第2型糖尿病患配對血糖測試之臨床建議

Clinical Suggestions of Paired Testing of Blood Glucose for the Patients with Type 2 Diabetes Mellitus

陳柏勳(Po-Hsun Chen) ； 許惠恒(Wayne H-H Sheu)

《內科學誌》 21卷5期 (2010/10) Pp. 330-336

https://doi.org/10.6314/JIMT.2010.21(5).04

摘要

第2型糖尿病(type 2 diabetes mellitus)患者之血糖控制指標過去多著重於空腹血糖與糖化血色素的監測。但是近年來多項對於餐後血糖之深入分析研究發現，血糖的控制不能忽略餐後血糖這個重要的指標，因爲過高的餐後血糖與心血管疾病的風險上升有密切相關。自我血糖監測（self-monitoring of blood glucose, 簡稱SMBG）是糖尿病患者自我血糖控制中最重要的步驟之一，可幫助病人本身或其醫療照護者調整生活方式甚至藥物的調整，而近年來提倡配對血糖測試(paired testing)的觀念，更有助於糖尿病患者清楚本身的飲食、生活型態或藥物對血糖變化所產生的影響。在2009年國際糖尿病聯盟(International Diabetes Federation)公佈的治療指引中，針對未使用胰島素的第2型糖尿病患者要如何正確即時利用SMBG，提出建議。中華民國糖尿病學會也在2009年針對餐後血糖的重要提出治療的建議指引。本文即針對自我血糖監測之重要性及實用性與如何應用配對血糖測試，增進醫療照護者及病人瞭解餐前與餐後血糖之變化，進而改善整體心血管疾病的風險，進行文獻回顧與建議。所得結論爲：對於第2型糖尿病患者而言，在有詳盡飲食記錄和良好的衛教諮詢系統的基礎上，當病人及其醫療照護者有共識和能力對於配對血糖測試的結果做出飲食及生活型態調整或是適當的藥物治療，可促進糖尿病患者的血糖控制、用藥安全性及其生活品質，以期能降低心血管疾病之風險。

關鍵字

第2型糖尿病 ； 自我血糖監測 ； 配對血糖測試 ； 餐後血糖 ； 餐前餐後血糖的差異大小，又稱

並列摘要

Previous clinical practice used to focus on fasting/preprandial glucose and glycated hemoglobin (HbA1c) as monitoring indicator in patients with type 2 diabetes mellitus. However, a number of studies have, through several analysis information, demonstrated that postprandial blood glucose provide a strong linkage to cardiovascular complication, both in diabetes and subjects with impaired glucose tolerance. Paired testing of blood glucose, derived from self-monitoring of blood glucose (SMBG), is a practical tool to help patients and their medical caregivers monitoring the blood glucose following meals or one events (exercise, for example). Patients with type 2 DM can take advantage of the paired testing to realize how their diet, lifestyle, or medicines can greatly influence the blood glucose variation. In this article, we had thoroughly reviewed the importance and utility of self monitoring of blood glucose and the practical application of the paired testing of blood glucose in how to improve postprandial glucose control to ameliorate the overall risk of cardiovascular disease. The conclusions are as follows: if a detailed diet/activity records and health care system are well established, better glucose control and medication safety could be achieved by optimal paired testing followed by therapeutic modification of diet, lifestyle, or medicine used.

並列關鍵字

Type 2 diabetes mellitus ； Self-monitoring of blood glucose, SMBG ； Paired testing ； Post-prandial glucose, PPG ； Postprandial glucose excursion, Postprandial delta glycaemia