扫描式葡萄糖监测系统在妊娠期血糖管理中的临床应用

安妍; 祖菲; 董雪洁; 于萍; 朱巍

doi:10.16766/j.cnki.issn.1674-4152.003905

扫描式葡萄糖监测系统在妊娠期血糖管理中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.003905

安妍¹,
祖菲²,
董雪洁¹,
于萍¹,
朱巍^1, ,

1.
北京航天总医院内分泌科，北京 100076
2.
中国人寿保险健康中心，北京 100033

基金项目:

糖尿病防治研究北京市重点实验室开放基金项目 10025220109

详细信息

通讯作者:
朱巍，E-mail：zhuwei2007@sina.com

中图分类号: R714.256
计量
- 文章访问数: 5
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-14
- 网络出版日期: 2025-05-14

Research on the clinical application of flash glucose monitoring system in blood glucose management during pregnancy

AN Yan¹,
ZU Fei²,
DONG Xuejie¹,
YU Ping¹,
ZHU Wei^{1
, ,}

1.
Department of Endocrinology, Beijing Aerospace General Hospital, Beijing 100076, China

摘要

摘要: 目的针对接受胰岛素治疗的妊娠糖尿病(GDM)患者应用28 d扫描式葡萄糖监测(FGM)系统，观察FGM对患者血糖管理及妊娠结局的影响，为临床选择更优的血糖监测手段提供依据。方法研究对象为2022年4—10月北京航天总医院确诊GDM并接受胰岛素治疗的患者98例，按照随机数字表法分为FGM组(49例)和自我血糖监测(SMBG)组(49例)，比较2组患者的空腹血糖(FBG)、餐后2小时血糖(2hPG)、平均血糖(MBG)、预估糖化血红蛋白(eHbA1c)、葡萄糖目标范围内时间(TIR)、低血糖发生率、体重达标情况及妊娠结局。结果 FGM组MBG、eHbA1c水平显著低于SMBG组(P＜0.05)，2组FBG、2hPG、TIR差异无统计学意义(P＞0.05)。FGM组患者孕期的体重达标情况明显高于SMBG组[61.22%(30/49)vs. 40.82%(20/49),P＜0.05]。FGM组孕妇剖宫产、早产、胎膜早破发生率、巨大儿发生率均显著低于SMBG组(P＜0.05)。多因素logistic回归分析显示，孕期体重增长未达标(OR=14.639, 95%CI: 1.747~122.655,P=0.013)是不良妊娠结局(包括剖宫产和早产)的独立危险因素。结论应用FGM系统有助于GDM患者达到理想血糖控制及体重控制目标，降低不良妊娠结局的发生风险。
- 妊娠糖尿病 /
- 扫描式葡萄糖监测 /
- 血糖管理 /
- 妊娠结局
Abstract: Objective To apply the 28-day flash glucose monitoring (FGM) system to gestational diabetes mellitus (GDM) patients undergoing insulin therapy, observe the impact of FGM on blood glucose management and pregnancy outcomes, and provide evidence for the selection of better blood glucose monitoring methods in clinical practice. Methods The study subjects were 98 patients diagnosed with GDM and receiving insulin therapy at Beijing Aerospace General Hospital from April to October 2022. They were divided into the FGM group (49 cases) and the self-monitoring of blood glucose (SMBG) group (49 cases) using a random number table method. The fasting blood glucose (FBG), 2-hour plasma glucose (2hPG), mean blood glucose (MBG), estimated glycated hemoglobin (eHbA1c), time to target blood glucose (TIR), incidence of hypoglycemia, weight compliance and pregnancy outcome were compared between the two groups. Results The levels of MBG and eHbA1c in FGM group were significantly lower than those in SMBG group (P < 0.05), but there was no statistical significance in FBG, 2hPG and TIR (P > 0.05). The weight control rate during pregnancy in the FGM group was significantly higher than that in the SMBG group [61.22% (30/49) vs. 40.82% (20/49), P < 0.05]. The incidence of cesarean section, premature birth, prelabor rupture of membranes, and macrosomia among pregnant women in the FGM group were significantly lower than those in the SMBG group (P < 0.05). Logistic regression analysis revealed that underweight during pregnancy was an independent risk factor for adverse pregnancy outcomes, including cesarean section and preterm birth (OR=14.639, 95% CI: 1.747-122.655, P=0.013). Conclusion The application of FGM system can help achieve ideal blood glucose control and weight control, reducing the risk of adverse pregnancy outcomes.
- Gestational diabetes mellitus /
- Flash glucose monitoring /
- Blood glucose management /
- Pregnancy outcome

