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【medical-news】新英格兰医学杂志：连续血糖监测
"The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined," write William V. Tamborlane, MD, from The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, and colleagues. "The availability of devices for continuous glucose monitoring permits the measurement of interstitial glucose in an ongoing fashion."
In this multicenter trial, 322 adults and children who were already receiving intensive therapy for type 1 diabetes were randomized to a group with continuous glucose monitoring or to a control group in which participants used a blood glucose meter for home monitoring. All participants were stratified into 3 groups based on age. At baseline, glycated hemoglobin level was 7.0% to 10.0%, and the main endpoint was the change in the glycated hemoglobin level at 26 weeks.
Age group was a significant predictor of changes in glycated hemoglobin levels in the 2 study groups (P = .003). Among patients 25 years or older, there was a significant difference favoring the continuous-monitoring group (mean difference in change, –0.53%; 95% confidence interval [CI], –0.71 to –0.35; P < .001). In contrast, between-group differences were not significant in participants 15 to 24 years of age (mean difference, 0.08; 95% CI, –0.17 to 0.33; P = .52) or in those 8 to 14 years of age (mean difference, –0.13; 95% CI, –0.38 to 0.11; P = .29).
Among the oldest and youngest patients, secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group. However, these outcomes were not significantly different between groups among those who were 15 to 24 years of age.
Average continuous glucose monitoring use was 6.0 or more days per week for 83% of patients 25 years or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The treatment groups had a low and comparable rate of severe hypoglycemia, but power was insufficient to detect a difference in this outcome.
Study limitations include insufficient power to detect a between-group difference in severe hypoglycemia and lack of generalizability to a less well-controlled, less motivated population of patients with type 1 diabetes.
"Continuous glucose monitoring can be associated with improved glycemic control in adults with type 1 diabetes," the study authors write. "Further work is needed to identify barriers to effectiveness of continuous monitoring in children and adolescents."
The Juvenile Diabetes Research Foundation supported this study. Some of the authors have disclosed relevant financial relationships with Abbott Diabetes Care, Lifescan, Medtronic, DexCom, Novo Nordisk, sanofi-aventis, Symlin, Roche, the Charles Hood Foundation, and/or AstraZeneca.
N Engl J Med. Published online September 8, 2008.
European Association for the Study of Diabetes 44th Annual Meeting. Presented September 8, 2008.
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作者:admin@医学,生命科学 2010-12-07 05:11
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