The Application Of CGMS In Newly Diagnosed Type2Diabetes

Background：Today，with the improvement of people’s living standards, changes inlifestyle, diet and environmental factors, diabetes has more and more seriously harmfu-l to human health.Many studies have confirmed that application of intensive insulintreatment early in type2diabetes mellitus (T2DM) not only making the islet B cellfunction was largely restored, but also can making blood glucose control to the idealstate within a short period of time,relie-ving the disease and delaying the variety ofchronic complications.Withing the generally application of intensive therapy, theblood glucose fluctuations and hypoglycemia have occurred frequently.How placidlyand quickly control the blood glucose has been research in the field of diabetestreatment.compared with self monitoring blood glucose,continuous glucosemonitoring system has more obvious advantages in revealing blood glucoseexcursions and hypoglycemia. It can also provide a reference for the intensive insulintherapy and has a high clinical value.Objective: Exploring the effect of the CGMS in the control of newly diagnosed type2diabetes;Analysis the correlation among the mean amplitude of glycemic excursions(MAGE), MBG, MBG4and glycosylated hemoglobin (HbA1c).Methods:63hospitalized patients who were in newly diagnosed type2Diabetes havebeen selected. including37males,26females.They comply with the diagnosticcriteria of the American Diabetes Association (ADA) in2003and have not receivedany diabetes interventions (including exercise, diet and drugs, etc.).Exclude a seriousinfection, heart failure, severe liver and kidney disease and acute complications ofdiabetes.Determining the patient’s height, weight, waist circumference, hipcircumference, blood pressure, biochemical, glycated hemoglobin (HbA1c) index, andcalculated body mass index (BMI) and waist-hip ratio (WHR) in first day ofadmission.63cases were randomly divided into two groups:(1)Group A, a total of30 patients using continuous glucose monitoring system (CGMS) and multiple dailysubcutaneous insulin injection (MBI).(2)Group B, a total of33cases of patients,using seven times a day monitoring of fingertip blood glucose,there are before meals,after meals and bedtime blood glucose.insulin dosage adjusted according to bloodglucose monitoring values.Two groups using the Roche (ROCHE) excellent type ofblood glucose glucose measured the fingertip blood glucose. Subcutaneous injectionusing Novolin R before breakfast and lunch and NovoMix30beforedinner.Observation and analysis the two groups of patients’ fasting glucose and2hpostprandial blood glucose levels in the treatment of the three days; Hypoglycemia,especially asymptomatic hypoglycemia (HUN);Determination the hemoglobin(HbA1c) level in the beginning.when the blood glucose control satisfiedly,the patientwere into the follow-up period, at the end of the follow-up period,the determing theHbA1c levels again.In group A,patients weared the CGMS for72hours.during themeasurement four times daily fingertip Blood glucose were determined to becalibrated. Recording the information downloaded to a computer to adjust the insulindosage.Analysis the high Blood glucose, normal blood glucose and low blood glucoseproportion, and the average of daily maximum and minimum blood glucose.Calculating MBG, MAGE and MBG4base on CGMS and making correlationanalysis.The experimental datas were statistically analyzed by SPSS18.0software.Thevalue of P <0.05was considered statistically significant.Results:(1)Comparing the two groups with fasting blood glucose (FBG) levels,before and after treatment, inside the two groups difference was statisticallysignificant (P <0.01), but between the two groups was no significant difference(P>0.05);Comparing the two groups with2-hour postprandial blood glucose (2hBG)levels, before and after treatment, inside the two groups difference was statisticallysignificant (P <0.01), and between the two groups was statistically significant(P<0.05);(2)Comparing the two groups with HbA1c levels, before and after treatment,inside the two groups difference was statistically significant (P <0.01), but betweenthe two groups was no significant difference(P>0.05).(3)The number ofhypoglycemia was found14cases (43.5%) and57times in group A,and it was found 8cases (28%) and13times in Group B.(4) CGMS monitoring of patients in group Ashowed the proportion of high blood sugar (blood glucose≥10.0mmol/L), normalblood sugar glucose (3.9mmol/L-10.0mmol/L) and hypoglycemia (blood glucose≤3.9mmol/L). The proportion of blood glucose within the normal range rose from66.4%to87.4%; the proportion of high blood sugar decreased from28.3%to10.3%;the proportion of low blood sugar decreased from5.7%to2.4%.(5)According toCGMS determination results, the treatment plan was adjusted. Days averagemaximum blood glucose levels decreased, while the lowest mean blood glucoseincreased. Compared the highest and lowest mean blood glucose between48h~72hand0h~24h, the difference was statistically significant (P <0.01).(6) MBG wasSignificantly related to MBG4in group A, the value of r is0.830, P <0.01.(7)HbA1cwas Significantly related to MBG and MBG4in group A, the values of r are0.830and0.886, P <0.01.(8)MAGE was not related to HbA1c in group A, the value of r is0.25，P>0.05.Conclousion:(1)According to CGMS monitoring results, the individualized treatmentprograms was made, which can effectively control blood glucose levels.(2)Thecontinuous glucose monitoring system(CGMS) has obvious advantages in found lowblood sugar, especially in asymptomatic hypoglycemia.(3)MAGE was not related toHbA1c.It’s an independent indicators to evaluate the fluctuations of blood glucose.