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表 1 2组GDM患者基线资料比较

Table 1. Comparison of baseline data between the two groups of GDM patients

项目	FGM组(n=49)	SMBG组(n=49)	统计量	P值
年龄(x±s，岁)	31.78±4.49	32.90±3.96	1.310^a	0.194
孕周(x±s，周)	29.76±1.51	30.04±1.70	0.862^a	0.391
孕前BMI(x±s)	27.72±2.34	27.95±2.93	0.429^a	0.669
收缩压(x±s，mmHg)	115.82±11.20	116.57±10.38	0.344^a	0.732
舒张压(x±s，mmHg)	77.10±7.42	74.86±9.46	1.304^a	0.195
ALT(x±s，U/L)	17.89±5.20	17.39±4.99	0.486^a	0.628
血肌酐(x±s，μmol/L)	58.59±7.22	56.49±5.88	0.579^a	0.118
甘油三酯(x±s，mmol/L)	2.32±0.72	2.28±0.95	0.235^a	0.815
总胆固醇(x±s，mmol/L)	5.13±1.00	5.16±0.90	0.156^a	0.876
LDL-C(x±s，mmol/L)	2.98±0.74	2.85±0.76	0.858^a	0.393
HbA1c(x±s，%)	5.80±0.44	5.96±0.46	1.759^a	0.082
合并症[例(%)]			1.333^b	0.248
无	44(89.80)	40(81.63)
有	5(10.20)	9(18.37)
注：^a为t值，^b为χ²值；1 mmHg=0.133 kPa。

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表 2 2组GDM患者监测效果比较(x)

Table 2. Comparison of monitoring effects between the two groups of GDM patient (x ±s)

组别	例数	MBG (mmol/L)	FBG (mmol/L)	2hPG (mmol/L)	TIR (%)	eHbA1c (%)
FGM组	49	5.30±0.35	5.11±0.72	6.58±0.94	91.12±6.03	5.59±0.15
SMBG组	49	5.89±1.23	5.27±0.69	6.66±0.82	88.30±11.29	5.84±0.24
t值		3.230	1.123	0.449	1.542	6.183
P值		0.002	0.264	0.655	0.126	＜0.001

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表 3 2组GDM患者安全性评估情况比较[例(%)]

Table 3. Comparison of safety evaluations between the two groups of GDM patients[cases (%)]

组别	例数	低血糖发生情况		体重达标情况
组别	例数	无	有	未达标	达标
FGM组	49	34(69.39)	15(30.61)	19(38.78)	30(61.22)
SMBG组	49	33(67.35)	16(32.65)	29(59.18)	20(40.82)
χ²值		0.047		4.083
P值		0.828		0.043

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表 4 2组GDM患者妊娠结局、新生儿结局比较[例(%)]

Table 4. Comparison of pregnancy outcomes and neonatal outcomes between the two groups of GDM patients [cases (%)]

