Limitations of conventional methods of self-monitoring of blood glucose - Lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes
Limitations of conventional methods of self-monitoring of blood glucose - Lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes
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DOI：
10.2337/diacare.24.11.1858
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发表时间：
2001-11-01
期刊：
影响因子：
16.2
通讯作者：
Tamborlane, WV
中科院分区：
文献类型：
--
作者：
Boland, E;Monsod, T;Tamborlane, WV
目的：I型糖尿病儿童通常被要求在饭前和睡前自我监测血糖(SMBG)，并假设如果结果在目标范围内，以及HBA(1c)测量，那么总体血糖控制是足够的。然而，SMBG提供的24小时血糖谱中的短暂一瞥可能会遗漏显著的血糖漂移。MiniMed连续血糖监测系统(CGMS)提供了一种新的方法来获得连续的血糖曲线，并提供了检查传统监测局限性的机会。研究设计和方法-共有56名I型糖尿病儿童(年龄2-18岁)佩戴CGMS 3天。患者将四个手指血样输入监护仪进行校准，并记录食物摄入量、运动和低血糖症状。结果：尽管糖化血红蛋白(1c)水平令人满意(7.7+/-1.4%)，餐前血糖水平接近目标范围，但CGMS显示出严重的餐后高血糖。几乎90%的餐后血糖峰值是180毫克/分升(高于目标)，近50%是300毫克/分升。此外，CGMS显示，几乎70%的儿童出现频繁且持续的无症状低血糖(葡萄糖60 mg/dl)。结论：尽管儿童的糖化血红蛋白(1c)水平和目标餐前血糖水平良好，但儿童经常出现常规监测中不明显的夜间低血糖和餐后高血糖。重复使用CGMS可能为优化1型糖尿病患者的基础和团注胰岛素替代提供一种手段。
OBJECTIVE - Children with type I diabetes are usually asked to perform Self-monitoring of blood glucose (SMBG) before meals and at bedtime, and it is assumed that if results are in target range, along with HbA(1c) measurements, then overall glycemic control is adequate. However, the brief glimpses in the 24-h glucose profile provided by SMBG may miss marked glycemic excursions. The MiniMed Continuous Glucose Monitoring System (CGMS) his provided a new method to obtain continuous glucose profiles and opportunities to examine limitations Of conventional monitoring.RESEARCH DESIGN AND METHODS - A total of 56 children with type I diabetes (age 2-18 years) wore the CGMS for 3 days. Patients entered four Fingerstick blood samples into the monitor for calibration and kept records of food intake, exercise, and hypoglycemic symptoms. Data were downloaded, and glycemic patterns were identified.RESULTS - Despite satisfactory HbA(1c) levels (7.7 +/- 1.4%) and premeal glucose levels near the target range, the CGMS revealed profound postprandial hyperglycemia. Almost 90% of the peak postprandial glucose levels after every, meal were > 180 mg/dl (above target), and almost 50% were > 300 mg/dl. Additionally, the CGMS revealed frequent and prolonged asymptomatic hypoglycemia (glucose < 60 mg/dl) in almost 70% of the children.CONCLUSIONS - Despite excellent HbA(1c) levels and target preprandial glucose levels, children often experience nocturnal hypoglycemia and postprandial hyperglycemia that are not evident with routine monitoring. Repeated use of the CGMS may provide a means to optimize basal and bolus insulin replacement in patients with type 1 diabetes.