瞬感扫描式葡萄糖监测系统联合胰岛素泵在老年人短期胰岛素治疗中的应用效果

来源:用户上传      作者:张志军 田建卿

　　[摘要] 目的 探扫描式葡萄糖监测系统（FGM）联合胰岛素泵在老年人短期胰岛素治疗中的应用效果。方法 选取2020年1―12月福建医科大学附属厦门弘爱医院接诊的58名老年2型糖尿病（T2DM）患者，随机分为观察组（n=27）和对照组（n=31），观察组使用FGM监测血糖，对照组使用指尖血糖仪监测血糖，两组均使用胰岛素泵控制血糖，根据血糖情况调整胰岛素用量。治疗1周后，对比两组患者治疗前后的空腹血糖（FPG）、餐后2 h血糖（2 h PG）、稳态模型评估胰岛素抵抗指数（HOMA-IR）、稳态模型评估β细胞功能指数（HOMA-β）、胰岛素剂量、血糖达标时间、人均低血糖次数以及治疗满意度、依从性。 结果 治疗后两组患者的FPG、2 h PG水平均较治疗前明显降低（P<0.01），其中治疗后观察组的FPG水平明显低于对照组（P<0.01），治疗后两组的2 h PG水平差异无统计学意义（P>0.05）;治疗前后两组患者的HOMA-IR差异无统计学意义（P>0.05），但治疗后观察组的HOMA-IR低于对照组（P<0.05）;观察组治疗后的HOMA-β较治疗前升高（P<0.05），对照组治疗前后差异无统计学意义（P>0.05），但两组治疗后的HOMA-β水平差异无统计学意义（P>0.05）。观察组的胰岛素剂量、单位体重胰岛素剂量、血糖达标时间及人均低血糖次数均显著低于对照组（P<0.01），治疗满意度和依从性显著高于对照组（P<0.01）。结论 老年糖尿病患者短期应用胰岛素泵治疗能够有效缓解高糖毒性、改善血糖控制，联合FGM能够显著减少胰岛素剂量、缩短血糖达标时间、降低低血糖风险，同时明显提高治疗满意度和依从性，值得临床应用推广。
　　[关键词] 瞬感扫描式葡萄糖监测系统;胰岛素泵;2型糖尿病;老年人
　　[中图分类号] R587.1 [文献标识码] B [文章编号] 1673-9701（2022）13-0094-04
　　[Abstract] Objective To investigate the application effect of scanning glucose monitoring system （FGM） combined with insulin pump in short-term insulin therapy in the elderly. Methods A total of 58 elderly patients with type 2 diabetes mellitus （T2DM） admitted to Xiamen Humanity Hospital Affiliated to Fujian Medical University from January to December 2020 were randomly divided into the observation group （n=27） and the control group （n=31）. The observation group used FGM to monitor blood glucose， while the control group used fingertip glucometer to monitor blood glucose. Both groups used insulin pump to control blood glucose. The insulin dosage was adjusted according to the blood glucose. The fasting plasma glucose （FPG）， 2-hour postprandial glucose （2 h PG）， homeostasis model assessment-insulin resistance （HOMA-IR）， homeostasis model assessment β-cell function index （HOMA-β）， insulin dose， time to blood glucose target， number of hypoglycemia per capita， treatment satisfaction and compliance were compared between the two groups before and after one week of treatment. Results FPG and 2 h PG in the two groups after treatment were significantly lower than those before treatment （P<0.01）. FPG in the observation group after treatment was significantly lower than that in the control group （P<0.01）. There was no significant difference in 2 h PG after treatment between the two groups （P>0.05）. There was no significant difference in HOMA-IR before and after treatment between the two groups （P>0.05）. But HOMA-IR in the observation group after treatment was lower than that in the control group （P<0.05）. HOMA-β in the observation group after treatment was higher than that before treatment （P<0.05）. There was no significant difference in HOMA-β level after treatment between the two groups （P>0.05）. The insulin dose， insulin dose per unit body weight， time to blood glucose target and number of hypoglycemia per capita in the observation group were significantly lower than those in the control group （P<0.01）. The treatment satisfaction and compliance of the observation group were significantly higher than those in the control group （P<0.01）. Conclusion Short-term use of insulin pump in elderly patients with diabetes can effectively alleviate high glucose toxicity and improve blood glucose control. Combined with transient scanning glucose monitoring system， it can significantly reduce insulin dose， shorten the time of blood glucose reaching target， reduce the risk of hypoglycemia， and significantly improve treatment satisfaction and compliance. It is worthy of being widely popularized in clinical application.

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