CGMS监测无知觉性低血糖的效果观察

目的 探讨CGMS监测无知觉性低血糖的效果和意义.方法 将接受胰岛素泵治疗的120例Ⅱ型糖尿病患者按照自愿的原则分为实验组和对照组,实验组使用CGMS,对照组使用强生血糖仪监测血糖,比较2组对患者发生无知觉性低血糖的检测效果和住院期间控制血糖需支付的医疗费用.结果 实验组对Ⅱ型糖尿病治疗中无知觉性低血糖检测率明显高于对照组(P＜0.01);实验组患者住院期间控制血糖的平均费用与对照组无明显差异(P＞0.05).结论 CGMS能准确有效地监测无知觉性低血糖,及时调整胰岛素用量,减少低血糖发生率,从而降低住院期间控制血糖需支付的总费用.     

胰岛素泵联合动态血糖监测系统治疗糖尿病的疗效分析

目的在胰岛素泵（CSII）皮下持续注射胰岛素的基础上,运用动态血糖监测系统（CGMS）监测血糖,研究联合方案对糖尿患者的治疗效果。方法将48例糖尿病患者随机分为2组：对照组24例和治疗组24例。对照组单纯用胰岛素泵治疗,同时用血糖仪监测指血糖。治疗组用胰岛素泵联合动态血糖监测系统治疗（双c治疗）,比较两组的相应血糖控制指标。结果治疗组的低血糖发生率显著低于对照组（P〈0．05）,治疗组血糖控制的一般情况要优于对照组,如血糖控制时间（4．3±1．7dv．S．6．4±2．3d,P〈0．05）,症状缓解时间（4．5±1．8dv．s．6．6±2．5d,P〈0．05）,平均住院时间（7．1±2．5dv．s10．3±3．3d,P〈0．01）;两组血糖控制的一般情况表明实验组的血糖控制比对照组平稳。结论胰岛素泵联合动态血糖监测系统治疗糖尿病效果要优于单纯使用胰岛素泵,能更好的控制血糖,可以在临床匕推广。     

应用动态血糖监测评估2型糖尿病的低血糖

目的评估2型糖尿病（T2DM）患者治疗中的低血糖、无症状低血糖。方法应用动态血糖监测系统（CGMS）监测1147例血糖控制稳定的T2DM患者血糖（BG）变化。结果2型糖尿病患者：低血糖发生率37．23％,其中无症状低血糖60．80％（697人次）,与病程呈指数曲线负相关。平均血糖（MBG）与低血糖发生率呈指数曲线负相关,与无症状低血糖发生率呈双曲线负相关。随着日内血糖差值逐渐增大,低血糖发生率呈等级增高。结论①2型糖尿病患者治疗中低血糖发生率高,MBG控制越低、日内BG波动越大,则低血糖、无症状低血糖发生率越高;（2）CGMS能及时准确发现无症状低血糖。     

应用动态血糖监测老年糖尿病患者无症状性低血糖的研究进展

<正>糖尿病并发症与控制试验(DCCT)[1]和英国前瞻性糖尿病研究(UKPDS)[2]显示,严格血糖控制可以预防或延缓糖尿病慢性并发症的发生。但是随着血糖控制达标,低血糖的发生机会明显增加,特别是夜间无感知低血糖,往往导致救治不及时而造成严重后果。如何及时准确地发现和预防夜间无症状性低血糖的发生至关重要,目前多采用指尖血糖监测了解血糖水平,但不稳定,随机性大,且由于疼痛及不便等原因,监测次数极为     

24h动态血糖监测妊娠期糖尿病患者的效果观察

目的 观察24h动态血糖监测系统用于妊娠期糖尿病(gestational diabetes mellitus,GDM)患者的效果。 方法 选取2013年1月-2015年1月入院治疗的GDM患者186例,按随机数字表法分为对照组99例、观察组87例。对照组采用传统方法人工测量血糖值(7次/d),观察组采用24h动态血糖监测系统(continuous glycose monitoring system,CGMS)监测血糖,共观察3d。比较2组患者低血糖的发生率。 结果 观察组发生低血糖37例,发生率为42.5%,高于对照组的25.3%(χ²=6.219,P=0.013);观察组发生低血糖的时间主要集中在夜间0∶00-3∶00,有症状低血糖发生率为29.7%,明显低于对照组的56.2%(χ²=7.789,P=0.005)。 结论 24h动态血糖监测系统比传统方法能够更早识别低血糖反应,降低低血糖的发生率,指导GDM的个体化治疗,降低母婴并发症。     

