不同血糖監測方式對第二型糖尿病患者血糖控制之影響：隨機對照研究

Effects of Different Blood Glucose Monitoring Methods on Glycemic Control in People with Type 2 Diabetes:A Randomized Controlled Study

目的：評估即時連續血糖監測（RT-CGM）與自我血糖監測（SMBG）對第二型糖尿病患者自我效能及血糖控制的影響。方法：共招募90名第二型糖尿病患者，隨機分配至RT-CGM組、SMBG組與控制組（各30人）。三組皆參與糖尿病衛教課程，SMBG與RT-CGM組另接受兩週的遠距照護。主要評估指標為血糖控制、自我效能及健康促進行為。結果：三組的糖化血色素皆顯著下降（RT-CGM：9.50％降至8.86％；SMBG：9.77％降至8.48％；對照組：9.30％降至8.83％；p<0.001）。空腹血糖改善顯著（RT-CGM：171.80降至167.54mg／dL；SMBG：162.34降至130.42mg／dL；對照組：177.13降至163.03mg／dL；p=0.002）。糖化血色素之組別與時間呈現顯著的交互作用（p=0.012），以SMBG組的降低幅度最大，從9.77％降至8.48％。遠距照護結束後三個月內，SMBG組每週監測≧2次者達76.9％（≧4次佔42.3％），顯著高於其他組（p<0.05）；RT-CGM組能偵測到更多無症狀的日夜間低血糖（p<0.05）。中文健康識能、自我效能及健康促進行為三組間無顯著差異。結論：糖尿病教育結合遠距照護可顯著改善血糖控制。SMBG在提升監測頻率與降低HbA1c方面表現較佳，而RT-CGM在低血糖偵測上具優勢。未來研究應整合兩者優點，發展更有效的糖尿病管理策略，以達最佳血糖控制。

Objectives. To evaluate the effects of real-time continuous glucose monitoring (RT-CGM) and self-monitoring of blood glucose (SMBG) on self-efficacy and glycemic control in people with type 2 diabetes.
Methods. Ninety patients were randomly assigned to RT-CGM, SMBG, or control groups (n=30 each). All received a diabetes education course, with RT-CGM and SMBG groups undergoing an additional two-week remote intervention. Outcome measures included, glucose control diabetes self-efficacy, and diabetes health behaviors.
Results. HbA1c improved significantly across all groups. (RT-CGM: 9.50% to 8.86%; SMBG: 9.77% to 8.48%; Control: 9.30% to 8.83%; p<0.001) and FPG (RT-CGM: 171.80 to 167.54mg/dL;
SMBG: 162.34 to 130.42mg/dL; Control: 177.13 to 163.03mg/dL; p=0.002) improved significantly. Notably, a significant group-by-time interaction was found for HbA1c (p=0.012). During the three months following the end of remote care, 76.9% of SMBG participants monitored their blood glucose at least twice weekly (42.3% monitored≥4 times per week), the highest among groups (p<0.05). RT-CGM detected more hypoglycemia events, both during the day and at night, with or without awareness (p<0.05). No significant differences were found in the Traditional Chinese Health Literacy Assessment, self-efficacy, or health-promoting behaviors (p>0.05).
Conclusion. Diabetes education combined with remote care can significantly improve glycemic control. SMBG performs better in increasing monitoring frequency and reducing HbA1c, whereas RT-CGM has an advantage in detecting hypoglycemia. Future research should integrate the strengths of both approaches to develop more effective diabetes management strategies and achieve optimal glycemic control.