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Самоконтроль гликемии при сахарном диабете: медицинские и психологические аспекты
Рунова Г.Е. Самоконтроль гликемии при сахарном диабете: медицинские и психологические аспекты. Consilium Medicum. 2016; 18 (5): 98–102. DOI: 10.26442/2075-1753_2016.5.98-102
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Runova G.E. Self-monitoring blood glucose levels and glycemic control in diabetes mellitus: medical and psychological aspects. Consilium Medicum. 2016; 18 (5): 98–102. DOI: 10.26442/2075-1753_2016.5.98-102
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Аннотация
Контроль гликемии играет важную роль в управлении сахарным диабетом (СД) и снижении риска развития острых и поздних осложнений диабета. Одна из причин неудовлетворительного гликемического контроля у пациентов с СД – недостаточный или неосмысленный самоконтроль уровня глюкозы крови. Результаты исследований наглядно продемонстрировали, что увеличение частоты самоконтроля приводит к снижению уровня гликированного гемоглобина у пациентов с СД типа 1. У пациентов с СД типа 2 особенно остро стоит вопрос экономической и клинической целесообразности регулярного контроля гликемии в связи с неоднозначными данными клинических исследований. Для пациентов с СД характерна низкая приверженность выполнению рекомендаций по самоконтролю глюкозы крови. Наиболее частыми причинами недостаточного самоконтроля являются психологические, социальные и экономические. Предполагается, что структурированная схема контроля гликемии с последующей консультацией лечащего врача вместо регулярного ежедневного измерения гликемии натощак имеет большее клиническое значение. Благодаря совершенствованию используемых технологий процедура самостоятельного измерения гликемии упрощается, сводятся к минимуму технические ошибки при проведении контроля гликемии. Введены новые критерии аналитической точности портативных приборов для проведения самоконтроля гликемии.
Ключевые слова: самоконтроль глюкозы крови, сахарный диабет типа 1, сахарный диабет типа 2, частота самоконтроля.
Ключевые слова: самоконтроль глюкозы крови, сахарный диабет типа 1, сахарный диабет типа 2, частота самоконтроля.
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Glycemic control plays an important role in the management of diabetes mellitus (DM) and in reducing the risk of the development of acute and late complications of diabetes. One of the causes of poor glycemic control in patients with DM is insufficient or unthought self-monitoring of blood glucose. The results of the studies have demonstrated that the increase in the frequency of self-monitoring blood glucose can lead to the decrease in glycosylated hemoglobin level in patients with type 1 DM. The issue concerning the economic and clinical necessity for regular glycemic control due to questionable data of clinical trials is particularly acute problem in patients with type 2 DM. DM patients are characterized by poor compliance to carry out self-monitoring of blood glucose recommendations. The most frequent causes of poor self-control are psychological, social and economic. It is expected that well-defined scheme of glycemic control, followed by consultation by the physician in charge instead of regular fasting glucose test will have better clinical significance. As a result of technology development, the process of self-monitoring of blood glucose is simplified and minimizes the technical errors during glycemic control. New criteria for analytical accuracy of the portable devices for analyzing blood glucose data have been shown.
Key words: self-monitoring of blood glucose, type 1 diabetes mellitus, type 2 diabetes mellitus, frequency of self-monitoring blood glucose.
Key words: self-monitoring of blood glucose, type 1 diabetes mellitus, type 2 diabetes mellitus, frequency of self-monitoring blood glucose.
Полный текст
Список литературы
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3. Handelsman Y, Bloomgarden ZT, Grunberger G et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan – 2015. Endocr Pract 2015; 21.
4. American Diabetes Association Standards of Medical Care in Diabetes. Glycemic targets. Diabetes Care 2016; 39 (Suppl. 1): S39–S46.
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6. Schramm W. Self-Monitoring of Blood Glucose: One STeP Forward? J Diabetes Sci Techno 2012; 6 (4): 978–82.
7. Taylor JR, Campbell KM. Home Monitoring of Glucose and Blood Pressure. American Family Physician 2007; 76 (2): 255–60.
8. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of diabetes 2 type (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.
9. Schütt M, Kern W, Krause U. DPV Initiative Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24,500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes 2006; 114: 384–8.
10. Ziegler R, Heidtmann B, Hilgard D et al. DPV-Wiss-Initiative Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12: 11–7.
11. Kolb H, Kempf K, Martin S et al. On what evidence-base do we recommend self-monitoring of blood glucose? Diabetes Res Clin Pract 2010; 87: 150–6.
12. Parkin CG, Buskirk A, Hinnen DA, Axel-Schweitzer M. Results that matter: structured vs. unstructured selfmonitoring of blood glucose in type 2 diabetes. Diabetes Res Clin Pract 2012; 97: 6–15.
13. Towfigh A, Romanova M, Weinreb JE et al. Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis. Am J Manag Care 2008; 14: 468–75.
