( Self-measurement of blood glucose, SMBG )

Transcription

1 ( Diabetes mellitus ) ( Continuous glucose monitor system, ) ( Self-measurement of blood glucose, SMBG ) DCCT(Diabetes Control and Complications Trial ) UKPDS ( U.K. Prospective Diabetes Study ) 1,2 3 Somogyi 24 ( Dawn phenomenon ) 7 4,

2 124 8 ( Holter monitor ) ( ) 1999 ( FDA ) % ) ( 10% 8.9% 9.8% 10.8% mg/dl mg/dl 100 mg/dl 70 mg/dl 300 mg/dl

3 % 7.0% mg/dl mg/dl 100 mg/dl 300 mg/dl ) ( % 7.1% 7.3% % mg/dl 55 mg/dl Bruce

4 126 ) 10 14,15 7,15 13 ( 16 ( HbA1C=6.5% ) ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) ( 6 ) 19 20, ( <70 mg/dl ) 8 1.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: UK Prospective Diabetes Study ( UKPDS ) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes ( UKPDS 33 ). Lancet 1998; 352: American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2006; 29 ( suppl 1 ): S Koro CE, Bowlin SJ, Bourgeois N, Fedder DO. Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care 2004; 27: Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291: Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD. Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database. BMJ 1999; 319: Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tamborlane WV. Limitations of conventional methods of selfmonitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care 2001; 24: Mastrototaro J. The MiniMed Continuous Glucose Monitoring System ( ). J Pediatr Endocrinol Metab 1999; 12 ( Suppl 3 ): Bode BW, Gross TM, Thornton KR, Mastrototaro JJ. Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study. Diabetes Res Clin Pract 1999; 46: Schaepelynck-Belicar P, Vague P, Simonin G, Lassmann-Vague V. Improved metabolic control in diabetic adolescents using the continuous glucose monitoring system ( ). Diabetes Metab 2003; 29: Maia FF, Araujo LR. Accuracy, utility and complications of continuous glucose monitoring system ( ) in pediatric patients with type 1 diabetes J Pediatr ( Rio J ) 2005; 81: Portuguese 12.Mlcak P, Fialova J, Trnkova K, Chlup R. A continuous glucose monitoring system ( ) - a promising approach for improving metabolic control in persons with type 1 Diabetes mellitus treated by insulin pumps. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2004; 148: Schiaffini R, Ciampalini P, Fierabracci A, et al. The Continuous Glucose Monitoring System ( ) in type 1 diabetic children is the way to reduce hypoglycemic risk. Diabetes Metab Res Rev 2002; 18: Bode BW, Schwartz S, Stubbs HA, Block JE. Glycemic characteristics in continuously monitored patients with type 1 and type 2 diabetes: normative values. Diabetes Care 2005; 28: Hay LC, Wilmshurst EG, Fulcher G. Unrecognized hypo- and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring. Diabetes

5 127 Technol Ther 2003; 5: Kyne-Grzebalski D, Wood L, Marshall SM, Taylor R. Episodic hyperglycemia in pregnant women with well-controlled type 1 diabetes mellitus: a major potential factor underlying macrosomia. Diabet Med 1999; 16: Jovanovic L. The role of continuous glucose monitoring in gestational diabetes mellitus. Diabetes Technol Ther 2000; 2 ( suppl 1 ): S Cheyne E, Kerr D. Making 'sense' of diabetes: using a continuous glucose sensor in clinical practice. Diabetes Metab Res Rev 2002; 18 ( Suppl 1 ): S McGowan K, Thomas W, Moran A. Spurious reporting of nocturnal hypoglycemia by in patients with tightly controlled type 1 diabetes. Diabetes Care 2002; 25: Guerci B, Floriot M, Bohme P, et al. Clinical performance of in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs. Diabetes Care 2003; 26: Kerssen A, De Valk HW, Visser GH. Validation of the Continuous Glucose Monitoring System ( ) by the use of two simultaneously in pregnant women with type 1 diabetes mellitus. Diabetes Technol Ther 2005; 7: The Application of Continuous Glucose Monitoring System Three Cases Reports Shi-Dou Lin, Shang-Ren Hsu, and Shih-Te Tu 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C. Department of Internal Medicine 1 Lu-Gang Christian Hospital, Lu-Gang, Changhua, Taiwan, R.O.C. Although tight control of blood sugar has been shown to reduce the complications of diabetes, there has been little improvement in the glycemic control of diabetic patients in the recent years. Patients in general do not practice self-monitoring of blood glucose sufficiently. Moreover, it is difficult to optimally tailor treatment measures in accordance to the discrete blood sugar readings acquired with the conventional glucometers. With continuous glucose measurements, however, it is possible to identify the glycemic excursions and obtain the general pattern of glucose levels, which is not achievable with discrete, periodic glucose measurements. We presented our experience with (continuous glucose monitoring system) in three different clinical scenarios. We also reviewed the current literature that discussed the utility of. The indications for include special situations such as pregnancy, for which the HbA1C may not reflect the wide fluctuations in blood glucose levels. The information provided by can be invaluable for improving the treatment and the quality of life of diabetic patients. It may also increase their understanding of diabetes. ( J Intern Med Taiwan 2006; 17: )