基于动态血糖监测结果评价门诊教育对2型糖尿病患者血糖谱的影响研究

doi:10.12114/j.issn.1007-9572.2023.0769

摘要/Abstract

摘要： 背景动态血糖监测（CGM）在门诊患者治疗中应用较少，基于CGM进行糖尿病教育，改变不良的生活、饮食习惯对血糖谱的影响尚不清楚。目的基于回顾性CGM结果，对使用口服降糖药的门诊2型糖尿病（T2DM）患者进行饮食、运动等门诊教育，评价其对患者血糖谱的影响。方法选取2021于南京市第一医院内分泌科门诊就诊使用口服降糖药的T2DM患者88例，其中男60例、女28例，给予CGM。入组患者给予门诊教育，即第1~3天维持原降糖治疗方案及生活习惯；第4天下载并分析CGM数据，结合患者饮食、运动等门诊教育，第6天取下CGM传感器和记录器，下载数据。比较第2天和第5天动态血糖数据[24 h平均血糖（MBG），平均血糖波动幅度（MAGE），葡萄糖目标范围内时间（TIR）]。结果基于CGM结果，给予门诊教育后（第5天）T2DM患者的MBG由（8.34±1.97）mmol/L下降到（7.85±1.65）mmol/L，TIR由（78.21±24.64）%上升到（84.28±21.87）%，MAGE由（4.53±2.25）mmol/L下降到（3.80±1.80）mmol/L（P<0.05）。按糖尿病病程、年龄进行分层分析：病程<10年组（62例）和病程≥10年组（26例）干预后MBG均较干预前降低，干预后病程<10年组标准差（SD）、MAGE、TAR较干预前降低，TIR较干预前升高（P<0.05）；按年龄分为<65岁组（55例）和≥65岁组（33例），两组干预后MBG、TAR较干预前降低，TIR较干预前升高，干预后<65岁组SD、MAGE较干预前降低（P<0.05）。结论基于CGM结果，对使用口服降糖药物的门诊T2DM患者进行饮食、运动等门诊教育，可以有效改善患者MBG、提高TIR水平，改善血糖变异度；<65岁、糖尿病病程<10年的患者获益更大。

关键词: 血糖自我监测, 动态血糖监测, 糖尿病，2型, 健康教育, 血糖谱, 目标范围内时间

Abstract:

Background

Continuous glucose monitoring (CGM) is rarely applied to outpatient treatments. The impact of CGM-based diabetes education to change unhealthy living and eating habits on the blood glucose profile is still unclear.

Objective

Based on the retrospective results of CGM, outpatient education such as diet and exercise was applied to outpatients with type 2 diabetes mellitus (T2DM) who were managed by oral hypoglycemic drugs. This study aims to evaluate the effects on blood glucose profiles.

Methods

A total of 88 outpatient T2DM patients medicated with oral hypoglycemic drugs in the Department of Endocrinology, Nanjing First Hospital in 2021 were included and managed by CGM, involving 60 male and 28 female patients. The enrolled patients maintained the original hypoglycemic treatment regimen and lifestyle habits on the 1st to 3rd day. On the 4th day, we downloaded and analyzed CGM data and provided outpatient education based on individualized eating habit and exercise. On the 6th day, the CGM sensor and recorder were removed. CGM data on the 2nd day versus 5th day were compared for dynamic blood glucose profiles, including the 24 h mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and time in target glucose range (TIR) .

