Emzabalazweni kazwelonke wokulwa nobhubhane lwesifo sikashukela, isikhali esidingekayo esikhuthazwa ngenkuthalo ezigulini siyingxenye eyodwa kwezine kuphela futhi singagqokwa esiswini noma engalweni.
Ama-monitor glucose ahlala efakwe inzwa encane engena ngaphansi kwesikhumba, okunciphisa isidingo sokuthi iziguli zihlabe iminwe yazo nsuku zonke ukuze zihlole i-glucose yegazi.Imonitha ilandelela izinga le-glucose, ithumele ukufundwa kumakhalekhukhwini wesiguli kanye nodokotela, futhi yazise isiguli uma ukufundwa kuphezulu kakhulu noma kuphansi kakhulu.
Ngokwemininingwane evela enkampanini yokutshala imali iBaird, cishe abantu abayizigidi ezi-2 banesifo sikashukela namuhla, okuyisibalo esiphindwe kabili kunangonyaka ka-2019.
Kunobufakazi obuncane bokuthi i-continuous blood glucose monitoring (CGM) inomphumela ongcono wokwelapha ezigulini eziningi ezinesifo sikashukela-ochwepheshe bezempilo bathi abantu abalinganiselwa ezigidini ezingu-25 abanesifo sohlobo 2 e-United States abanayo imijovo ye-insulin ukuze balawule ushukela wabo wegazi.Kodwa-ke, umenzi, kanye nodokotela abathile nezinkampani zomshwalense, bathi uma kuqhathaniswa nokuhlolwa kweminwe kwansuku zonke, idivayisi isiza iziguli ukulawula isifo sikashukela ngokunikeza impendulo esheshayo yokushintsha ukudla nokuzivocavoca.Bathi lokhu kunganciphisa izinkinga ezibizayo zezifo ezifana nenhliziyo kanye nesifo sohlangothi.
UDkt. Silvio Inzucchi, umqondisi weYale Diabetes Center, uthe ama-monitor glucose egazini angabizi kakhulu ezigulini ezinesifo sikashukela sohlobo 2 ezingasebenzisi i-insulin.
Wathi kuqinisekile ukuthi ukukhipha idivayisi engalweni kanye njalo emasontweni amabili kulula kakhulu kunokuba nezinti zeminwe eziningi ezibiza ngaphansi kwe-$1 ngosuku.Kepha "ezigulini ezijwayelekile ezinesifo sikashukela sohlobo 2, intengo yalezi zisetshenziswa ayinangqondo futhi ayikwazi ukusetshenziswa njengokujwayelekile."
Ngaphandle komshwalense, izindleko zonyaka zokusebenzisa i-monitor glucose eqhubekayo ziphakathi kuka-$1,000 no-$3,000.
Abantu abanesifo sikashukela sohlobo loku-1 (esingakhiqizi i-insulin) badinga idatha kaningi evela kumonitha ukuze bajove imithamo efanelekile yamahomoni okwenziwa ngepompo noma isirinji.Ngenxa yokuthi imijovo ye-insulin ingabangela ukwehla kukashukela osegazini obeka impilo engozini, lezi zisetshenziswa ziphinde zixwayise iziguli uma lokhu kwenzeka, ikakhulukazi ngesikhathi sokulala.
Iziguli ezinesifo sikashukela sohlobo 2 ezinesinye isifo ziyayenza i-insulin ukuze ilawule ukukhuphuka kukashukela egazini ngemva kokudla, kodwa imizimba yazo ayiphenduli ngokuqinile kubantu abangenaso lesi sifo.Cishe u-20% weziguli zohlobo 2 zisajova i-insulin ngenxa yokuthi imizimba yazo ayikwazi ukuthola imisoco eyanele futhi nemithi ephuzwayo ayikwazi ukulawula isifo sazo sikashukela.