组别	例数	剖宫产		早产		胎膜早破		低出生体重儿		巨大儿
组别	例数	无	有	无	有	无	有	无	有	无	有
FGM组	49	17(34.69)	32(65.31)	46(93.88)	3(6.12)	45(91.84)	4(8.16)	44(89.80)	5(10.20)	41(83.67)	8(16.33)
SMBG组	49	8(16.33)	41(83.67)	39(79.59)	10(20.41)	38(77.55)	11(22.45)	43(87.76)	6(12.24)	32(65.31)	17(34.69)
χ²值		4.350		4.301		3.857		0.102		4.350
P值		0.037		0.038		0.049		0.749		0.037

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表 5 GDM患者不良妊娠结局的单因素logistic回归分析

Table 5. Univariate logistic regression analysis of adverse pregnancy outcomes of GDM patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
应用FGM	-2.955	1.059	7.790	0.005	0.052	0.007~0.415
TIR	-0.069	0.068	1.038	0.308	0.934	0.818~1.066
年龄	0.036	0.067	0.284	0.594	1.036	0.909~1.181
孕周	0.046	0.179	0.067	0.796	1.047	0.738~1.487
孕前BMI	0.011	0.004	7.123	0.008	1.011	1.003~1.019
收缩压	0.004	0.026	0.024	0.877	1.004	0.954~1.057
舒张压	-0.013	0.034	0.139	0.709	0.987	0.924~1.055
ALT	-0.096	0.060	2.528	0.112	0.908	0.807~1.023
Scr	-0.039	0.041	0.933	0.334	0.962	0.888~1.041
TG	0.079	0.340	0.054	0.816	1.082	0.556~2.108
TC	-0.113	0.295	0.146	0.702	0.893	0.501~1.593
LDL-C	-0.378	0.355	1.135	0.287	0.685	0.342~1.373
HbA1c	-0.456	0.646	0.498	0.480	0.634	0.179~2.249
合并症	0.956	1.078	0.785	0.376	2.600	0.314~21.517
MBG	0.658	0.583	1.275	0.259	1.931	0.616~6.054
eHbA1c	1.832	1.408	1.694	0.193	6.249	0.396~98.668
低血糖发生	0.282	0.629	0.201	0.654	1.326	0.386~4.550
体重增长未达标	2.470	1.058	5.447	0.020	11.822	1.486~94.083

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表 6 GDM患者不良妊娠结局的多因素logistic回归分析

Table 6. Multivariate logistic regression analysis of adverse pregnancy outcomes of GDM patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
应用FGM	-5.521	0.707	60.941	＜0.001	0.004	0.001~0.016
孕前BMI	-0.009	0.014	0.411	0.521	0.991	0.964~1.019
体重增长未达标	2.684	1.085	6.123	0.013	14.639	1.747~122.655

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参考文献(21)