14. McIntosh B, Yu C, Lal A et al. Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Med 2010; 4: e102–e113.
15. Farmer AJ, Perera R, Ward A et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012; 344: e486.
16. Malanda UL, Welschen LM, Riphagen II et al. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1: CD005060.
17. Ezenwaka CE, Dimgba A, Okali F et al. Self-monitoring of SMBG IN CENTRAL AND EASTERN EUROPE 473 blood glucose improved glycaemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago. Niger J Clin Pract 2011; 14: 1–5.
18. Martin S, Kolb H, Schneider B et al. Myocardial infarction and stroke in early years after diagnosis of type 2 diabetes: risk factors and relation to selfmonitoring of blood glucose. Diabetes Technol Ther 2009; 11: 234–41.
19. Davis WA, Bruce DG, Davis TM. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study. Diabetologia 2007; 50: 510–5.
20. Duran A, Martin P, Runkle I et al. Benefits of self-monitoring blood glucose in the management of newonset type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups. J Diabetes 2010; 2: 203–11.
21. Kleefstra N, Hortensius J, Logtenberg SJ et al. Self-monitoring of blood glucose in tablet-treated type 2 diabetic patients (ZODIAC). Neth J Med 2010; 68: 311–6.
22. Polonsky WH, Fisher L, Schikman CH et al. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technol Ther 2011; 13: 797–802.
23. Peyrot M, Rubin RR, Lauritzen T et al. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med 2005; 22 (10): 1379–85.
24. Harris MI. National Health and Nutrition Examination Survey. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001; 24 (6): 979–82.
25. Vincze G, Barner JC, Lopez D. Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Diabetes Educ 2004; 30 (1): 112–25.
26. Simmons JH, Chen V, Miller KM et al. Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry. Diabetes Care 2013; 36 (11): 3573–7.
27. Caswell M et al. Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7.
2. Miller KM, Beck RW, Bergenstal RM et al. Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants. Diabetes Care 2013; 36 (7): 2009–14.
3. Handelsman Y, Bloomgarden ZT, Grunberger G et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan – 2015. Endocr Pract 2015; 21.
4. American Diabetes Association Standards of Medical Care in Diabetes. Glycemic targets. Diabetes Care 2016; 39 (Suppl. 1): S39–S46.
5. Patton SR. Adherence to Glycemic Monitoring in Diabetes. J Diabetes Sci Techno 2015; 9 (3): 668–75.
6. Schramm W. Self-Monitoring of Blood Glucose: One STeP Forward? J Diabetes Sci Techno 2012; 6 (4): 978–82.
7. Taylor JR, Campbell KM. Home Monitoring of Glucose and Blood Pressure. American Family Physician 2007; 76 (2): 255–60.
8. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of diabetes 2 type (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.
9. Schütt M, Kern W, Krause U. DPV Initiative Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24,500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes 2006; 114: 384–8.
10. Ziegler R, Heidtmann B, Hilgard D et al. DPV-Wiss-Initiative Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12: 11–7.
11. Kolb H, Kempf K, Martin S et al. On what evidence-base do we recommend self-monitoring of blood glucose? Diabetes Res Clin Pract 2010; 87: 150–6.
12. Parkin CG, Buskirk A, Hinnen DA, Axel-Schweitzer M. Results that matter: structured vs. unstructured selfmonitoring of blood glucose in type 2 diabetes. Diabetes Res Clin Pract 2012; 97: 6–15.
13. Towfigh A, Romanova M, Weinreb JE et al. Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis. Am J Manag Care 2008; 14: 468–75.
14. McIntosh B, Yu C, Lal A et al. Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Med 2010; 4: e102–e113.
15. Farmer AJ, Perera R, Ward A et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012; 344: e486.
16. Malanda UL, Welschen LM, Riphagen II et al. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1: CD005060.
17. Ezenwaka CE, Dimgba A, Okali F et al. Self-monitoring of SMBG IN CENTRAL AND EASTERN EUROPE 473 blood glucose improved glycaemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago. Niger J Clin Pract 2011; 14: 1–5.
18. Martin S, Kolb H, Schneider B et al. Myocardial infarction and stroke in early years after diagnosis of type 2 diabetes: risk factors and relation to selfmonitoring of blood glucose. Diabetes Technol Ther 2009; 11: 234–41.
19. Davis WA, Bruce DG, Davis TM. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study. Diabetologia 2007; 50: 510–5.
20. Duran A, Martin P, Runkle I et al. Benefits of self-monitoring blood glucose in the management of newonset type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups. J Diabetes 2010; 2: 203–11.
21. Kleefstra N, Hortensius J, Logtenberg SJ et al. Self-monitoring of blood glucose in tablet-treated type 2 diabetic patients (ZODIAC). Neth J Med 2010; 68: 311–6.
22. Polonsky WH, Fisher L, Schikman CH et al. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technol Ther 2011; 13: 797–802.
23. Peyrot M, Rubin RR, Lauritzen T et al. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med 2005; 22 (10): 1379–85.