Odokotela bavame ukweluleka abanesifo sikashukela ukuthi bahlole i-glucose yabo ekhaya ukuze balandelele ukuthi bayafinyelela yini imigomo yokwelashwa futhi baqonde ukuthi imithi, ukudla, ukuvivinya umzimba, kanye nengcindezi kuwathinta kanjani amazinga kashukela egazini.
Kodwa-ke, ukuhlolwa kwegazi okubalulekile odokotela abasebenzisa ukuqapha isifo sikashukela ezigulini ezinesifo sohlobo 2 kubizwa nge-hemoglobin A1c, engakala amazinga kashukela egazini isikhathi eside.Isivivinyo somunwe noma isiqaphi seglucose egazini ngeke sibheke i-A1c.Njengoba lokhu kuhlola kuhilela inani elikhulu legazi, akunakukwenziwa elabhorethri.
Ama-monitor glucose aqhubekayo nawo awawuhloli u-glucose wegazi.Kunalokho, balinganisa amazinga eglucose phakathi kwezicubu, okungamazinga kashukela atholakala oketshezini oluphakathi kwamaseli.
Le nkampani ibonakala izimisele ukudayisela i-monitor ezigulini ezinesifo sikashukela sohlobo 2 (kokubili abantu abajova i-insulin nabantu abangayijoviyo) ngoba le yimakethe enabantu abangaphezu kwezigidi ezingu-30.Ngokuphambene, cishe abantu abayizigidi ezingu-1.6 banesifo sikashukela sohlobo loku-1.
Ukwehla kwezintengo bekukhuphula ukukhula kwesidingo semibukiso.I-FreeStyle Libre ka-Abbott ingenye yemikhiqizo ehamba phambili nenenani eliphansi kakhulu.Idivayisi inenani lama-US$70 futhi inzwa ibiza cishe u-$75 ngenyanga, okumele ishintshwe njalo emavikini amabili.
Cishe zonke izinkampani zomshwalense zihlinzeka ngokuqapha okuqhubekayo kweglucose yegazi kubantu abanesifo sikashukela sohlobo loku-1, okuwutshani obusebenzayo obusindisa impilo kubo.Ngokuka-Baird, cishe ingxenye yabantu abanesifo sikashukela sohlobo loku-1 manje basebenzisa ama-monitor.
Inani elincane kodwa elikhulayo lezinkampani zomshwalense seziqalile ukunikeza umshwalense wezokwelapha kwezinye iziguli zohlobo 2 ezingasebenzisi i-insulin, okuhlanganisa i-UnitedHealthcare kanye ne-CareFirst BlueCross BlueShield ese-Maryland.Lezi zinkampani zomshwalense zithe zithole impumelelo yokuqala ekusebenziseni ama-monitor nabaqeqeshi bezempilo ukusiza ukulawula amalungu azo anesifo sikashukela.
Olunye lwezifundo ezimbalwa (ezikhokhelwa kakhulu umkhiqizi wemishini, futhi ngezindleko eziphansi) luye lwahlola umthelela wabaqaphi empilweni yeziguli, futhi imiphumela ibonise imiphumela engqubuzanayo ekunciphiseni i-hemoglobin A1c.
U-Inzucchi uthe naphezu kwalokhu, umqaphi usize ezinye zeziguli zakhe ezingayidingi i-insulin futhi ezingathandi ukubhoboza iminwe ukuze zishintshe indlela ezidla ngayo futhi zehlise noshukela egazini.Odokotela bathe abanabo ubufakazi bokuthi ukufundwa kungenza izinguquko ezihlala njalo emikhubeni yokudla neyokuzivocavoca kweziguli.Bathi iziguli eziningi ezingasebenzisi i-insulin zingcono uma ziye emakilasini okufundisa ngesifo sikashukela, ukuya ezindaweni zokuzivocavoca noma ukubona udokotela.