[1]	徐嘉蔚, 林萱. 妊娠期糖尿病的研究进展[J]. 临床内科杂志, 2023, 40(10): 716-718. doi: 10.3969/j.issn.1001-9057.2023.10.020 XU J H, LIN X. Research progress in gestational diabetes[J]. Journal of Clinical Internal Medicine, 2023, 40(10): 716-718. doi: 10.3969/j.issn.1001-9057.2023.10.020
[2]	郑凯, 袁晶. 脂肪因子与妊娠期糖尿病及糖脂代谢[J]. 国际生殖健康/计划生育杂志, 2021, 40(5): 431-435. ZHENG K, YUAN J. Adipokines and gestational diabetes mellitus and glucose lipid metabolism[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(5): 431-435.
[3]	刘莎莎, 赵云, 孙国强, 等. 妊娠期糖尿病患者胎盘组织中Apelin和APJ的表达及其对滋养层细胞胰岛素抵抗和行为的影响[J]. 吉林大学学报(医学版), 2022, 48(5): 1314-1323. LIU S S, ZHAO Y, SUN G Q, et al. Expressions of Apelin and APJ in placental tissue of gestational diabetes mellitus patients and its effect on insulin resistance and behavior of trophoblast cells[J]. Journal of Jilin University: Medicine Edition, 2022, 48(5): 1314-1323.
[4]	邱青梅, 梁莉, 陆洁清, 等. 妊娠期糖尿病患者孕期增重情况调查及对母婴并发症发生率影响[J]. 临床军医杂志, 2023, 51(1): 86-88. QIU Q M, LIANG L, LU J Q, et al. Investigation of gestational weight gain in patients with gestational diabetes mellitus and its impact on the incidence of maternal and infant complications[J]. Clinical Journal of Medical Officers, 2023, 51(1): 86-88.
[5]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. Chinese Society of Diabetes. Guidelines for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(4): 315-409.
[6]	王倩, 陈琳, 谢克亮. 血糖监测技术及管理指标的临床应用进展[J]. 实用检验医师杂志, 2022, 14(3): 332-336. doi: 10.3969/j.issn.1674-7151.2022.03.027 WANG Q, CHEN L, XIE K L. Clinical application progress of blood glucose monitoring technology and management indicators[J]. Chinese Journal of Clinical Pathologist, 2022, 14(3): 332-336. doi: 10.3969/j.issn.1674-7151.2022.03.027
[7]	隽娟, 孙祎赢, 叶彩云, 等. 妊娠期糖尿病合并慢性高血压孕妇胰岛素抵抗水平及其对妊娠结局的影响[J]. 中华围产医学杂志, 2020, 23(2): 91-97. doi: 10.3760/cma.j.issn.1007-9408.2020.02.004 JUAN J, SUN Y Y, YE C Y, et al. Insulin resistance and pregnancy outcomes in gestational diabetes mellitus gravida complicated by chronic hypertension[J]. Chinese Journal of Perinatal Medicine, 2020, 23(2): 91-97. doi: 10.3760/cma.j.issn.1007-9408.2020.02.004
[8]	于春梅, 李武珊, 王青. 妊娠糖尿病孕妇胰岛素相关指标水平变化及临床意义[J]. 国际医药卫生导报, 2023, 29(17): 2459-2462. doi: 10.3760/cma.j.issn.1007-1245.2023.17.020 YU C M, LI W S, WANG Q. Changes and clinical significance of insulin related indexes in pregnant women with gestational diabetes mellitus[J]. International Medicine and Health Guidance News, 2023, 29(17): 2459-2462. doi: 10.3760/cma.j.issn.1007-1245.2023.17.020
[9]	WANG N, SONG L, SUN B. Contribution of gestational diabetes mellitus heterogeneity and prepregnancy body mass index to large-for-gestational-age infants: a retrospective case-control study[J]. J Diabetes, 2021, 13(4): 307-317. doi: 10.1111/1753-0407.13113
[10]	ELLERBROCK J, SPAANDERMAN B, DRONGELEN J V, et al. Role of beta cell function and insulin resistance in the development of gestational diabetes mellitus[J]. Nutrients, 2022, 14(12): 2444. DOI: 10.3390/nu14122444.
[11]	BATTELINO T, DANNE T, BERGENSTAL R M, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range[J]. Diabetes Care, 2019, 42(8): 1593-1603. doi: 10.2337/dci19-0028