临床护理路径在动态血糖监测联合胰岛素泵治疗期间的效果观察

目的:探讨应用临床护理路径对糖尿病患者实施动态血糖监测联合胰岛素泵治疗健康教育效果。方法:将采用动态血糖监测联合胰岛素泵治疗的80例糖尿病患者随机分成实验组和对照组,各40例。对照组使用常规方法治疗和护理,实验组应用临床护理路径实施护理。结果:实验组患者平均住院时间、对护理满意度、遵医行为、血糖控制方面均优于对照组(P<0.05)。结论:临床路径可行性强,效果好,它体现了以患者为中心的理念,缩短了患者平均住院时间,提高了患者血糖达标率、遵医行为及患者满意度。     

应用动态血糖监测系统监测2型糖尿病患者低血糖的护理体会

目的通过动态血糖监测及时发现低血糖,以便制定更加准确全面的血糖调整方案。方法通过采用动态血糖监测系统(CGMS)对58例2型糖尿病患者进行72h动态血糖监测。结果应用CGMS过程中,27例患者出现69例次低血糖(血糖<3.9mmol/L),其中20例出现无症状低血糖,以0:00～5:00为多;2例因未及时进餐而发生低血糖。结论 CGMS可以更全面反映患者血糖波动情况,有效地降低低血糖的发生,同时帮助医生及时有效地调整胰岛素或降糖药的用量及用法,使患者血糖得到控制。     

应用动态血糖监测系统评估2型糖尿病的无症状低血糖

目的评估2型糖尿病（T2DM）患者的无症状低血糖。方法应用动态血糖监测系统（CGMS）监测1147例血糖控制稳定的T2DM患者连续3d（65—72h）的血糖变化。结果①无症状低血糖发生率25．54％,占低血糖60．8％（697例）,与病程呈指数曲线正相关（r=0．913,tr=3．636,P〈0．05）;②平均血糖（MBG）与无症状低血糖发生率呈双曲线负相关（r=-0．963,P〈0．01）;③随着最大血糖波动幅度（LAGE）增大,无症状低血糖发生率增高;④低血糖发生率男女相仿,与年龄呈负相关（男r=旬．929,tr=5．613,P〈0．01。女r=m．824,tr=3．251,P〈0．01）;⑤老年组MBG水平明显高于非老年组（t=6．81,P〈0．01）,低血糖发生率明显低于非老年组（x^2=60．37,P〈0．01）。结论①2型糖尿病患者无症状低血糖发生率高,且随病程延长而增高。MBG控制越低、最大血糖波动幅度越大,无症状低血糖发生率越高;②放宽老年DM患者血糖控制要求,提高MBG水平可有效降低其低血糖发生率;③cGMS能及时准确发现无症状低血糖。     

动态血糖监测联合胰岛素泵治疗糖尿病的护理

总结78例2型糖尿病患者应用动态血糖监测系统联合胰岛素泵治疗的护理。护理重点是给予糖尿病饮食。加强血糖监测系统及胰岛素泵使用的管理,严密监测血糖变化,并重视心理护理及健康教育,以提高治疗效果。     

实时动态血糖监测系统在胰岛素泵强化治疗初发肥胖2型糖尿病患者低血糖规律中的应用

目的探讨实时动态血糖监测系统在胰岛素泵强化治疗初发肥胖2型糖尿病患者低血糖规律中的应用,以指导临床治疗和护理。方法573例住院初发肥胖2型糖尿病患者胰岛素泵强化治疗1周血糖稳定后,佩戴实时动态血糖监测系统72h,收集数据,进行分析,探讨胰岛素泵强化治疗初发肥胖2型糖尿病患者的低血糖规律。结果平均血糖与无症状低血糖、夜间低血糖发生率均呈双曲线负相关,餐后4h血糖与平均血糖呈直线正相关,晚餐后4h血糖值与夜间低血糖发生率呈指数曲线负相关。晚餐后4h血糖值4．5mmol／L时夜间低血糖发生率达50％以上。结论胰岛素泵强化治疗初发肥胖2型糖尿病患者的低血糖规律,可为胰岛素泵强化治疗而未佩戴实时动态血糖监测系统的初发肥胖2型糖尿病患者提供低血糖常见时段的参考,指导临床治疗和护理,具有重要的临床意义和社会经济效益。     