Results

Based on the CGM results, MBG in outpatients with T2DM on the 5th day after outpatient education was significantly reduced from (8.34±1.97) mmol/L to (7.85±1.65) mmol/L (P<0.05). TIR was significantly elevated from (78.21±24.64) % to (84.28±21.87) % (P<0.05). Moreover, MAGE was significantly reduced from (4.53±2.25) mmol/L to (3.80±1.80) mmol/L (P<0.05). Stratified by the course of T2DM, MBG after outpatient education significantly decreased in both patients with T2DM course <10 years (n=62) and those with T2DM course ≥10 years (n=26) than the baseline before education (P<0.05). After outpatient education, the standard deviation (SD), MAGE and target glucose range (TAR) were significantly reduced, while TIR was significantly elevated in patients with T2DM course <10 years (P<0.05). Stratified by age, MBG and TAR after outpatient education were significantly reduced in both patients aged <65 years old (n=55) and those aged ≥65 years old (n=33) than the baseline before education, while TIR was significantly elevated (P<0.05). SD and MAGE were significantly reduced after outpatient education in patients aged <65 years old (P<0.05) .

Conclusion

Based on CGM results, outpatient education such as diet and exercise could effectively improve MBG, TIR levels, and blood glucose variability in outpatient T2DM patients using oral hypoglycemic drugs. Patients with less than 10 years of T2DM course and younger than 65 years of age gain more clinical benefits.

Key words: Blood glucose self-monitoring, Continuous glucose monitoring, Diabetes mellitus, type 2, Health education, Blood glucose profile, Time in range

中图分类号:

R 587.1

周潇,周云婷,孔小岑,等. 基于动态血糖监测结果评价门诊教育对2型糖尿病患者血糖谱的影响研究[J]. 中国全科医学, 2024, 27(21): 2572-2577. DOI: 10.12114/j.issn.1007-9572.2023.0769.
ZHOU Xiao,ZHOU Yunting,KONG Xiaocen, et al. Effect of Outpatient Education on Blood Glucose Profile of Type 2 Diabetes Mellitus Patients Based on the Results of Continuous Glucose Monitoring[J]. Chinese General Practice, 2024, 27(21): 2572-2577. DOI: 10.12114/j.issn.1007-9572.2023.0769.

图/表 6

参考文献 26

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项目	数值
性别（男/女）	60/28
年龄[M（P₂₅，P₇₅），岁]	61.0（51.3，67.8）
病程[M（P₂₅，P₇₅），年]	5（2，10）
Hb（g/L）	146.61±27.19
BUN（mmol/L）	5.19±1.14
Scr（μmol/L）	66.47±13.60
ALT（U/L）	25.14±9.87
AST（U/L）	24.18±8.17
Alb（g/L）	43.90±3.31
TP（g/L）	71.28±4.06
UA（μmol/L）	332.02±81.69
TC（mmol/L）	4.76±1.54
TG[M（P₂₅，P₇₅），mmol/L]	1.66（0.97，2.35）
HDL（mmol/L）	1.19±0.27
LDL（mmol/L）	2.56±0.98
HbA_1c（%）	6.85±0.97

项目	数值
性别（男/女）	60/28
年龄[M（P₂₅，P₇₅），岁]	61.0（51.3，67.8）
病程[M（P₂₅，P₇₅），年]	5（2，10）
Hb（g/L）	146.61±27.19
BUN（mmol/L）	5.19±1.14
Scr（μmol/L）	66.47±13.60
ALT（U/L）	25.14±9.87
AST（U/L）	24.18±8.17
Alb（g/L）	43.90±3.31
TP（g/L）	71.28±4.06
UA（μmol/L）	332.02±81.69
TC（mmol/L）	4.76±1.54
TG[M（P₂₅，P₇₅），mmol/L]	1.66（0.97，2.35）
HDL（mmol/L）	1.19±0.27
LDL（mmol/L）	2.56±0.98
HbA_1c（%）	6.85±0.97

