, P＜0.05]. The frequency of hypoglycemia was lower in the BIAsp 30 group than in the BHI 30 group, but there was no statistical difference (P＞0.05). Conclusion Pre-meal injection of BIAsp 30 in a twice-daily regimen could significantly improve the control of postprandial glucose level and reduce the overall glucose excursions so as to lower the risk of hypoglycaemia when compared to BHI 30.     

动态血糖监测系统在妊娠期糖尿病患者中的应用

目的:运用一种新的持续检测血糖的方法,确定妊娠期糖尿病患者餐后血糖的轮廓特点。方法:孕妇身上连续72 h连接上一个动态血糖检测系统。该装置每5 min检测一次皮下间质组织的血糖水平。孕妇记录下检测期间每次用餐的时间。分析每次餐后240 min内的血糖值。结果:58名孕妇参与此项研究,其中21名妊娠期糖尿病孕妇单纯饮食控制,19名妊娠期糖尿病孕妇接受胰岛素治疗,另有18名孕妇为I型糖尿病患者。对于检测的所有各组糖尿病孕妇,从其用餐至达到最高血糖峰值的时间均相似,大约为90 min,早、午、晚3餐的餐后血糖峰值的时间亦相似。Ⅰ型糖尿病患者组餐后低血糖的发生率为12.8%,妊娠期糖尿病组为8.7%。结论:妊娠期糖尿病患者,达到餐后血糖峰值的时间约为餐后90 min。动态血糖监测系统可以更清楚全面地了解妊娠期糖尿病患者的血糖情况,有助于孕期糖尿病患者的管理和治疗。     

便携式血糖仪与全自动生化分析仪血糖监测的比较研究

目的:探讨便携式血糖仪与大型生化分析仪检测血糖是否存在差异,为临床糖尿病患者及时检测、调控血糖水平等提供快速、简便、准确可靠的血糖检测方法。方法:60例门诊患者同时抽取末梢血与静脉血。末梢血葡萄糖采用酶电极法分别使用当前医院临床使用的2种便携式血糖仪进行测定。静脉血离心后,血清葡萄糖浓度采用葡萄糖氧化酶法使用全自动生化分析仪进行测定。结果:2种便携式血糖仪与大生化分析仪检测血糖水平差异无统计学意义(P>0.05),检测结果之间存在明显相关性,R2分别为0.980 5,0.986 7;2种便携式血糖仪进行比较,检测血糖水平差异无统计学意义(P>0.05),结果之间存在明显相关性,R2=0.960 6。结论:2种便携式血糖仪与全自动生化分析仪检测的血糖结果具有良好的相关性,但应定期对院内便携式血糖仪与实验室全自动生化分析仪的结果进行比对,以确保结果的准确性。     

Evaluation of a continuous glucose monitoring system for home-use conditions

OBJECTIVE: To evaluate the safety and effectiveness of the FreeStyle Navigator Continuous Glucose Monitoring System when used by adult patients with type 1 or 2 diabetes requiring insulin in the home environment. RESEARCH DESIGN AND METHODS: Multicenter, prospective study enrolling 137 subjects. This was a two-phase study consisting of 20 days of use ("masked period") without access to continuous glucose readings followed by 21 days of use ("unmasked period") with access to continuous glucose readings and glucose alarms. At the conclusion of the study, all subjects were asked to complete a User's Questionnaire. RESULTS: A total of 11,487 paired continuous glucose sensor and blood glucose reference results from 961 sensors were evaluated; 77.2 percent were in Clarke error grid zone A and 19.6 percent were in zone B. Only 13.1 percent of the hypoglycemic and 0.5 percent of the hyperglycemic threshold alarms were false alerts. Subjects with type 1 diabetes demonstrated a 55 percent reduction in time spent with significant hypoglycemia (below 55 mg/dL) (P < .0001) from masked to unmasked periods. Their average number of hypoglycemic episodes (below 70 mg/dL) per day fell from 1.1 to 0.8 (P < .0001). Results from patient questionnaires demonstrated high levels of subject satisfaction and the ability to use and understand the system. CONCLUSIONS: FreeStyle Navigator Continuous Glucose Monitoring System is safe and effective, and results in a high level of subject satisfaction while used in the home setting. Utilization of continuous glucose monitors with alerts may result in cost offsets by reducing the number and severity of clinically significant events and assisting in the maintenance of optimal glycemic control.     

葡萄糖耐量减低患者72小时动态血糖与早时相胰岛素分泌的相关性研究

目的 研究葡萄糖耐量减低(IGT)患者72 h动态血糖特征与早时相胰岛素分泌的相关性.方法 根据连续2次75 g口服葡萄糖耐量试验(OGTT)结果,选取正常糖耐量(NGT)组30例和IGT组32例.测定胰岛素水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、Δ130/ΔG30和胰岛素曲线下面积(AUCI).所有受试对象均行72 h动态血糖监测系统(CGMS)监测,分析比较两组餐后血糖峰值(PPG)、达峰时间(Δt)、餐后血糖波动幅度(PPGE)、餐后血糖波动持续时间(DPE).结果 IGT组的PPG、PPGE较NGT组明显升高(P<0.05),Δt、DPE明显延长(P<0.05).IGT组HOMA-IR高于NGT组(1.68 ±1.03比1.15±0.90)(P<0.01),Δ130/ΔG30和HOMA-β显著低于NGT组(3.85±1.04比6.42±1.05和52.97±2.02比55.68±12.45)(P<0.01或<0.05).结论 IGT患者以餐后血糖升高为特征,其糖负荷后的胰岛β细胞早时相分泌功能受损较重,空腹血糖和餐后2 h血糖的升高与胰岛素抵抗呈正相关,与胰岛β细胞功能呈负相关.     

Comparison of Glucose Monitoring Methods during Steady-State Exercise in Women

Data from Continuous Glucose Monitoring (CGM) systems may help improve overall daily glycemia; however, the accuracy of CGM during exercise remains questionable. The objective of this single group experimental study was to compare CGM-estimated values to venous plasma glucose (VPG) and capillary plasma glucose (CPG) during steady-state exercise. Twelve recreationally active females without diabetes (aged 21.8 ± 2.4 years), from Central Washington University completed the study. CGM is used by individuals with diabetes, however the purpose of this study was to first validate the use of this device during exercise for anyone. Data were collected between November 2009 and April 2010. Participants performed two identical 45-min steady-state cycling trials (~60% P_max) on non-consecutive days. Glucose concentrations (CGM-estimated, VPG, and CPG values) were measured every 5 min. Two carbohydrate gel supplements along with 360 mL of water were consumed 15 min into exercise. A product-moment correlation was used to assess the relationship and a Bland-Altman analysis determined error between the three glucose measurement methods. It was found that the CGM system overestimated mean VPG (mean absolute difference 17.4 mg/dL (0.97 mmol/L)) and mean CPG (mean absolute difference 15.5 mg/dL (0.86 mmol/L)). Bland-Altman analysis displayed wide limits of agreement (95% confidence interval) of 44.3 mg/dL (2.46 mmol/L) (VPG compared with CGM) and 41.2 mg/dL (2.29 mmol/L) (CPG compared with CGM). Results from the current study support that data from CGM did not meet accuracy standards from the 15197 International Organization for Standardization (ISO).     

基于模糊逻辑的冷、热交替治疗仪控制方法设计

分别设计了用于液氮冷疗的模糊控制器和用于射频热疗的模糊逻辑PID控制器。在离体猪肝上所做的实验结果表明,所提出的方法能控制冷、热疗的过程,有实用价值。