Benefits of self-monitoring blood glucose in the management of new-onset Type 2 diabetes mellitus: The St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups
Benefits of self-monitoring blood glucose in the management of new-onset Type 2 diabetes mellitus: The St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups
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DOI：
10.1111/j.1753-0407.2010.00081.x
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发表时间：
2010-09-01
影响因子：
4.5
通讯作者：
Luis Calle-Pascual, Alfonso
中科院分区：
文献类型：
--
作者：
Duran, Alejandra;Martin, Patricia;Luis Calle-Pascual, Alfonso
背景：2型糖尿病（T2 DM）患者从确诊之时起接受强化治疗有助于β细胞恢复。以自我血糖监测（SMBG）为基础的教育和药物干预可能优于传统的HbA 1c算法治疗新诊断的T2 DM。方法：将新诊断的T2 DM患者随机分为以SMBG为基础的干预组和以HbA 1c为基础的对照组（分别为99例和62例），随访1年。更高的糖尿病消退率（二甲双胍单药治疗时HbA 1c < 6%）和缓解HbA 1c在6.0%~ 6.4%之间的干预组与对照组相比分别为39%vs5%（P < 0.001）和37%vs30%（P < 0.01）。此外，在1年的治疗中，干预组的中位HbA 1c（6.6%至6.1%; P < 0.05）和体重指数（29.6-27.9 kg/m2; P < 0.001）下降幅度更大。SMBG组生活方式评分> 12分的患者比例显著高于对照组（分别为38.4%和9.7%; P < 0.001）。SMBG与HbA 1c水平呈负相关（P <0. 04）。结论：基于SMBG的结构化教育和药理学项目使患者能够实现营养和体力活动目标，并鼓励医生和患者使用SMBG来优化治疗。我们认为，T2 DM患者强化治疗的概念应该修改;该术语不应指治疗类型（胰岛素使用），而应反映我们为达到血糖目标而努力的强度。
Background: Intensive treatment of patients with Type 2 diabetes mellitus (T2DM) from the moment of diagnosis facilitates beta-cell recovery. Self-monitoring of blood glucose (SMBG)-based educational and pharmacological intervention may be better than conventional HbA1c algorithms in the treatment of newly diagnosed T2DM.Methods: Newly diagnosed T2DM patients were randomized to either an SMBG-based intervention or an HbA1c-based control group (n = 99 and 62, respectively) and were followed for 1 year.Results: Higher rates of diabetes regression (HbA1c < 6% on metformin alone) and remission (HbA1c between 6.0% and 6.4%) were achieved in the intervention compared with the control group (39% vs 5% (P < 0.001) and 37% vs 30% (P < 0.01), respectively). Furthermore, significantly greater reductions in median HbA1c (6.6% to 6.1%; P < 0.05) and body mass index (29.6-27.9 kg/m(2); P < 0.001) were seen in the intervention over the 1 year of therapy. The percentage of patients achieving a lifestyle score > 12 was significantly greater in the SMBG compared with the control group (38.4% vs 9.7% respectively; P < 0.001). An inverse correlation was observed between SMBG and HbA1c levels (P < 0.04).Conclusions: The results indicate that SMBG-based structured educational and pharmacological programs empower patients to achieve nutritional and physical activity goals, and encourage physicians and patients to use SMBG to optimize therapy. We believe that the concept of intensive treatment of T2DM patients should be modified; instead of referring to the type of treatment (insulin use), the term should reflect the intensity with which we work to reach glucose objectives.