Improving epinephrine responses in hypoglycemia unawareness with real-time continuous glucose monitoring in adolescents with type 1 diabetes

OBJECTIVE

To determine whether real-time continuous glucose monitoring (CGM) with preset alarms at specific glucose levels would prove a useful tool to achieve avoidance of hypoglycemia and improve the counterregulatory response to hypoglycemia in adolescents with type 1 diabetes with hypoglycemia unawareness.

RESEARCH DESIGN AND METHODS

Adolescents with type 1 diabetes with hypoglycemia unawareness underwent hyperinsulinemic hypoglycemic clamp studies at baseline to determine their counterregulatory hormone responses to hypoglycemia. Subjects were then randomized to either standard therapy or real-time CGM for 4 weeks. The clamp study was then repeated.

RESULTS

The epinephrine response during hypoglycemia after the intervention was greater in the CGM group than in the standard therapy group.

CONCLUSIONS

A greater epinephrine response during hypoglycemia suggests that real-time CGM is a useful clinical tool to improve hypoglycemia unawareness in adolescents with type 1 diabetes.Hypoglycemia unawareness is defined as the onset of neuroglycopenia before autonomic activation (1). Patients have defective symptomatic and counterregulatory responses, in particular impaired epinephrine response to hypoglycemia. Both defective counterregulatory responses and hypoglycemia unawareness constitute the hypoglycemia-associated autonomic failure associated with recurrent iatrogenic hypoglycemia (2–4).In adults, it has been demonstrated that as little time as 2 to 3 weeks of avoidance of hypoglycemia reverses hypoglycemia unawareness and improves the attenuated epinephrine component of defective counterregulation in affected patients (5–7). Although strict avoidance of hypoglycemia can restore autonomic symptoms of hypoglycemia and improve counterregulatory responses to hypoglycemia, this is difficult to achieve in practice. Real-time continuous glucose monitoring (CGM) allows patients to view their blood glucose levels almost instantaneously and offers potential to reduce hypoglycemia frequency.This study was designed to determine whether real-time CGM with preset alarms at specific glucose levels would prove a useful tool to achieve avoidance of hypoglycemia and therefore improve the counterregulatory response to hypoglycemia in adolescents with type 1 diabetes with hypoglycemia unawareness.     

Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes

OBJECTIVE

To assess the impact of continuous glucose monitoring on hypoglycemia in people with type 1 diabetes.

RESEARCH DESIGN AND METHODS

In this randomized, controlled, multicenter study, 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glycated hemoglobin A_1c (HbA_1c) <7.5% were randomly assigned to a control group performing conventional home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring. The primary outcome was the time spent in hypoglycemia (interstitial glucose concentration <63 mg/dL) over a period of 26 weeks. Analysis was by intention to treat for all randomized patients.

RESULTS

The time per day spent in hypoglycemia was significantly shorter in the continuous monitoring group than in the control group (mean ± SD 0.48 ± 0.57 and 0.97 ± 1.55 h/day, respectively; ratio of means 0.49; 95% CI 0.26–0.76; P = 0.03). HbA_1c at 26 weeks was lower in the continuous monitoring group than in the control group (difference −0.27%; 95% CI −0.47 to −0.07; P = 0.008). Time spent in 70 to 180 mg/dL normoglycemia was significantly longer in the continuous glucose monitoring group compared with the control group (mean hours per day, 17.6 vs. 16.0, P = 0.009).