时间	1 h	2 h	3 h	4 h	5 h	6 h	7 h	8 h	9 h	10 h	11 h	12 h
第2天血糖	7.41±2.28	7.01±2.14	6.87±2.00	6.84±1.91	6.87±1.91	7.02±1.90	7.42±2.00	8.19±2.20	9.29±2.31	9.79±2.75	9.32±2.99	8.85±3.23
第5天血糖	6.94±1.66	6.68±1.51	6.55±1.46	6.48±1.54	6.59±1.57	6.76±1.60	7.02±1.63	7.63±1.84	8.90±2.43	9.19±2.82	8.40±2.72	7.67±2.40
t_配对值	2.37	1.87	1.75	1.93	1.74	1.85	3.05	3.04	1.62	2.23	3.49	3.88
P值	0.020	0.065	0.084	0.057	0.086	0.068	0.003	0.003	0.110	0.028	0.001	<0.001
时间	13 h	14 h	15 h	16 h	17 h	18 h	19 h	20 h	21 h	22 h	23 h	24 h
第2天血糖	8.87±3.17	9.52±2.89	9.39±2.83	8.98±2.76	8.63±2.53	8.32±2.61	8.52±2.57	8.96±2.67	9.22±3.00	8.83±3.03	8.33±2.77	7.72±2.43
第5天血糖	7.83±2.33	8.66±2.57	8.83±2.70	8.72±2.78	8.36±2.76	7.95±2.57	7.89±2.37	8.37±2.18	8.75±2.18	8.51±2.31	8.12±2.37	7.66±2.10
t_配对值	3.72	3.11	2.00	1.02	1.11	1.49	2.94	2.72	1.73	1.20	0.85	0.28
P值	<0.001	0.003	0.049	0.311	0.270	0.140	0.004	0.008	0.086	0.233	0.397	0.778

时间	1 h	2 h	3 h	4 h	5 h	6 h	7 h	8 h	9 h	10 h	11 h	12 h
第2天血糖	7.41±2.28	7.01±2.14	6.87±2.00	6.84±1.91	6.87±1.91	7.02±1.90	7.42±2.00	8.19±2.20	9.29±2.31	9.79±2.75	9.32±2.99	8.85±3.23
第5天血糖	6.94±1.66	6.68±1.51	6.55±1.46	6.48±1.54	6.59±1.57	6.76±1.60	7.02±1.63	7.63±1.84	8.90±2.43	9.19±2.82	8.40±2.72	7.67±2.40
t_配对值	2.37	1.87	1.75	1.93	1.74	1.85	3.05	3.04	1.62	2.23	3.49	3.88
P值	0.020	0.065	0.084	0.057	0.086	0.068	0.003	0.003	0.110	0.028	0.001	<0.001
时间	13 h	14 h	15 h	16 h	17 h	18 h	19 h	20 h	21 h	22 h	23 h	24 h
第2天血糖	8.87±3.17	9.52±2.89	9.39±2.83	8.98±2.76	8.63±2.53	8.32±2.61	8.52±2.57	8.96±2.67	9.22±3.00	8.83±3.03	8.33±2.77	7.72±2.43
第5天血糖	7.83±2.33	8.66±2.57	8.83±2.70	8.72±2.78	8.36±2.76	7.95±2.57	7.89±2.37	8.37±2.18	8.75±2.18	8.51±2.31	8.12±2.37	7.66±2.10
t_配对值	3.72	3.11	2.00	1.02	1.11	1.49	2.94	2.72	1.73	1.20	0.85	0.28
P值	<0.001	0.003	0.049	0.311	0.270	0.140	0.004	0.008	0.086	0.233	0.397	0.778

项目	MBG（mmol/L）	SD（mmol/L）	MAGE（mmol/L）	TIR（%）	TAR[M（P₂₅，P₇₅），%]	TBR[M（P₂₅，P₇₅），%]
第2天	8.34±1.97	1.80±0.80	4.53±2.25	78.21±24.64	9.90（3.82，31.86）	0（0，0）
第5天	7.85±1.65	1.62±0.74	3.80±1.80	84.28±21.87	5.38 （0，22.83）	0（0，0）
t_配对（Z_配对）值	4.07	2.79	3.24	3.41	-3.83^a	-0.73^a
P值	<0.001	0.006	0.002	0.001	<0.001	0.463