扫描式葡萄糖监测在儿童1型糖尿病胰岛素强化治疗中的应用价值

Application Value of Flash Glucose Monitoring in Intensive Insulin Therapy in Children with Type 1 Diabetes Mellitus

摘要: 目的：调查扫描式葡萄糖监测(Flash Glucose Monitoring, FGM)对接受胰岛素强化治疗的1型糖尿病(Type 1 Diabetes Mellitus, T1DM)儿童血糖控制的影响及患儿满意度。方法：回顾性分析长期在青岛妇女儿童医院内分泌代谢科随访的142例T1DM儿童的临床资料，包括糖化血红蛋白(Hemoglobin A1c, HbA1c)、目标范围内时间(Time in Range, TIR)、胰岛素用量、低血糖次数等相关指标，并进行问卷调查了解应用FGM的满意度情况。结果：① FGM组较自我血糖监测组(self monitoring of blood glucose, SMBG)在血糖监测第1年后胰岛素用量、第2年的HbA1c及低血糖发生率均显著降低，差异均有统计学意义；② 在82名佩戴FGM的患儿中，联合使用持续皮下胰岛素输注(continuous subcutaneous insulin infusion, CSII)第二年HbA1c (6.4%)较使每日多次胰岛素输注(multiple daily injections, MDI) HbA1c (7.1%)显著下降。其中联合CSII的患儿TIR为(79%)较使用MDI的患儿TIR (72%)控制更佳，差异均有统计学意义(P < 0.05)；③ 相关因素分析显示，佩戴FGM、遵循糖尿病饮食、每天运动时间60分钟以上、坚持3~6个月来院复诊的患儿血糖控制更优，差异均有统计学意义；④ 问卷调查显示佩戴FGM总体满意度(90.7%)较高，其中无痛及监测方便(97.67%)为其选择的主要初衷，部分不良反应包括扫描仪故障；皮肤过敏；传感器脱落；出血。结论：强化治疗的T1DM患儿中佩戴FGM有利于血糖控制，可明显降低HbA1c、胰岛素用量及低血糖发生率。FGM联合CSII治疗不但更好地降低HbA1c，显著提高TIR，而且满意度较高，是目前儿童T1DM强化治疗的理想选择。

Abstract: Objective: To investigate the effect of Flash Glucose Monitoring (FGM) on blood glucose control in children with type 1 diabetes mellitus (T1DM) who has been receiving intensive insulin therapy and the satisfaction of the children. Methods: Retrospectively analyzed of the clinical data of 142 children with T1DM who were followed up in the Department of Endocrinology and Metabolism of Qingdao Women and Children’s Hospital for a long time, including hemoglobin A1c (HbA1c), time in range (TIR), insulin dosage, number of hypoglycemia and other related indexes, and a questionnaire survey was conducted to understand the satisfaction of applying FGM. Results: ① The FGM group compared with the self-monitoring of blood glucose (SMBG) group in insulin dosage, HbA1c and the incidence of hypoglycemia in the second year of blood glucose monitoring were significantly lower, and the differences were statistically significant; ② Continuous subcutaneous Insulin Infusion (CSII) was used in combination with FGM for 82 patients. CSII HbA1c (6.4%) was significantly reduced when using multiple daily insulin injections (MDI) HbA1c (7.1%) in the second year. The TIR (79%) of children with combined CSII were better than those TIR (76%) with MDI, and the differences were statistically significant (P < 0.05). ③ Analysis of related factors showed that children who wore FGM, followed diabetic diet, had more than 60 minutes of exercise per day, and insisted on returning to hospital for 3~6 months had better blood glucose control, and the differences were statistically significant. ④ The questionnaire survey showed that the overall satisfaction of wearing FGM (90.7%) was higher, and painless and convenient monitoring (97.67%) were the main initial reasons for their selection, and some adverse reactions included scanner malfunction, skin allergy, sensor dislodgement, bleeding. Conclusion: In intensive treatment of T1DM children, wearing FGM is beneficial to blood glucose control, and can significantly reduce HbA1c, insulin dosage and the incidence of hypoglycemia. FGM combined with CSII not only reduced HbA1c better, but also significantly improved TIR. Moreover, the high degree of satisfaction indicates that this regimen is currently the ideal choice for intensive treatment of T1DM in children.