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。 1型糖尿病(T1 DM)儿童低血糖是强化胰岛素治疗的急性并发症，在没有任何体征或症状的情况下，这个年龄段的儿童通常会发生低血糖事件。由于检测程序的困难，强化治疗和患者年龄对青年T1 DM患者交感-肾上腺反应的影响尚未确定。我们开发了一种标准化的持续皮下胰岛素输注方案，使控制良好、接受胰岛素泵治疗的患者的血糖浓度适度、渐进地下降。对14名幼儿(3岁至8岁)和14名青少年(12岁至18岁)的血糖和反调节激素浓度进行了连续测定。两组患者的血糖水平降至相似的最低值。4名儿童和4名青少年从未出现肾上腺素反应，另外4名儿童和5名青少年只有在血糖降至60 mg/dL时才触发肾上腺素反应。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。青少年发现低血糖症状的能力更强。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，而那些有低血糖反应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型糖尿病的儿童和青少年容易发生与低血糖相关的自主神经衰竭。此外，幼儿患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在下降到危险的范围。

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.