Measures of Glycemic Variability in Type 1 Diabetes and the Effect of Real-Time Continuous Glucose Monitoring
Measures of Glycemic Variability in Type 1 Diabetes and the Effect of Real-Time Continuous Glucose Monitoring
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DOI：
10.1089/dia.2016.0146
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发表时间：
2016-12-01
影响因子：
5.4
通讯作者：
Oliver, Nick S.
中科院分区：
文献类型：
--
作者：
El-Laboudi, Ahmed H.;Godsland, Ian F.;Oliver, Nick S.
目的：报告动态血糖监测（CGM）对血糖变异性（GV）指数的影响，预测变化的因素，并将变异性与传统标志物的risk.Methods：数据来自JDRF研究CGM的参与者与1型糖尿病。参与者被随机分配到CGM或自我监测血糖（SMBG）。分析两组基线、26周和对照组52周时的GV指数。人口统计学和临床因素与GV指数从基线到26 wk的变化进行了评估。GV指数均超出正常范围（P < 0.001）。GV指数之间的相互关系很常见，除变异系数（CV）、低血糖指数（LBGI）和低血糖导致的血糖风险评估糖尿病方程评分百分比（%GRADE（低血糖））外，所有指数均与HbA1c呈正相关。低血糖时间与CV、LBGI和%GRADE（低血糖）之间存在强相关性，但与HbA1c无关。与对照组相比，干预组在26周时所有GV指数（不稳定指数和单位时间平均绝对葡萄糖变化（MAG）除外）均显著降低。基线因素预测与CGM GV的变化包括基线HbA1c，基线GV，每日SMBG的频率，和胰岛素泵use.Conclusions：CGM降低大多数GV指数相比，SMBG在1型糖尿病患者。低血糖花费时间与CV、LBGI和%GRADE（低血糖）之间的强相关性突出了这些指标在评估低血糖时的价值，作为HbA1c的辅助指标，用于总体评估HbA1c。
Objective: To report the impact of continuous glucose monitoring (CGM) on glycemic variability (GV) indices, factors predictive of change, and to correlate variability with conventional markers of glycemia.Methods: Data from the JDRF study of CGM in participants with type 1 diabetes were used. Participants were randomized to CGM or self-monitored blood glucose (SMBG). GV indices at baseline, at 26 weeks in both groups, and at 52 weeks in the control group were analyzed. The associations of demographic and clinical factors with change in GV indices from baseline to 26 weeks were evaluated.Results: Baseline data were available for 448 subjects. GV indices were all outside normative ranges (P < 0.001). Intercorrelation between GV indices was common and, apart from coefficient of variation (CV), low blood glucose index (LBGI), and percentage of glycemic risk assessment diabetes equation score attributable to hypoglycemia (%GRADE(hypoglycemia)), all indices correlate positively with HbA1c. There was strong correlation between time spent in hypoglycemia, and CV, LBGI, and %GRADE(hypoglycemia), but not with HbA1c. A significant reduction in all GV indices, except lability index and mean absolute glucose change per unit time (MAG), was demonstrated in the intervention group at 26 weeks compared with the control group. Baseline factors predicting a change in GV with CGM include baseline HbA1c, baseline GV, frequency of daily SMBG, and insulin pump use.Conclusions: CGM reduces most GV indices compared with SMBG in people with type 1 diabetes. The strong correlation between time spent in hypoglycemia and CV, LBGI, and %GRADE(hypoglycemia) highlights the value of these metrics in assessing hypoglycemia as an adjunct to HbA1c in the overall assessment of glycemia.