CLINICAL TRIAL: HYPOGLYCEMIA AND THE ACCURACY OF CONTINUOUS GLUCOSE MONITORS IN

临床试验：低血糖和连续血糖监测仪的准确性

• 批准号: 7717922
• 负责人: BRUCE A BUCKINGHAM
• 金额: $ 0.2万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-12-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7717922
• 关键词: Acute; Adolescent; Adrenal Glands; Age; Age-Years; Child; Clinical Trials; Complication; Computer Retrieval of Information on Scientific Projects Database; Data; Epinephrine; Event; Failure; Funding; Glucose; Glucose Plasma Concentration; Grant; Hormones; Hypoglycemia; Hypoglycemic Agents; Infusion procedures; Institution; Insulin; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Measures; Parents; Patients; Plasma; Procedures; Protocols documentation; Range; Research; Research Personnel; Resources; Risk; Rosa; Score; Source; Symptoms; Testing; United States National Institutes of Health; Youth; age group; falls; glucose monitor; response; subcutaneous

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. Hypoglycemia in young children with Type 1 Diabetes Mellitus (T1DM) is an acute complication of intensive insulin therapy and hypoglycemic events are commonly observed in this age group in the absence of any signs or symptoms. The effect of intensive treatment and patient age on sympatho-adrenal responses has not been established in youth with T1DM, due to difficulties in testing procedures. We developed a standardized continuous subcutaneous insulin infusion protocol to produce a moderate, progressive fall in plasma glucose concentrations in well-controlled, insulin pump treated patients. Plasma glucose and counter-regulatory hormone concentrations were measured sequentially in 14 young children (3 to <8 years of age) versus 14 adolescents (12 to <18 years of age). Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and 4 adolescents never had an epinephrine response and an additional 4 young children and 5 adolescents triggered an epinephrine response only when plasma glucose fell to < 60 mg/dL. In evaluating symptom scores, only a small fraction of parents of young children felt that their child looked low even at the lowest plasma glucose concentrations. Adolescents were better able to detect symptoms of hypoglycemia. Several children and adolescents failed to stimulate any epinephrine response to hypoglycemia, and plasma epinephrine only rose modestly in those who did. These data suggest that young children and adolescents with Type 1 diabetes are prone to develop hypoglycemia-associated autonomic failure. In addition, the risk of hypoglycemia may be increased in young children because their parents are unable to recognize that plasma glucose concentrations are falling into a dangerous range.

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目及 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 1 型糖尿病 (T1DM) 幼儿的低血糖是强化胰岛素治疗的一种急性并发症，在这个年龄组中，通常会在没有任何体征或症状的情况下观察到低血糖事件。由于测试程序困难，强化治疗和患者年龄对 T1DM 青少年交感肾上腺反应的影响尚未确定。我们开发了一种标准化的连续皮下胰岛素输注方案，以在控制良好的胰岛素泵治疗患者中产生适度的、渐进的血浆葡萄糖浓度下降。对 14 名幼儿（3 至 <8 岁）和 14 名青少年（12 至 <18 岁）的血浆葡萄糖和反调节激素浓度进行了连续测量。两组的血浆葡萄糖降至相似的最低浓度。 4 名幼儿和 4 名青少年从未产生过肾上腺素反应，另外 4 名幼儿和 5 名青少年仅在血糖降至 < 60 mg/dL 时才引发肾上腺素反应。在评估症状评分时，只有一小部分幼儿家长认为，即使在最低的血浆葡萄糖浓度下，他们的孩子看起来也很低。青少年能够更好地发现低血糖症状。一些儿童和青少年未能刺激任何肾上腺素对低血糖的反应，而那些刺激了肾上腺素的儿童和青少年的血浆肾上腺素仅略有上升。这些数据表明，患有 1 型糖尿病的幼儿和青少年容易出现低血糖相关的自主神经衰竭。此外，幼儿发生低血糖的风险可能会增加，因为他们的父母无法意识到血浆葡萄糖浓度已落入危险范围。