UDkt. Katrina Donahue, umqondisi wocwaningo woMnyango Wezokwelapha Zomndeni eNyuvesi yaseNorth Carolina, wathi: “Ngokusekelwe ebufakazini bethu obutholakalayo, ngikholelwa ukuthi i-CGM ayinayo inzuzo eyengeziwe kulaba bantu.”“Anginaso isiqiniseko ngeziguli eziningi., Ukuthi ubuchwepheshe obengeziwe buyimpendulo efanele yini.”
U-Donahue ungumbhali-ndawonye wocwaningo oluphawulekayo ku-JAMA Internal Medicine ngo-2017. Ucwaningo lubonise ukuthi ngemva konyaka, ukuhlolwa kweminwe ukuhlola njalo izinga legazi le-glucose yeziguli ezinesifo sikashukela sohlobo lwe-2 akuzuzisi ukwehlisa i-hemoglobin A1c.
Ukholelwa ukuthi, ngokuhamba kwesikhathi, lezi zilinganiso azizange zikushintshe ukudla kwesiguli kanye nemikhuba yokuzivocavoca—okufanayo kungase kube iqiniso kuma-monitor glucose aqhubekayo.
U-Veronica Brady, uchwepheshe wezemfundo yesifo sikashukela e-University of Texas Health Sciences Center futhi okhulumela i-Association of Diabetes Care and Education Experts, uthe: “Kufanele siqaphele ukuthi isetshenziswa kanjani i-CGM.”Uthe uma abantu Laba baqaphi benza umqondo emasontweni ambalwa lapho beshintsha imithi engase ithinte amazinga kashukela egazini, noma kulabo abangenawo amandla anele okwenza izivivinyo zeminwe.
Kodwa-ke, ezinye iziguli ezifana ne-Trevis Hall zikholelwa ukuthi umqaphi ungabasiza ukulawula isifo sabo.
Ngonyaka odlule, njengengxenye yohlelo lokulawula isifo sikashukela, uhlelo lwezempilo luka-Hall oluthi “United Healthcare” lumnikeze amamonitha mahhala.Uthe ukuxhuma imonitha esiswini kabili ngenyanga ngeke kudale ukungakhululeki.
Imininingwane ikhombisa ukuthi uHall, 53, waseFort Washington, eMaryland, uthe ushukela wakhe uzofinyelela emazingeni ayingozi ngosuku.Wathi nge-alamu ucingo oluzoyithumela ocingweni: “Bekuthuse ekuqaleni.”
Ezinyangeni ezimbalwa ezedlule, lokhu kufundwa kuye kwamsiza ukuthi ashintshe indlela adla ngayo kanye namaphethini okuzivocavoca ukuze avimbele lezi zigilamkhuba futhi alawule isifo.Kulezi zinsuku, lokhu kusho ukuhamba ngokushesha ngemva kokudla noma ukudla imifino esidlweni sakusihlwa.
Laba bakhiqizi basebenzise izigidi zamaRandi ukuze bakhuthaze odokotela ukuba banikeze ama-monitor glucose njalo, futhi bakhangisa iziguli ngokuqondile ezikhangisweni ze-inthanethi ne-TV, kuhlanganise ne-Super Bowl yalo nyaka yomculi u-Nick Jonas (Nick Jonas).Jonas) edlala ezikhangisweni ezibukhoma.
U-Kevin Sayer, oyi-CEO ye-Dexcom, ongomunye wabakhiqizi abahamba phambili bemibukiso, utshele abahlaziyi ngonyaka odlule ukuthi imakethe ye-non-insulin type 2 iyikusasa.“Ithimba lethu lihlale lingitshela ukuthi uma le makethe ikhula izoqhuma.Ngeke libe lincane, futhi ngeke liphuze,” kusho yena.
Wengeze wathi: “Mina ngokwami ngicabanga ukuthi iziguli zizohlala ziyisebenzisa ngentengo efanele nesixazululo esifanele.”
Isikhathi sokuthumela: Mar-15-2021