Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus.
Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus.
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DOI：
10.1080/713606657
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发表时间：
2003-10-01
期刊：
影响因子：
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通讯作者：
Phillip, M
中科院分区：
文献类型：
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作者：
Chen, R;Yogev, Y;Phillip, M
目的：比较每日血糖曲线反映的连续与自我监测血糖的妇女与妊娠期糖尿病（GDM），并评估可能的差异，在治疗策略的基础上的两个monitoringmethods.MATERIALS和METHODS：研究样本包括57名妇女与妊娠期糖尿病，47在以色列和10在加州。以色列妇女的怀孕年龄为24至32周，美国妇女为32至36周。将来自连续葡萄糖监测（CGM）系统（MiniMed）72小时的数据与手指针刺葡萄糖测量结果（每天6-8次）进行比较。在连续监测期间，患者记录的时间摄入食物，胰岛素注射和低血糖events.RESULTS：在以色列组，23名妇女单独饮食治疗，24饮食加胰岛素。每例患者平均记录763 +/- 62次葡萄糖测量值，并进行持续葡萄糖监测。用手指针刺法未检测到的高血糖（葡萄糖水平> 140 mg/dl）的平均总时间在胰岛素治疗组为132 ± 31分钟/天，在饮食治疗组为94 ± 23分钟/天。在14名患者中记录了夜间低血糖事件（葡萄糖水平< 50 mg/dl），所有患者均接受胰岛素治疗。根据连续监测提供的额外信息，47例患者中有36例改变了治疗方案（胰岛素治疗、饮食调整或两者兼而有之）。所有10名美国妇女都接受了胰岛素治疗。在30天的总组监测时间内，未检测到高血糖的平均时间为78 ± 13分钟/天。8名女性在总共12个晚上的监测中至少有一个晚上发生了夜间低血糖。根据动态血糖监测提供的数据，对所有孕妇进行胰岛素剂量调整。结论：动态血糖监测有助于监测妊娠期糖尿病妇女，并有助于调整糖尿病治疗。它可以准确地检测高餐后血糖水平和夜间低血糖事件，这些事件可能会被间歇性血糖监测所识别。需要对产妇和新生儿结局进行大型前瞻性研究，以确定这种新监测技术的临床意义。
OBJECTIVES: To compare the daily glycemic profile reflected by continuous versus self-monitoring of blood glucose in women with gestational diabetes mellitus (GDM), and to evaluate possible differences in treatment strategy based on the two monitoring methods.MATERIALS AND METHODS: The study sample consisted of 57 women with gestational diabetes, 47 in Israel and ten in California. Gestational age ranged from 24 to 32 weeks in the Israeli women, and 32 to 36 weeks in the American women. Data derived from the Continuous Glucose Monitoring (CGM) System (MiniMed) for 72 h were compared to fingerstick glucose measurements (6-8 times a day). During continuous monitoring, patients documented the timing of food intake, insulin injections and hypoglycemic events.RESULTS: In the Israeli group, 23 women were treated by diet alone, and 24 by diet plus insulin. An average of 763 +/- 62 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level > 140 mg/dl) undetected by the fingerstick method was 132 +/- 31 min/day in the insulin-treated group and 94 +/- 23 min/day in the diet-treated group. Nocturnal hypoglycemic events (glucose levels < 50 mg/dl) were recorded in 14 patients, all insulin-treated. On the basis of the additional information provided by continuous monitoring, the therapeutic regimen (insulin therapy, diet adjustment, or both) was changed in 36 of the 47 patients. All ten American women were treated with insulin. The mean time of undetected hyperglycemia for a total group monitoring time of 30 days was 78 +/- 13 min/day. Eight women had nocturnal hypoglycemia on at least one of the three nights of monitoring for a total of 12 nights. A change in insulin dosage was made in all women on the basis of the data provided by continuous glucose monitoring.CONCLUSION: Continuous glucose monitoring is helpful for monitoring women with GDM and for adjusting diabetes therapy. It can accurately detect high postprandial blood glucose levels and nocturnal hypoglycemic events that may go unrecognized by intermittent blood glucose monitoring. A large prospective study on maternal and neonatal outcome is needed to determine the clinical implications of this new monitoring technique.