动态血糖监测的准确性评估及相关因素分析

【】　目的　评价2型糖尿病（type2diabetesmellitus，T2DM）患者动态血糖监测（continuousglucosemonitoring，CGM）的准确性及其相关因素。　方法　2009年1月―2010年1月共纳入患者530例，其中口服降糖药治疗者和胰岛素强化治疗者各265例。应用动态血糖监测系统（美国MedtronicMiniMed公司）连续监测3d，同时每天输入4次指尖血糖值（self-monitoringofbloodglucose，SMBG）进行校正。用直线回归分析CGM值与SMBG的相关性，用Clarke误差表格分析一致性，用平均绝对差（meanabsoluterelativedifference，MAD）评价准确性，并分析MAD的相关因素。　结果　①共收集到6350对CGM值（9.66±3.54）mmol/L与SMBG值（9.64±3.38）mmol/L，两者差异无统计学意义（P>0.05）。Pearson相关性分析显示，两者呈正相关（r=0.959，P0.05.PearsoncorrelationanalysisshowedthatCGMvaluewaspositivelycorrelatedwithSMBGvalue(r=0.959,P<0.001).②Clarkeerrorgriddemonstratedthat99.89%ofpairedSMBG-CGMvalueswerelocatedinzoneAandzoneBandtheremainingsevenpairs(0.11%)ofglucosevalueswerelocatedinzoneD.③TheoverallMADvaluewas7.2%(5.5%-9.5%).AccordingtotheanalysisofdailyMADvalue,MADvaluedecreased,whileaccuracyelevatedgraduallywithmonitoringtime.④MADvalueofintensiveinsulintreatmentgroupwashigherthanthatoftheoralhypoglycemicagenttreatmentgroup(P<0.05).AndstepwisemultipleregressionanalysisindicatedthatMADvaluehadnegativecorrelationwithglycatedalbuminlevel(β=-0.134,P<0.01)andpositivecorrelationwithintensiveinsulintreatment(β=0.117,P<0.05).　Conclusions　①TheresultsofCGMareaccurate,andhavegoodcorrelationandconsistencywithcapillaryglucose.②Besidesmonitoringtime,theaccuracyofcontinuousglucosemonitoringmaybealsoassociatedwithhypoglycemictreatmentstrategy.