[12]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第二部分] [J]. 中华妇产科杂志, 2022, 57(2): 81-90. doi: 10.3760/cma.j.cn112141-20210917-00529 Chinese Medical Association Obstetrics and Gynecology Branch, Chinese Medical Association Perinatal Medicine branch, China Maternal and Child Health Association pregnancy and diabetes professional Committee. Guideline of diagnosis and treatment of hyperglycemia in pregnancy(2022)[Part two] [J]. Chinese Journal of Obstetrics and Gynecology, 2022, 57(2): 81-90. doi: 10.3760/cma.j.cn112141-20210917-00529
[13]	中华医学会糖尿病学分会. 中国血糖监测临床应用指南(2021年版)[J]. 中华糖尿病杂志, 2021, 13(10): 936-948. doi: 10.3760/cma.j.cn115791-20210810-00436 Chinese Diabetes Society. Clinical application guideline for blood glucose monitoring in China (2021 edition)[J]. Chinese Journal of Diabetes Mellitus, 2021, 13(10): 936-948. doi: 10.3760/cma.j.cn115791-20210810-00436
[14]	YARON M, ROITMAN E, AHARON-HANANEL G, et al. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes[J]. Diabetes Care, 2019, 42(7): 1178-1184. doi: 10.2337/dc18-0166
[15]	龚莉, 赵晶, 陈曙新. 高龄妊娠糖尿病危险因素及其母婴结局分析[J]. 中华全科医学, 2022, 20(12): 2068-2070, 2074. doi: 10.16766/j.cnki.issn.1674-4152.002771 GONG L, ZHAO J, CHEN S X. Risk factors of gestational diabetes mellitus in advanced age and analysis of maternal and infant outcomes[J]. Chinese Journal of General Practice, 2022, 20(12): 2068-2070, 2074. doi: 10.16766/j.cnki.issn.1674-4152.002771
[16]	YE W R, LUO C, HUANG J. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis[J]. BMJ, 2022, 25(377): e067946. DOI: 10.1136/bmj-2021-067946.
[17]	陆艳萍, 周莹, 臧丽娟. 妊娠期糖尿病患者血糖波动幅度对母婴结局的影响[J]. 中国妇幼保健, 2022, 37(3): 412-415. LU Y P, ZHOU Y, ZANG L J. Effect of blood glucose fluctuation in patients with gestational diabetes mellitus on maternal and infant outcomes[J]. Maternal and Child Health Care of China, 2022, 37(3): 412-415.
[18]	陈云燕, 吴琪, 张丽霞, 等. 妊娠糖尿病孕妇孕中期口服葡萄糖耐量试验异常项数及孕期增重与不良妊娠结局的关系[J]. 浙江大学学报(医学版), 2021, 50(3): 313-319. CHEN Y Y, WU Q, ZHANG L X, et al. Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus[J]. Journal of Zhejiang University (Medical Sciences), 2021, 50(3): 313-319.
[19]	王薇, 黄婵, 顾华妍, 等. 围孕期空腹血糖对妊娠期糖尿病发生的预测作用及其与不良妊娠结局的关系[J]. 实用妇产科杂志, 2023, 39(2): 142-146. WANG W, HUANG C, GU H Y, et al. Predictive effect of fasting blood glucose during pregnancy on the occurrence of gestational diabetes mellitus and its relationship with adverse pregnancy outcomes[J]. Journal of Practical Obstetrics and Gynecology, 2023, 39(2): 142-146.
[20]	唐艺, 查红英, 孙璐, 等. 妊娠期糖尿病患者口服葡萄糖耐量试验不同时间点血糖特征与妊娠结局相关性的研究[J]. 中国糖尿病杂志, 2023, 31(7): 491-499. doi: 10.3969/j.issn.1006-6187.2023.07.003 TANG Y, ZHA H Y, SUN L, et al. Associations between blood glucose characteristics based on OGTT values and pregnancy outcomes in gestational diabetes mellitus[J]. Chinese Journal of Diabetes, 2023, 31(7): 491-499. doi: 10.3969/j.issn.1006-6187.2023.07.003
[21]	杨严政, 周玉娥, 李团, 等. 孕前体质指数、孕期血红蛋白水平及孕期体重增长对妊娠结局的影响[J]. 昆明医科大学学报, 2022, 43(11): 112-117. doi: 10.12259/j.issn.2095-610X.S20221103 YANG Y Z, ZHOU Y E, LI T, et al. Effects of prepregnancy body mass index, hemoglobin and gestational weight gain on pregnancy outcomes[J]. Journal of Kunming Medical University, 2022, 43(11): 112-117. doi: 10.12259/j.issn.2095-610X.S20221103