DIABETES MELLITUS / END STAGE RENAL DISEASE USING CONTINUOUS GLUCOSE MONITORING

这个子项目是众多研究子项目之一

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. One of the main obstacles to evaluating and improving glycemic control is that self monitoring of blood glucose can only provide snapshots of information about blood glucose. Continuous glucose monitoring (CGM) devices overcome this problem by providing frequent measurements of glucose. To date, there has been limited published on the use of CGM devices in patients with ESRD on PD and no detailed studies in patients on HD.14 Several CGM devices are now available and a number a currently undergoing evaluation by the FDA. They typically measure glucose in the interstitial fluid every 5-10 minutes, facilitating quantification of glucose, evaluation of change in concentration and identification of patterns in glycemic control. The accuracy of CGM devices may be altered in patients with diabetic renal disease as a result of changes in vascular structure, sub-cutaneous tissue and vascular permeability. As a result, the relationship between interstitial fluid and venous plasma glucose may be altered, impairing the accuracy of CGM devices. It is therefore important that the accuracy of CGM devices in patients with ESRD be evaluated. With this information, effective use of CGM devices could lead to significant improvements in our understanding of the challenges of controlling glucose in patients with ESRD. Utilizing the information gained from CGM may facilitate informed intensification of glycemic control without unnecessarily increasing the patients risk of exposure to hypoglycemia. As a result, improvements in morbidity and mortality may be obtained for this high risk patient population. We plan to perform a study using the Continuous Monitoring Glucose System (CGMS) (Minimed Medtronic USA) in patients with ESRD and diabetes. This device measures interstitial fluid glucose concentrations every 5 minutes using the glucose oxidase technique. CGMS is commercially available and frequently used in routine clinical practice to help evaluate glycemic control. We plan to evaluate the accuracy of the CGMS device in patients with ESRD and subsequently utilize the CGMS to improve glycemic control in patients with diabetes and ESRD.