CGM与SMBG改善1型糖尿病患者血糖控制及减少低血糖事件发生的meta分析

Comparison of continuous glucose monitoring with self-monitored blood glucose in glucose control and reducing hypoglycemic episodes in type 1 diabetic patients: a meta-analysis

关键词:  1型糖尿病  动态血糖监测  自我血糖监测  meta分析

Key words:  type 1 diabetes  continuous glucose mornitoring  self-monitored blood glucose  meta-analysis

摘要:

目的 探讨动态血糖监测(continuous glucose monitoring, CGM)与自我血糖监测(self-monitored blood glucose, SMBG)改善1型糖尿病患者血糖控制及减少低血糖事件发生的效果。方法 检索国内外各类大型数据库自建库以来发表的关于应用CGM对比SMBG的临床随机对照试验(randomized controlled trial, RCT),采用meta分析的方法,利用stata 12.0软件评价应用CGM对比SMBG的效果。结果 与SMBG相比,1型糖尿病患者应用CGM能够有效降低糖化血红蛋白(HbA1c)(WMD: -0.23%,95%CI: -0.29～-0.16)。亚组分析显示,应用动态血糖监测能降低成人(WMD: -0.33%,95%CI: -0.46～-0.20)及儿童、青少年(WMD: -0.13%,95%CI: -0.26～-0.01)1型糖尿病患者糖化血红蛋白值。实时动态血糖监测(real-time CGM)可有效改善血糖控制(WMD: -0.23%,95%CI: -0.30～-0.16)。应用CGM可减少低血糖事件发生(SMD: -0.27,95% CI: -0.45～-0.09)。结论 动态血糖监测,特别是实时动态血糖监测可有效改善1型糖尿病患者的血糖控制,减少低血糖事件发生。

Abstract:

Objective To compare continuous glucose monitoring(CGM) with self-monitored blood glucose(SMBG) in glucose control and reducing hypoglyemic episodes in patients with type 1 diabetes. Methods We searched major international and domestic databases up to August 2014 for randomized controlled trials comparing CGM and SMBG in type 1 diabetes. Meta-analysis was performed by stata 12.0 software. ResultsPatients using CGM had a greater decrease in HbA1c from baseline compared with those using SMBG(WMD: -0.23%, 95%CI: -0.29--0.16). We found that it was effective both for adults(WMD-0.33%, 95%CI: -0.46--0.20) as and children/adolescents(WMD: -0.13%,95%CI: -0.26--0.01). Only real-time devices for CGM improved glycemic control(WMD: -0.23%,95%CI: -0.30--0.16). Pooled results from 5 studies revealed a reduction in hypoglycemic events in the CGM group(SMD: -0.27,95%CI: -0.45--0.09). Conclusion CGM, particularly real-time system, has a favorable effect on glycemic control and reducing hypoglycemic episodes in patients with type 1 diabetes.