測量血糖的新趨勢：即時性連續血糖監測（Real-time CGM）

Upcoming Trend of Glucose Measurement: Real-Time Continuous Glucose Monitoring System

黃俊達(Chun-Ta Huang) ； 李淳權(Chun-Chuan Lee)

《內科學誌》 31卷1期 (2020/02) Pp. 30-39

https://doi.org/10.6314/JIMT.202002_31(1).06

摘要

糖化血色素（glycated hemoglobin, HbA1c）是評估血糖控制好壞的重要指標，因其檢測方便且準確性高，成了臨床醫師不可或缺的利器，多數研究也常以糖化血色素做為實驗的觀察終點（endpoint）。糖化血色素的數值雖可反映患者過去二至三個月血糖的平均值，卻仍有諸多細節無法被呈現，包含患者暴露在過高或過低血糖值的時間、血糖變異度（glycemic variability）、短期內血糖值的快速變化等。為使血糖管理能夠最佳化，除了要定期評估糖化血色素之外，另需仰賴自我血糖監測（self-monitor blood glucose, SMBG）彌補其不足，可惜過往利用指尖採血監測血糖所造成的不便常使患者無法有效的遵循醫囑。為克服上述臨床困境，連續血糖監測（continuous glucose monitoring, CGM）的技術因應而生。拜科技進步所賜，從第一個連續血糖監測系統發明至今，儀器不論在持久性、功能性與準確性皆有長足的進展，進而改變醫護人員及患者固有的血糖監測模式。本文將針對即時性連續血糖監測（real-time CGM,以下簡稱rtCGM）進行文獻回顧與臨床運用的探討。

關鍵字

連續血糖監測（Continuous glucose monitoring, CGM） ； 即時性（Real-time） ； 糖尿病（Diabetes mellitus） ； 低血糖（Hypoglycemia） ； 糖化血色素（Glycated hemoglobin, HbA1c）

並列摘要

Glycated hemoglobin A1c is an important indicator of glycemic control. The convenience and accuracy of HbA1c make it an indispensable tool for clinician and it has been widely used as endpoints in clinical trials. Although HbA1c is an integrated marker of glycemic control of previous 2 to 3 months, many details can't be disclosed by this marker. Information such as glycemic variability, time spent in hyper- or hypoglycemia and the speed of glucose excursion may be just as important in terms of clinical outcomes. Self-monitor blood glucose in adjunct to HbA1c measurement is crucial to optimize glycemic control. Unfortunately, traditional glucose monitoring by fingerstick and glucometer is inconvenient and painful, making most patients unwilling to continue on. The invention of less invasive continuous glucose monitoring system (CGMS) is a technology breakthrough to overcome the aforementioned barrier. It also offers healthcare provider an opportunity to make a more comprehensive plan in accordance to patients' glycemic pattern. The durability, functionality and accuracy of CGMS have greatly improved in the past decades since the first generation was announced. As a result, the generality and indication of CGMS will gradually expand and brings impact to the way we practice. In this article, our aim is to review the evidence and clinical application of CGMS, focusing mainly on real-time continuous glucose monitoring.