实时动态血糖监测系统在白族糖尿病合并老年多器官功能不全综合征患者中的临床应用优势

Advantages of real-time continuous glucose monitoring system in diabetic patients complicated with multiple organ dysfunction syndrome in the Bai elderly

摘要:

目的 探讨实时动态血糖监测系统(RT-CGMS)在白族糖尿病合并老年多器官功能不全综合征(MODSE)患者治疗中的临床应用价值。方法 纳入2018年1月至12月在大理白族自治州人民医院老年病科住院的白族糖尿病合并MODSE、急性生理和慢性健康状况APACHE Ⅱ评分>15分的患者112例。患者分为2组,RT-CGMS组和自我血糖监测(SMBG)组,每组56例。比较2组患者的一般临床资料、血糖波动指标、低血糖发生率、平均每日胰岛素用量、住院时间及28d病死率。采用SPSS 16.0软件进行统计分析,2组间比较采用t检验或χ²检验。结果 与观察第2天相比,SMBG组患者第3天的血糖水平标准差(SDBG)显著降低[(3.2±1.1)和(2.9±1.0)mmol/L；P<0.05],RT-CGMS组患者第3天的平均血糖水平[MBG,(10.8±2.5)和(8.8±1.9)mmol/L；SDBG,(2.8±0.8)和(1.8±0.7)mmol/L]、最大血糖波动幅度[LAGE,(8.9±3.6)和(7.2±1.6)mmol/L]、平均血糖波动幅度[MAGE,(6.3±1.0)和(5.0±0.4)mmol/L]均显著降低(P＜0.05)。观察第2天,与SMBG组患者相比,RT-CGMS组患者SDBG显著降低[(2.8±0.8)和(3.2±1.1)mmol/L；P<0.05]；观察第3天,与SMBG组患者相比,RT-CGMS组患者MBG[(8.8±1.9)和(10.9±2.8)mmol/L]、SDBG[(1.8±0.7)和(2.9±1.0)mmol/L]、LAGE[(7.2±1.6)和(9.6±3.1)mmol/L]均显著降低(P＜0.05)。与SMBG组相比,RT-CGMS组患者的低血糖发生率(16.1%和3.6%)、平均每日胰岛素量[(38.2±6.8)和(32.1±5.4)IU/d]、住院时间[(14.6±4.2)和(12.1±4.0)d]均显著降低(P＜0.05)。结论 RT-CGMS的应用可降低糖尿病合并MODSE患者的血糖波动,对提高抢救成功率、延长生存期及减少平均住院日具有重要的临床意义。

Abstract:

Objective To explore the clinical application value of real-time continuous glucose monitoring system (RT-CGMS) in the treatment of patients with diabetes mellitus complicated with multiple organ dysfunction syndrome (MODSE) in the elderly of Bai Ethnic Minority. Methods From January to December 2018,112 elderly patients with diabetes mellitus complicated with MODSE admitted to People′s Hospital of Dali Bai Autonomous Prefecture (APACHE Ⅱ score >15 points) were enrolled and then randomly divided into RT-CGMS group (n=56) and self-monitoring blood glucose group (SMBG group, n=56). The general clinical data, blood glucose fluctuation index, incidence of hypoglycemia, average daily insulin dosage, length of hospital stay and 28-day mortality were compared between the two groups. SPSS statistics 16.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between the two groups. Results The standard deviation of blood glucose (SDBG) was decreased from (3.2±1.1)mmol/L on the second day to (2.9±1.0)mmol/L on the third day of the treatment in the SMBG group (P<0.05), and in the RT-CGMS group, the mean blood glucose (MBG) was reduced from (10.8±2.5) to (8.8±1.9) mmol/L, SDBG from (2.8±0.8) to (1.8±0.7)mmol/L, largest amplitude of glycemic excursion (LAGE) from (8.9±3.6) to (7.2±1.6) mmol/L, and mean amplitude of glycemic excursions (MAGE) from (6.3±1.0) to(5.0±0.4) mmol/L (all P<0.05). On the second day, the decrease of SDBG was more obvious in the RT-CGMS than the SMBG group [(2.8±0.8) vs (3.2±1.1)mmol/L, P<0.05). While, on the third day, the RT-CGMS group had more significant decrease in MBG [(8.8±1.9) vs (10.9±2.8) mmol/L], SDBG [(1.8±0.7) vs (2.9±1.0)mmol/L, and LAGE [(7.2±1.6) vs (9.6±3.1) mmol/L] when compared with the SMBG group (P<0.05). What′s more, the incidence of hypoglycemia (3.6% vs 16.1%), average daily insulin [(32.1±5.4) vs (38.2±6.8) IU/d] and length of hospital stay [(12.1±4.0) vs (14.6±4.2) d] in the RT-CGMS group were notably lower than those in the SMBG group (P<0.05). Conclusion The application of RT-CGMS can reduce the fluctuation of blood glucose in Bai elderly diabetic patients complicated with MODSE, and show important clinical significance in improvement of rescue success rate, prolongation of survival period, and decrease of average length of hospital stay.