| Purpose of observationThe treating goal of diabetes patients is to maintain the level of their blood glucose in the normal range and no low or high blood glucose occurs. For this reason, the observations need to be carried out to detective the low blood glucose in time, especially asymptomatic hypoglycemia. There are 3 clinical ways now to monitor blood glucose, as venous blood, fingertip blood and CGMS. Single time blood glucose can only show the blood glucose at that time but not the general description of patient's disease. Even if there is frequent single-time monitoring, many fluctuations may be missed out, especially those occurred at night. With CGMS, the monitoring is continuous and the fluctuation of the blood glucose can also be recorded, especially the asymptomatic hypoglycemia, providing the foundation for doctors to adjust the treat schemes. We use both CGMS and the finger tip blood glucose monitor making observations for comparison, and the analysis is as following. Clinical information1 General informationThere were 82 patients with DM hospitalized in the Endocrine branch of the First Affiliated Hospital of Zhengzhou University from 2009.1-2009.8, from which there are 71 type 2 diabetes patients, and 11 type 1 diabetes patients. that met the 1999 WHO Diagnostic Criteria for Diabetes Mellitus:including male 46 and female 36, aging from 26～80, with the median age 58, from which there are 16 patients aging under 40,25 patients aging from 40 to 54,25 patients aging from 55 to 69, and 16 patients aging equal or above 70.The history of diabetes is from half a month to 21 years with the median of 6 years, among which 14 patients are under 5 years,27 patients from 5 to 9years,23 patients from 10 to 14years and 18 patients equal or more than 15 years, None of the selected cases got acute complications and severe chronic complications, getting rid of the possibility other diseases such as infection, or applied hormones that may lead to disorders of glucose metabolism. All patients received standard guidance in diet and exercise for diabetes treatment.2 Method of monitoring blood glucose and the standards for detecting lowblood glucoseThe observation is divided into four time periods:7:00～,12:00～,18:00～and 23:00～.①All patients were equipped with CGSM (MiniMed) for at least 72 hours, with the blood glucose being recorded 288 times per day. And the data then is analyzed by specialized analyzing software.②During the observation by CGMS, at least 7 times fingertip blood glucose checks are carried out every day for all the patients (before meals and after meals 2 hours and at 1:00AM) by the Germany Roche ACCU-CHEK Compact Plus blood glucose meter. The standard to diagnose low blood glucose:blood glucose≤2.8mmol/L; if the patients show no clinical symptoms of low blood glucose, then it is called Asymptomatic hypoglycemia.3 Statistics process Data analyzed by SPSS 17.0, compare the 2 ways for detecting Asymptomatic hypoglycemia byΧ2 and compare the detectable rates of Asymptomatic hypoglycemia by CGMS in different time period, of the different ages and histories of disease of the patients. There are statistical difference when P<0.05.Results1-. The results from CGMS and the finger tip blood glucose monitor:There are 63 cases of low blood glucose of 36 patients being detected out by CGMS, from which there are 40 cases of 24 patients being asymptomatic hypoglycemia, The rate of asymptomatic hypoglycemia detection is 29.3%; while with the finger tip blood glucose monitoring, there are 10 cases of low blood glucose of 5 patients, from which there are 2 cases of Asymptomatic hypoglycemia of 2 patients, The rate of asymptomatic hypoglycemia detection is 2.4%. The longest of the asymptomatic hypoglycemia being recorded by CGMS is from 22:00-6:00, as long as 8 hours. From the CGMS records, we can see 6 I-type diabetes patients with asymptomatic hypoglycemia,55% of all the I-type diabetes patients, we also see the incident ofⅡ-type diabetes patients with asymptomatic hypoglycemia is 25.3%. To monitoring asymptomatic hypoglycemia, there is notable difference between CGMS and finger tip blood glucose monitoring (P<0.001).2,Analysis of the effective factors for 24 asymptomatic hypoglycemia which has been monitor by CGMS:1) Each time period influence to asymptomatic hypoglycemia:7:00～2(2.4%) patients occur asymptomatic hypoglycemia; 12:00～4(4.9%) patients; 18:00～7 (8.5%) patients; 23:00～11 (13.4%) patients. The detection rates of asymptomatic hypoglycemia have notable difference at each time period. 2)Different age group influence to asymptomatic hypoglycemia:16 cases less than 40-year-old, which 3cases occur asymptomatic hypoglycemia. Incidents is 18.8%; 40-year-old～have 25 cases, which 3 cases occur. Incidents is 12.0%; 55-year-old～have 25 cases, which 13 cases occur. Incidents is 52.0%; 70-year-old～have 16 cases, which 5 cases occur. Incidents is 31.3%. The detection rates of asymptomatic hypoglycemia have notable difference in different age group(P=0.013). Aged is easy to occur asymptomatic hypoglycemia.3) Course of disease influence to asymptomatic hypoglycemia:14 cases less than 5a, which 2 cases occur asymptomatic hypoglycemia. Incidents is 14.3%; 5～a have 27 cases, which 4cases occur. Incidents is 14.8%; 10～a have 23 cases, which 10 cases occur. Incidents is 43.5%; 15～a have 18 cases, which 8 cases occur. Incidents is 44.4%. The detection rates of asymptomatic hypoglycemia have notable difference in different course of disease (P=0.037). The course of disease is longer, the incident of asymptomatic hypoglycemia is higher.Discussion1. The way with CGMS is more flexible and more convenient, and can detect more asymptomatic hypoglycemia cases which are often been ignored by normal finger tip blood check, reveal many hypoglycemia which has been ignored, from several minutes to several hours, especially low blood glucose happened during the night.2. This research shows that 29.3% patients may have asymptomatic hypoglycemia in the treatment by CGMS monitoring. And at the same time, we found that asymptomatic hypoglycemia is more often detected in aged patients who have long history of disease and have been in insulin treatment and I-type diabetes patients. And asymptomatic hypoglycemia occurring at night has been found long-last, high-frequency and the longest records been monitored is 8 hours. |
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