Do sensor glucose levels accurately predict plasma glucose concentrations during hypoglycemia and hyperinsulinemia?
Do sensor glucose levels accurately predict plasma glucose concentrations during hypoglycemia and hyperinsulinemia?
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DOI：
10.2337/diacare.25.5.889
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发表时间：
2002-05-01
期刊：
影响因子：
16.2
通讯作者：
Tamborlane, WV
中科院分区：
文献类型：
--
作者：
Monsod, TP;Flanagan, DE;Tamborlane, WV
目的-MiniMed连续葡萄糖监测系统（CGMS）测量皮下间质葡萄糖水平，并根据每日三次或更多次手指针刺葡萄糖水平进行校准。本研究的目的是检查血浆和间质液葡萄糖之间的关系是否改变了血浆葡萄糖和胰岛素水平的变化，以及这种改变如何可能影响CGMS performance.RESEARCH设计和方法-动脉化血浆葡萄糖，传感器葡萄糖，和间质液葡萄糖测定微透析11名健康受试者在1.0 mU（.）k（-1 .）分（-1）阶跃式正常血糖-低血糖-高血糖（血浆葡萄糖分别类似于5、3.1和8.6mmolA）胰岛素钳夹，将血浆胰岛素升高至-360-390pmol/l。基础探头和血糖相似（分别为5.0 +/- 0.3和5.2 +/- 0.3 mmol/l）;透析液阿拉伯糖为3.3 +/- 0.9 mmol/l。在高胰岛素血症-内皮素研究期间（血浆葡萄糖4.9 +/- 0.3 mmol/l），透析液葡萄糖下降30- 35%，同时探头葡萄糖显著降低（至3.7 +/- 0.6 mmol/l;与血浆相比P < 0.001）。随后，在轻度低血糖期间，探头水平仍低于血浆值（2.5 +/- 0.6 vs. 3.1 +/- 0.3 mmo/l P < 0.01）和低血糖恢复期间（7.3 +/- 1.2对比8.6 +/- 0.6 P < 0.01）-然而，当在钳夹的每个步骤之前和期间针对血浆葡萄糖水平校准CGMS时，传感器葡萄糖水平在整个研究过程中增加，并且在低血糖期间与血浆葡萄糖值没有差异。结论-虽然高胰岛素血症可能导致血浆和传感器葡萄糖水平之间的适度差异，但是CGMS能够在血浆葡萄糖和胰岛素水平范围内校准时准确地跟踪血浆葡萄糖的急性变化。
OBJECTIVE - The MiniMed Continuous Glucose Monitoring System (CGMS) measures subcutaneous interstitial glucose levels that are calibrated against three or more fingerstick glucose levels daily. The objective of the present Study was to examine whether the relationship between plasma and interstitial fluid glucose is altered by changes in plasma glucose and insulin levels and how such alterations might influence CGMS performance.RESEARCH DESIGN AND METHODS - Arterialized plasma glucose, sensor glucose, and interstitial fluid glucose were measured by microdialysis in 11 healthy subjects during a 1.0 mU (.) k(-1 .) min(-1) Stepped euglycemic-hypoglycemic-hyperglycemic (plasma glucose similar to5, 3.1, and 8.6 mmolA, respectively) insulin clamp that raised plasma insulin to -360-390 pmol/l.RESULTS - When the CGMS was calibrated versus plasma glucose levels before insulin infusion. basal sensor and plasma glucose were similar (5.0 +/- 0.3 vS. 5.2 +/- 0.3 mmol/l, respectively); dialysate alucose was 3.3 +/- 0.9 mmol/l. During the hyperinsulinemic-euglycemia study (plasma glucose 4.9 +/- 0.3 mmol/l), dialysate glucose fell by 30-35%, accompanied by a significant reduction in sensor glucose (to 3.7 +/- 0.6 mmol/l; P < 0.001 vs. plasma). Subsequently, sensor levels remained lower than plasma values during mild hypoglycemia (2.5 +/- 0.6 vs. 3.1 +/- 0.3 mmo/l P < 0.01) and during recovery from hypoglycemia (7.3 +/- 1.2 vs. 8.6 +/- 0.6 P < 0.01)- However, when the CGMS was calibrated against plasma glucose levels before and during each Step of the clamp, sensor glucose levels increased throughout the study and did not differ from plasma glucose values during hypoglycemia.CONCLUSIONS - Although hyperinsulinema may contribute to modest discrepancies between plasma and sensor glucose levels, the CGMS is able to accurately track acute changes in plasma glucose when calibrated across a range of plasma glucose and insulin levels.