CONCLUSIONS

Continuous glucose monitoring was associated with reduced time spent in hypoglycemia and a concomitant decrease in HbA_1c in children and adults with type 1 diabetes.The benefits of intensive treatment of type 1 diabetes, established almost 20 years ago (1), are difficult to achieve, despite the increased use of insulin analogs and insulin pumps, with only a minority of patients maintaining their glycated hemoglobin A_1c (HbA_1c) within the target range (2). Intensive insulin treatment and lower HbA_1c increase exposure to hypoglycemia (3,4). The risk of hypoglycemia is even higher in children and adolescents (5,6) and increases with the duration of diabetes (7). Frequent hypoglycemia is associated with hypoglycemia unawareness (8,9), which may in turn lead to reduced adherence to therapeutic decisions (10). Finally, hypoglycemia may be associated with permanent damage to the central nervous system (11) and may permanently influence cognitive functions in children (12) but not in adults (13).Recently, devices for real-time continuous glucose monitoring have been introduced to aid self-management of glycemic control and have been shown to improve HbA_1c levels in people with type 1 diabetes (14–17). In clinical practice recommendations, it has also been suggested that continuous glucose monitoring is especially useful in patients with hypoglycemia unawareness and/or frequent episodes of hypoglycemia (18). However, the hypoglycemia preventive effect of continuous glucose monitoring has not been established. Therefore, we designed a randomized, controlled, multicenter clinical trial to evaluate the effect of continuous glucose monitoring on hypoglycemia in children and adults with type 1 diabetes.     

利用动态血糖监测早期发现无症状低血糖症对脑卒中合并糖尿病患者康复治疗的意义

目的:评价动态血糖监测系统(continuous glucose monitoring system,CGMS)对脑卒中合并糖尿病患者在康复治疗中发生无症状低血糖症的意义。方法:35例康复医学科脑卒中合并糖尿病患者入院后在康复治疗介入时均安装CGMS,连续佩戴72h,同时使用便携式末梢血糖仪和试纸进行每日末梢血糖监测(三餐前、三餐后2h、睡前及凌晨3∶00),比较两种方法对低血糖及无症状低血糖检出情况。结果:CGMS监测出无症状低血糖例数比末梢血糖监测高,差异有显著性意义(P0.01)。35例患者无症状低血糖多发生在3∶00—8∶00,占22.86%,血糖值平均为(3.25±1.07)mmol/L,最低值为2.3mmol/L。结论:CGMS能及时监测无症状低血糖现象,避免风险发生。     

糖尿病患者动态血糖监测低血糖及危险因素评估

目的探讨糖尿病患者实施动态血糖监测低血糖的意义,同时评估发生低血糖的危险因素。方法选择1型糖尿病或胰岛功能较差的2型糖尿病患者41例。采用动态血糖监测系统连续72h血糖监测,同期每天测毛细血管血糖,采集患者的身高、体重、血压、糖尿病病程、HbA1c等资料。分析低血糖发生次数及持续时间,总结低血糖发生特点及与患者临床特征的相关性。结果 41例糖尿病患者中,72h内指测毛细血管血糖发现低血糖患者13例(17例次),动态血糖监测发现低血糖29例(43例次),其中无症状低血糖22例(占75.9%)、有症状低血糖7例(占24.1%)。低血糖好发于后半夜,危险因素包括性别、年龄、时段、HbA1c和指测最低血糖值。当HbA1c/(指测最低血糖值·BMI)≥0.04时,78%患者动态血糖监测可见低血糖反应;当该指数0.04时,未见低血糖患者。结论对于胰岛功能较差的糖尿病患者,常规每天6次指测毛细血管血糖易漏诊后半夜低血糖的发现。HbA1c/(指测最低血糖值·BMI)可作为低血糖的预测指数,该指数≥0.04提示低血糖风险较高,宜行动态血糖监测。     

动态血糖监测系统在临床中的应用

目的：探讨动态血糖监测系统监测糖尿病患者血糖变化的精确性及护理要点和注意事项。方法：采用动态血糖监测系统对50例2型糖尿病患者在护理指导下进行72h连续血糖监测。结果：50例2型糖尿病患者中有43例患者存在餐后高血糖,2例出现黎明现象,3例存在无感知低血糖。患者行动态血糖监测系统检查的耐受性良好,无不良反应。结论：加强动态血糖监测系统知识的宣教和护理观察,有助于获得完整可靠的血糖变化信息,及时发现和预防患者即时的血糖漂移,对2型糖尿病患者的血糖控制和指导胰岛素及口服药物治疗方案的调整有重要的指导意义。     

