DIABETES MELLITUS / END STAGE RENAL DISEASE USING CONTINUOUS GLUCOSE MONITORING

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 评估和改善血糖控制的主要障碍之一是自我监测血糖只能提供有关血糖的信息的快照。连续血糖监测(CGM)设备通过提供频繁的血糖测量克服了这一问题。到目前为止，关于使用CGM装置治疗PD的终末期肾病患者的报道有限，还没有关于HD患者使用CGM装置的详细研究。14目前已有几种CGM装置可用，一些CGM装置正在接受FDA的评估。他们通常每隔5-10分钟测量间质液体中的葡萄糖，便于量化葡萄糖，评估浓度变化，并确定血糖控制的模式。糖尿病肾病患者的CGM装置的准确性可能会因血管结构、皮下组织和血管通透性的改变而改变。因此，间质液体和静脉血糖之间的关系可能会改变，从而影响CGM设备的准确性。因此，对终末期肾病患者CGM装置的准确性进行评估是很重要的。有了这些信息，CGM设备的有效使用可以显著提高我们对终末期肾病患者血糖控制挑战的理解。利用从CGM获得的信息可能有助于在知情的情况下强化血糖控制，而不会不必要地增加患者暴露于低血糖的风险。因此，这一高危人群的发病率和死亡率可能会得到改善。 我们计划使用持续血糖监测系统(CGMS)(Minimed Medtronic USA)在终末期肾病和糖尿病患者中进行一项研究。该设备使用葡萄糖氧化酶技术每5分钟测量一次间质液体葡萄糖浓度。CGMS是商业上可用的，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设备在ESRD患者中的准确性，并随后利用CGMS来改善糖尿病和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.