DIABETES MELLITUS / END STAGE RENAL DISEASE USING CONTINUOUS GLUCOSE MONITORING

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 评估和改善血糖控制的主要障碍之一是血糖的自我监测只能提供关于血糖的信息的快照。连续葡萄糖监测（CGM）设备通过提供频繁的葡萄糖测量来克服这个问题。 到目前为止，关于CGM器械在ESRD PD患者中使用的出版物有限，并且没有在HD患者中进行详细研究。14目前已有几种CGM器械可用，并且FDA正在对一些器械进行评估。 他们通常每5-10分钟测量一次间质液中的葡萄糖，便于葡萄糖的定量、浓度变化的评估和血糖控制模式的识别。 由于血管结构、皮下组织和血管渗透性的变化，CGM器械在糖尿病肾病患者中的准确性可能会改变。因此，组织液和静脉血糖之间的关系可能会改变，从而损害CGM设备的准确性。因此，评价CGM器械在ESRD患者中的准确性非常重要。 有了这些信息，CGM设备的有效使用可能会显著改善我们对ESRD患者血糖控制挑战的理解。利用从CGM获得的信息可以促进知情强化血糖控制，而不会不必要地增加患者暴露于低血糖的风险。 因此，对于该高风险患者人群，可以获得发病率和死亡率的改善。 我们计划在ESRD和糖尿病患者中使用持续血糖监测系统（CGMS）（Minimed Medtronic USA）进行一项研究。 该器械使用葡萄糖氧化酶技术每5分钟测量一次组织液葡萄糖浓度。 CGMS已上市，并经常用于常规临床实践，以帮助评估血糖控制。 我们计划评估CGMS器械在ESRD患者中的准确性，随后利用CGMS改善糖尿病和ESRD患者的血糖控制。

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.