Effect of 2 weeks of theophylline on glucose counterregulation in patients with type 1 diabetes and unawareness of hypoglycemia

BACKGROUND AND OBJECTIVE: A single dose of theophylline improves hypoglycemia unawareness in type 1 diabetic patients. Prolonged theophylline use is, however, associated with emergence of tolerance. This study investigated whether prolonged use of theophylline retains efficacy for counterregulatory defects in patients with type 1 diabetes and hypoglycemia unawareness. METHODS: Experiments were performed with 12 subjects with type 1 diabetes and hypoglycemia unawareness. All subjects participated in a crossover study of 2 randomly scheduled 15-day study periods during which 250 mg theophylline twice daily or matching placebo was used. On the final day of each period, hyperinsulinemic (360 pmol x m(-2) x min(-1)) hypoglycemic (5.0, 3.5, 2.5 mmol x L(-1)) glucose clamps were used to assess counterregulatory and cardiovascular responses. RESULTS: Under normoglycemic conditions, there were no differences between theophylline and placebo. Under hypoglycemic conditions, theophylline enhanced responses of growth hormone, symptoms, heart rate, and pulse pressure (all P <.05), induced sweating at higher plasma glucose levels (P =.039), and reduced exogenous glucose requirements (P =.018). Hypoglycemia-induced responses of epinephrine, norepinephrine, and cortisol were not enhanced by theophylline. CONCLUSIONS: Prolonged use of theophylline has a sustained effect on cardiovascular, metabolic, and symptom responses to hypoglycemia in patients with type 1 diabetes and hypoglycemia unawareness. Whether these results translate into clinical benefit remains to be determined.     

实时动态血糖监测在2型糖尿病患者无症状低血糖中的应用效果

目的探讨实时动态血糖监测在2型糖尿病患者无症状低血糖中的应用效果。方法 174例患者入院时均安装实时动态血糖监测系统连续佩戴72 h,同时使用便携式末梢血糖仪和试纸进行每日末梢血糖监测(空腹,三餐前,夜间100),分析两种方法无症状低血糖检出情况。结果实时动态血糖监测出低血糖例数比末梢血糖监测高,差异有统计学意义(P0.01)。174例患者无症状性低血糖多发生在夜间000~600,其中200~400发生率最高,达10.34%,血糖值平均为(3.30±1.14)mmol/L,最低值为2.2 mmol/L。结论实时动态血糖监测能及时监测无症状低血糖现象,避免风险发生。     

Influence of caffeine on frequency of hypoglycemia detected by continuous interstitial glucose monitoring system in patients with long-standing type 1 diabetes

OBJECTIVE: The aim of this study was to investigate the effect of caffeine (in doses equivalent to normal daily ingestion) on rates and severity of hypoglycemia in patients with long-standing type 1 diabetes to determine the relationship between caffeine, autonomic function, and hypoglycemia. RESEARCH DESIGN AND METHODS: Using a double-blinded randomized study, we investigated the effect of caffeine versus placebo in 19 patients with long-standing type 1 diabetes using continuous glucose sensing technology and simultaneous assessment of autonomic function using Holter monitoring. RESULTS: Caffeine reduced the duration of nocturnal hypoglycemia with a mean duration of 49 minutes (range 0-235) versus 132 (0-468) minutes (P = 0.035). The reduction in duration of nighttime hypoglycemia was due to a decline in the number of episodes of moderate hypoglycemia at the expense of mild hypoglycemic episodes (P = 0.04). There was no overall correlation between reduced heart rate variability (a marker of autonomic dysfunction) and hypoglycemic events (r(s) = 0.12, P = 0.62). CONCLUSIONS: Our results suggest that caffeine is associated with a significant reduction in nocturnal hypoglycemia. The reduction in nocturnal hypoglycemia was not linked to the concomitant rise in parasympathetic activity associated with caffeine.