主页 > 医学信息 >
【NEJM】1型糖尿病的持续血糖监测和强化治疗
The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
ABSTRACT
Background The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined.
Methods In a multicenter clinical trial, we randomly assigned 322 adults and children who were already receiving intensive therapy for type 1 diabetes to a group with continuous glucose monitoring or to a control group performing home monitoring with a blood glucose meter. All the patients were stratified into three groups according to age and had a glycated hemoglobin level of 7.0 to 10.0%. The primary outcome was the change in the glycated hemoglobin level at 26 weeks.
Results The changes in glycated hemoglobin levels in the two study groups varied markedly according to age group (P=0.003), with a significant difference among patients 25 years of age or older that favored the continuous-monitoring group (mean difference in change, –0.53%; 95% confidence interval [CI], –0.71 to –0.35; P<0.001). The between-group difference was not significant among those who were 15 to 24 years of age (mean difference, 0.08; 95% CI, –0.17 to 0.33; P=0.52) or among those who were 8 to 14 years of age (mean difference, –0.13; 95% CI, –0.38 to 0.11; P=0.29). Secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group among the oldest and youngest patients but not among those who were 15 to 24 years of age. The use of continuous glucose monitoring averaged 6.0 or more days per week for 83% of patients 25 years of age or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The rate of severe hypoglycemia was low and did not differ between the two study groups; however, the trial was not powered to detect such a difference.
Conclusions Continuous glucose monitoring can be associated with improved glycemic control in adults with type 1 diabetes. Further work is needed to identify barriers to effectiveness of continuous monitoring in children and adolescents. 本人自己认领，若48小时未上交译文则视为放弃，请其他战友继续。 Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes
1型糖尿病的持续血糖监测和强化治疗
The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
糖尿病青年研究基金会持续血糖监测研究组
Background The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined.
背景:持续血糖监测在1型糖尿病的管理中的价值尚未确定
Methods In a multicenter clinical trial, we randomly assigned 322 adults and children who were already receiving intensive therapy for type 1 diabetes to a group with continuous glucose monitoring or to a control group performing home monitoring with a blood glucose meter. All the patients were stratified into three groups according to age and had a glycated hemoglobin level of 7.0 to 10.0%. The primary outcome was the change in the glycated hemoglobin level at 26 weeks.
方法:作为一个多中心的研究,我们随机将322名正在接受强化治疗的成人和小孩分入持续血糖监测组和对照组(在家通过血糖仪自测血糖).所有的患者均按年龄分为3个层次,他们的糖化血红蛋白水平7-10%,在26周的观察期内,我们把糖化血红蛋白的变化作为一个主要的指标.
Results The changes in glycated hemoglobin levels in the two study groups varied markedly according to age group (P=0.003), with a significant difference among patients 25 years of age or older that favored the continuous-monitoring group (mean difference in change, –0.53%; 95% confidence interval [CI], –0.71 to –0.35; P<0.001). The between-group difference was not significant among those who were 15 to 24 years of age (mean difference, 0.08; 95% CI, –0.17 to 0.33; P=0.52) or among those who were 8 to 14 years of age (mean difference, –0.13; 95% CI, –0.38 to 0.11; P=0.29). Secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group among the oldest and youngest patients but not among those who were 15 to 24 years of age. The use of continuous glucose monitoring averaged 6.0 or more days per week for 83% of patients 25 years of age or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The rate of severe hypoglycemia was low and did not differ between the two study groups; however, the trial was not powered to detect such a difference.
结果:两个大组中各个年龄层次之间糖化血红蛋白差异显著(P=0.003), 在持续血糖监测组,25岁及以上层次的患者这种差异尤其显著(标准差–0.53%;95%置信区间为–0.71 -–0.35; P<0.001),而两组之中的15-24岁和8-14岁层次之间的比较则无明显差异,分别为(标准差0.08%;95%置信区间为–0.17 -0.33; P=0.52),(标准差-0.13%;95%置信区间为–0.38 -0.11; P=0.29).其次,分别比较两组在最年轻和最老层次(不包括15-24岁层次)的糖化血红蛋白结果,持续血糖检测组优于对照组.在25岁及以上层次的患者中,83%为每周平均进行6天或以上持续血糖监测,而这个比例在15-24岁层次中,有30%,在8-14岁层次中,有50%.两组之间的严重低血糖事件发生率比较低,并没有明显差异,此外,这个研究并不能检测出这种差异.
阅读本文的人还阅读：
作者:admin@医学,生命科学 2010-10-17 17:11
医学,生命科学网