Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes
Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes
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DOI：
10.1111/j.1399-5448.2010.00650.x
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发表时间：
2011-02-01
影响因子：
3.4
通讯作者：
Holl, Reinhard
中科院分区：
文献类型：
--
作者：
Ziegler, Ralph;Heidtmann, Bettina;Holl, Reinhard
本研究的目的是将自我监测血糖（SMBG）的频率与血红蛋白A1c （HbA1c）测量的代谢控制质量、低血糖和酮症酸中毒的频率联系起来，并观察SMBG与这些结果之间的关联是否受到患者年龄或治疗方案的影响。我们分析了dpv - wss数据库中1995-2006年间记录的26 723名0-18岁1型糖尿病儿童和青少年的数据。评估的变量包括性别、就诊年龄、糖尿病病程、治疗方案、胰岛素剂量、体重指数-标准差评分（BMI-SDS）、糖化血红蛋白（HbA1c）、低血糖率和酮症酸中毒。年龄最小的6岁以下儿童发生SMBG的频率最高，分别为6.0/d、5.3/d、4.4/d （p < 0.001）。在不同的治疗组中，SMBG的频率也有显著差异（p < 0.001），但只有连续皮下胰岛素输注（CSII）组的频率明显更高：5.3/d (CSII) vs 4.7/d（每日多次注射）vs 4.6/d（常规治疗）。调整年龄、性别、糖尿病病程、治疗年份、胰岛素方案、胰岛素剂量、BMI-SDS和中心差异后，SMBG频率与更好的代谢控制显著相关，每天增加一个SMBG可使HbA1c下降0.20% （p < 0.001）。将SMBG频率增加到5次/d以上并不能进一步改善代谢控制。更高频率的SMBG测量与更好的代谢控制有关。但只有在10 - 12岁的青少年中，代谢控制（HbA1c）在两次或两次以上的血糖测量中明显改善。
The aim of this study was to correlate the frequency of self-monitoring of blood glucose (SMBG) to the quality of metabolic control as measured by hemoglobin A1c (HbA1c), the frequency of hypoglycemia and ketoacidosis, and to see whether the associations between SMBG and these outcomes are influenced by the patient's age or treatment regime. We analyzed data from the DPV-Wiss-database of 26 723 children and adolescents aged 0-18 yr with type 1 diabetes recorded during 1995-2006. Variables evaluated were gender, age at visit, diabetes duration, therapy regime, insulin dose, body mass index-standard deviation scores (BMI-SDS), HbA1c, rate of hypoglycemia, and ketoacidosis. In the youngest age group of children under the age of 6 yr, the frequency of SMBG was the highest compared with that in children aged 6-12 yr or children aged > 12 yr: 6.0/d vs. 5.3/d vs. 4.4/d (p < 0.001). Frequency of SMBG differed significantly also in the different groups of treatment (p < 0.001), but only for the continuous subcutaneous insulin infusion (CSII) group the frequency was considerably higher: 5.3/d (CSII) vs. 4.7/d (multiple daily injections) vs. 4.6/d (conventional therapy). Adjusted for age, gender, diabetes duration, year of treatment, insulin regimen, insulin dose, BMI-SDS, and center difference, SMBG frequency was significantly associated with better metabolic control with a drop of HbA1c of 0.20% for one additional SMBG per day (p < 0.001). Increasing the SMBG frequency above 5/d did not result in further improvement of metabolic control. A higher frequency of SMBG measurements was related to better metabolic control. But only among adolescents aged > 12 yr, metabolic control (HbA1c) improved distinctively with two or more blood glucose measurements.