24. Harris MI. National Health and Nutrition Examination Survey. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001; 24 (6): 979–82.
25. Vincze G, Barner JC, Lopez D. Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Diabetes Educ 2004; 30 (1): 112–25.
26. Simmons JH, Chen V, Miller KM et al. Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry. Diabetes Care 2013; 36 (11): 3573–7.
27. Caswell M et al. Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7.
________________________________________________
1. Dedov I.I., Shestakova M.V., Galstian G.R. i dr. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Pod red. I.I.Dedova, M.V.Shestakovoi (7-i vypusk). Sakharnyi diabet. 2015; 18 (1S): 1–112. [in Russian]
2. Miller KM, Beck RW, Bergenstal RM et al. Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants. Diabetes Care 2013; 36 (7): 2009–14.
3. Handelsman Y, Bloomgarden ZT, Grunberger G et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan – 2015. Endocr Pract 2015; 21.
4. American Diabetes Association Standards of Medical Care in Diabetes. Glycemic targets. Diabetes Care 2016; 39 (Suppl. 1): S39–S46.
5. Patton SR. Adherence to Glycemic Monitoring in Diabetes. J Diabetes Sci Techno 2015; 9 (3): 668–75.
6. Schramm W. Self-Monitoring of Blood Glucose: One STeP Forward? J Diabetes Sci Techno 2012; 6 (4): 978–82.
7. Taylor JR, Campbell KM. Home Monitoring of Glucose and Blood Pressure. American Family Physician 2007; 76 (2): 255–60.
8. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of diabetes 2 type (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.
9. Schütt M, Kern W, Krause U. DPV Initiative Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24,500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes 2006; 114: 384–8.
10. Ziegler R, Heidtmann B, Hilgard D et al. DPV-Wiss-Initiative Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12: 11–7.
11. Kolb H, Kempf K, Martin S et al. On what evidence-base do we recommend self-monitoring of blood glucose? Diabetes Res Clin Pract 2010; 87: 150–6.
12. Parkin CG, Buskirk A, Hinnen DA, Axel-Schweitzer M. Results that matter: structured vs. unstructured selfmonitoring of blood glucose in type 2 diabetes. Diabetes Res Clin Pract 2012; 97: 6–15.
13. Towfigh A, Romanova M, Weinreb JE et al. Self-monitoring of blood glucose levels in patients with type 2 diabetes mellitus not taking insulin: a meta-analysis. Am J Manag Care 2008; 14: 468–75.
14. McIntosh B, Yu C, Lal A et al. Efficacy of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin: a systematic review and meta-analysis. Open Med 2010; 4: e102–e113.
15. Farmer AJ, Perera R, Ward A et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012; 344: e486.
16. Malanda UL, Welschen LM, Riphagen II et al. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1: CD005060.
17. Ezenwaka CE, Dimgba A, Okali F et al. Self-monitoring of SMBG IN CENTRAL AND EASTERN EUROPE 473 blood glucose improved glycaemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago. Niger J Clin Pract 2011; 14: 1–5.
18. Martin S, Kolb H, Schneider B et al. Myocardial infarction and stroke in early years after diagnosis of type 2 diabetes: risk factors and relation to selfmonitoring of blood glucose. Diabetes Technol Ther 2009; 11: 234–41.
19. Davis WA, Bruce DG, Davis TM. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study. Diabetologia 2007; 50: 510–5.
20. Duran A, Martin P, Runkle I et al. Benefits of self-monitoring blood glucose in the management of newonset type 2 diabetes mellitus: the St Carlos Study, a prospective randomized clinic-based interventional study with parallel groups. J Diabetes 2010; 2: 203–11.
21. Kleefstra N, Hortensius J, Logtenberg SJ et al. Self-monitoring of blood glucose in tablet-treated type 2 diabetic patients (ZODIAC). Neth J Med 2010; 68: 311–6.
22. Polonsky WH, Fisher L, Schikman CH et al. A structured self-monitoring of blood glucose approach in type 2 diabetes encourages more frequent, intensive, and effective physician interventions: results from the STeP study. Diabetes Technol Ther 2011; 13: 797–802.
23. Peyrot M, Rubin RR, Lauritzen T et al. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med 2005; 22 (10): 1379–85.
24. Harris MI. National Health and Nutrition Examination Survey. Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Diabetes Care 2001; 24 (6): 979–82.
25. Vincze G, Barner JC, Lopez D. Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Diabetes Educ 2004; 30 (1): 112–25.
26. Simmons JH, Chen V, Miller KM et al. Differences in the management of type 1 diabetes among adults under excellent control compared with those under poor control in the T1D Exchange Clinic Registry. Diabetes Care 2013; 36 (11): 3573–7.
27. Caswell M et al. Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7.
Авторы
Г.Е.Рунова
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
guzelvolkova@yandex.ru
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
guzelvolkova@yandex.ru
________________________________________________
G.E.Runova
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
guzelvolkova@yandex.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
guzelvolkova@yandex.ru
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