Clinical Significance Of The Combination Of The CGMS And CSII In Diabetes Mellitus

Diabetes mellitus (DM) has become one of the main diseases recently while it continues to show an upward tendency.Diabetic patients are under insulin therapy which includes the conventional diabetes therapy, multiple daily injection (MDI) and continuous subcutaneous insulin infusion (CSII) because of acute or chronic complications. DCCT demonstrated that Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM. Accordingly, more and more people select CSII threpy. However, the rate of hypoglycemias increases greatly with the wide use of intensive therapy. So diabetic clinicians pay much attention on how to control blood glucose, how to reduce the excursions of blood glucose and how to prevent hypoglycemias better and effectively.Objective To evaluate clinical significance of the combination of the continuous glucose monitoring system (CGMS) and CSII, ie "double C" therapy, in diabetic patients.Research design and method The study was carried out on 118 diabetic subjects diagnosed according to WHO criteria in 1999. These subjects selected for the study had been coming to our outpatient or inpatient clinic,and they didn't suffer from serious infection, severe malfunction of livers, kidneys or hearts, and they had no acute diabetic complications such as DKA and NHDC. We measured all subjects' body mass indexes (BMIs), blood pressure, and tested the liver function, kidney function and lipid levels in the blood. A total of 118 subjects were randomly divided into 3 groups: (1) the "double C" group: A total of 78 diabetic subjects were treated with CSII, using the CGMS for 3 days. The CGMS consists of a glucose oxidase-based sensor inserted subcutaneously in an abdominal site and attached via a cable to a monitor that can be worn like an insulin pump. The chemical reaction creates a current measurable by the device that in turn generates a corresponding glucose value. The monitor takes a reading every 10s and displays an average every 5 min for a total of 288 readings per day. CGMS is calibrated by entering SMBG readings four times per day. The patients recorded all key events (meals, exercise, hypoglycemias and insulin doses) and other information they considered relevant in a logbook. (2)the CSII group: 40 subjects were monitored with the CSII therapy. (3) the MDI group: other 40 subjects were treated with multiple daily injection. The two former groups both used the American MinMed 508 pump. Meanwhile,we measured blood glucose levels of the subjects in two latter groups at lesast 8 times per day. All subjects used the same brand of glucomoter during the monitoring periods.The information of the mean blood glucose (MBG), mean amplitude of glycemic excursions (MAGE) and hypoglycemias were registered. In addition, HbAlc levels were measured before the monitoring period and 3 months later.Results (1) MBG and HbAlc: The levels of MBG and HbAlc in all groups decreased, but the greatest reduction was observed in the subgroups of subjects who started CSII therapy. (2) The MAGE revealed by CGMS was lower than the other two groups. (3) Hypoglycemias: the CGMS detected 73 unrecognized hypoglycemias, most of which occurred at night, while frequent capillary glucose measurements detected only 15 and 18 hypoglycemias respectively.Conclusions (1) The short term CSII therapy can reduce hyperglycemic memory and control the blood glucose levels better than the MDI therapy. (2) The HbAlc level can't reflect the excursion of blood glucose, but CGMS can get a whole blood glucose picture and lower the excursion steadily in a short term. (3) The CGMS is useful and effective for detecting hypoglycemias, especially awereness of hypoglycemias. (4) We found no obvious difference between glood glucose and interstitial glucose using the CGMS, and it showed to be a very safe, well-tolerated and highly accurate method. (5) The "double C" therapy can get enough information to control blood glucose more effectively than other therapies.Accordingly, patients can gain more free life-styles and avoid spending much more money because of late severe complications. (6) Clinicians should make use of every method to evaluate hypoglycemias especially unwareness of hypoglycemias properly, and control metabolism qualitatively and quantitatively.