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

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。子项目及 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。 1型糖尿病（T1 DM）幼儿的低血糖是强化胰岛素治疗的急性并发症，在该年龄组中，在没有任何体征或症状的情况下，通常观察到低血糖事件。由于检测程序的困难，尚未在T1 DM青年患者中确定强化治疗和患者年龄对交感-肾上腺反应的影响。我们开发了一种标准化的持续皮下胰岛素输注方案，以使血糖控制良好的胰岛素泵治疗患者的血糖浓度适度、进行性下降。依次测量了14名幼儿（3至<8岁）和14名青少年（12至<18岁）的血糖和反调节激素浓度。两组中血糖降至相似的最低浓度。4名幼儿和4名青少年从未发生肾上腺素反应，另外4名幼儿和5名青少年仅在血糖降至< 60 mg/dL时触发肾上腺素反应。在评估症状评分时，只有一小部分幼儿的父母认为他们的孩子即使在最低的血糖浓度下也看起来很低。青少年能够更好地发现低血糖的症状。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，而血浆肾上腺素仅在这些人中适度上升。这些数据表明，患有1型糖尿病的幼儿和青少年容易发生低血糖相关的自主神经功能衰竭。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认识到血糖浓度正落入危险范围。

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.