餐后血糖管理指南idf2007ppt课件.ppt

* SMBG allows people with diabetes to obtain and use information about “real-time” plasma glucose levels. This facilitates timely intervention to achieve and maintain near-normal glycaemia and provides feedback to people with diabetes. Thus, most diabetes organizations and other medical associations advocate use of SMBG in people with diabetes.(126-128) While much of the literature has focused primarily on the utility of SMBG in people treated with insulin, (2;129) a number of studies have demonstrated that therapeutic management programmes that include structured SMBG result in greater HbA1c reduction in people with non-insulin-requiring type 2 diabetes compared with programmes without SMBG.(130-134) Nonetheless, debate continues on the clinical benefits of SMBG, particularly in non-insulin-treated type 2 diabetes. Some studies have shown little or no difference in glycaemic control (HbA1c) when comparing use of SMBG and urine glucose testing,(135;136) whereas other reports have demonstrated that SMBG has distinct advantages in terms of improved glycaemic control.(133) A recent meta-analysis by Jansen and colleagues,(133)which looked at 13 randomized controlled trials investigating the effects of SMBG, found that interventions with SMBG showed a reduction in HbA1c of 0.40% compared with interventions without SMBG. Moreover, when regular medical feedback was provided to people, the HbA1c reduction more than doubled, whereas self-monitoring of urine glucose showed comparable results to interventions without self-monitoring of blood glucose or urine glucose. However the recently published DiGEM study failed to show that SMBG significantly reduced on HbA1c which was only 0.17% lower in the group using intensive SMBG compared with usual care without SMBG.(137) SMBG is only one component of diabetes management. Its potential benefits require training of people to perform SMBG,