第49届欧洲糖尿病研究协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月26日下午，在“Closed loops and CGMS”壁报讨论专场上，希腊Venizelion医院糖尿病中心Angelos Pappas博士的一项多中心研究(DIAMOND研究)表明，对使用
该前瞻性研究旨在评估连续动态血糖监测(CGM)与胰岛素泵治疗联合应用3个月对1型糖尿病患者的临床疗效。
研究人员从希腊11家糖尿病中心共计入选43例应用持续皮下胰岛素输注(CSII)的患者，平均年龄为33.6±8.1岁，平均糖尿病病程为14.5±9.8年，女性24例(占55.8%)。在进行CGM前，所有患者均使用美敦力MiniMed Paradigm胰岛素泵接受过至少为期3个月的CSII。在接下来3个月的研究期间，所有患者改用美敦力MiniMed Paradigm实时动态胰岛素泵系统，该系统同时具备CSII与RT-CGM功能。
研究结束时，评估患者的HbA1c、BMI、低血糖发作(HYPO)、每日所需胰岛素总剂量(TDI)、每日餐前胰岛素用量(TDIBOL)、每日餐前胰岛素注射次数(NOBOL)、每日基础胰岛素用量(TDIBASAL)及每天探头佩戴时间所占的百分比(PTTU)。
结果显示，平均PTTU为74%±17.0%。与使用RT-CGM前相比，患者在使用后，HbA1c水平显著降低(7.5±1.0%vs. 8.3±1.2%，P< 0.001)，TDI(50.8±23.9 vs. 45.7±15.3，P=0.018)、TDIBOL (28.3±19.0 vs. 24.1±10.4，P=0.033) 及NOBOL (6.3±2.4 vs. 4.7±1.5，P<0.001) 均显著增加；BMI、HYPO及TDIBASAL无明显变化。在整个研究期间未见酮症酸中毒发生，研究结束时有44.2%的患者HbA1c达标(< 7%)。
研究表明，连续动态血糖监测可显着改善应用CSII治疗的T1DM患者的血糖控制，且对BMI及低血糖发作无影响。上述益处主要与其能实现更好的自我管理及增加胰岛素用量有关。
研究摘要：
Improvement of metabolic control after three months use of RT-CGM in type 1 diabetics treated with insulin pump: the multicentre Greek DIAMOND study (3个月实时动态血糖监测[RT-CGM]改善使用胰岛素泵的T1DM患者的代谢控制：多中心希腊DIAMOND研究) |
| Background and aims: To evaluate the efficacy of adding continuous glucose monitoring (CGM) for three months to insulin pump therapy (CSII) in patients with siabetes mellitus type 1 (DMT1) in a multicenter Greek study (THE DIAMOND STUDY). Materials and methods: In total, 11 Diabetes Centers in Greece participated to the study. Forty three patients (24 female, 55.8%), with mean age 33.6±8.1, mean duration of T1DM 14.5±9.8 years and treated with continuous subcutaneous insulin infusion were enrolled prospectively. All patients were on CSII (MiniMed Paradigm) for three months at least before the use of CGM. Then all participants were instructed to wear the MiniMed Paradigm REAL-Time System (Medtronic Inc.), which integrates both CSII and RT-CGM functionalities, at all times throughout the study for the next three months. At the end of the study we evaluated the following parameters: HbA1c, BMI, hypoglycaemic episodes (HYPO), total daily insulin requirement (TDI), total daily insulin for boluses (TDIBOL), number of daily boluses (NOBOL), total daily insulin basal (TDIBASAL) and percentage of total time use of sensor (PTTU). Results: The mean PTTU was 74±17.0%. The results of the other examined variables were as follows [mean±1SD] in patients before and after the use of CGM: HbA1c 8.3±1.2% vs 7.5±1.0% (p< 0.001), TDI 45.7±15.3 vs 50.8±23.9 (p= 0.018), TDIBOL 24.1±10.4 vs 28.3±19.0 (p= 0.033) and NOBOL 4.7±1.5 vs 6.3±2.4 (p< 0.001). No significant change observed in BMI, HYPO and TDIBASAL before and after the use of CGM. No ketoacidosis observed throughout the study. 44, 2% of the patients achieved HbA1c targets ( < 7%). Conclusion: In the present study continuous glucose monitoring was associated significantly with improvement of glycaemic control without BMI and hypoglycaemic episodes change, in patients with type 1 diabetes using CSII. Better self-management and increase of the doses and units of insulin may have contributed to these beneficial effects. |
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