Glucose sensing in the peritoneal space offers faster kinetics than sensing in the subcutaneous space.
Glucose sensing in the peritoneal space offers faster kinetics than sensing in the subcutaneous space.
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作者：
Burnett DR;Huyett LM;Zisser HC;Doyle FJ 3rd;Mensh BD
治疗1型糖尿病的首要目标是维持血糖正常。连续葡萄糖监测（CGM）技术能够频繁检测葡萄糖，以告知外源性胰岛素输注时间和剂量。最常用的CGM受到其所在的皮下空间的生理学的限制。这种微创方法的相同优点是速度方面的缺点。由于皮下血流对局部波动敏感（例如，温度、机械压力），皮下感测可以是缓慢且可变的。我们建议使用一个更中心的，生理上稳定的身体空间CGM：腹腔内空间。我们比较了同时放置皮下和腹腔内传感器在静脉葡萄糖耐量试验在8头猪的时间响应特性。使用基于同时静脉内感知、抽血和动脉内感知的房室模型，我们发现腹膜内动力学比皮下动力学快两倍以上（腹膜内的平均时间常数为5.6 min，皮下为12.4 min）。结合已知的腹膜内胰岛素递送比皮下递送更快的动力学，我们的研究结果表明，人工胰腺技术可以通过感测葡萄糖并在腹膜内空间递送胰岛素来优化。
The paramount goal in the treatment of type 1 diabetes is the maintenance of normoglycemia. Continuous glucose monitoring (CGM) technologies enable frequent sensing of glucose to inform exogenous insulin delivery timing and dosages. The most commonly available CGMs are limited by the physiology of the subcutaneous space in which they reside. The very same advantages of this minimally invasive approach are disadvantages with respect to speed. Because subcutaneous blood flow is sensitive to local fluctuations (e.g., temperature, mechanical pressure), subcutaneous sensing can be slow and variable. We propose the use of a more central, physiologically stable body space for CGM: the intraperitoneal space. We compared the temporal response characteristics of simultaneously placed subcutaneous and intraperitoneal sensors during intravenous glucose tolerance tests in eight swine. Using compartmental modeling based on simultaneous intravenous sensing, blood draws, and intraarterial sensing, we found that intraperitoneal kinetics were more than twice as fast as subcutaneous kinetics (mean time constant of 5.6 min for intraperitoneal vs. 12.4 min for subcutaneous). Combined with the known faster kinetics of intraperitoneal insulin delivery over subcutaneous delivery, our findings suggest that artificial pancreas technologies may be optimized by sensing glucose and delivering insulin in the intraperitoneal space.
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