A Tale of Two Compartments: Interstitial Versus Blood Glucose Monitoring

Cengiz, Eda; Tamborlane, William V.

doi:10.1089/dia.2009.0002

Cited by 319 publications

(268 citation statements)

References 59 publications

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“…The lag (5-10 min) is greatest during times of rapidly changing plasma glucose levels and can affect calibrations and long-term accuracy of the CGM. 53 Another potential problem is the physiologic change in the interstitial fluid that accompanies pregnancy and may impact sensor accuracy, although one study found that this was not relevant for the sensor used. 44 As with any medical device, CGMs can be costprohibitive.…”

Section: Caveats About Cgm Use In Pregnancymentioning

confidence: 99%

CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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The glycemic goals of pregnancy are very narrow to reduce excess risks for numerous maternal and fetal complications. Continuous glucose monitors (CGMs) may help women achieve glucose goals and reduce hypoglycemia. CGM use has been found to be safe and effective in pregnancies associated with diabetes. CGM use can accurately identify glycemic patterns among women with and without diabetes in pregnancy. The data on the effects of CGM use on maternal and fetal outcomes are conflicting. Using CGMs in conjunction with continuous subcutaneous insulin infusion therapy in pregnancies complicated by diabetes may improve outcomes. There are limitations of CGM use that affect patients in and outside of pregnancy, as well as specific barriers that only affect pregnant women. Of importance, CGM use does not replace standard clinical care, but may be used an adjunctive tool in pregnancy. CGM remote monitoring in pregnancy is an understudied field. In this study, we review the studies on CGM use in pregnancy.

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Section: Caveats About Cgm Use In Pregnancymentioning

confidence: 99%

CGM, Pregnancy, and Remote Monitoring

Polsky

Garcetti

2017

Diabetes Technology & Therapeutics

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“…While intraarterial (IA) and intravenous (IV) measurements are not practically usable in outpatients, subcutaneous (SC) sensing has become the standard for continuous glucose monitoring (CGM) during the last 15 years. However, state of the art SC glucose sensing technologies with enzyme-based amperometric technology still face challenges with time delays and slow dynamics (Basu et al, 2013;Cengiz and Tamborlane, 2009;Boyne et al, 2003;Davey et al, 2010) as well as poor robustness (Helton et al, 2011;Mensh et al, 2013), even though recent publications indicate that novel CGM systems may be less prone to such problems (Garcia et al, 2013;Bailey et al, 2015). These challenges originate partly from the sensor technology and partly from the physiologically slow glucose transfer between intravascular glucose levels and glucose levels in subcutaneous tissue.…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal Glucose Sensing is Sometimes Surprisingly Rapid

Fougner¹,

Kölle²,

Skjærvold³

et al. 2016

MIC

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Rapid, accurate and robust glucose measurements are needed to make a safe artificial pancreas for the treatment of diabetes mellitus type 1 and 2. The present gold standard of continuous glucose sensing, subcutaneous (SC) glucose sensing, has been claimed to have slow response and poor robustness towards local tissue changes such as mechanical pressure, temperature changes, etc. The present study aimed at quantifying glucose dynamics from central circulation to intraperitoneal (IP) sensor sites, as an alternative to the SC location.Intraarterial (IA) and IP sensors were tested in three anaesthetized non-diabetic pigs during experiments with intravenous infusion of glucose boluses, enforcing rapid glucose level excursions in the range 70-360 mg/dL (approximately 3.8-20 mmol/L). Optical interferometric sensors were used for IA and IP measurements. A first-order dynamic model with time delay was fitted to the data after compensating for sensor dynamics. Additionally, off-the-shelf Medtronic Enlite sensors were used for illustration of SC glucose sensing.The time delay in glucose excursions from central circulation (IA) to IP sensor location was found to be in the range 0-26 s (median: 8.5 s, mean: 9.7 s, SD 9.5 s), and the time constant was found to be 0.5-10.2 min (median: 4.8 min, mean: 4.7 min, SD 2.9 min).IP glucose sensing sites have a substantially faster and more distinctive response than SC sites when sensor dynamics is ignored, and the peritoneal fluid reacts even faster to changes in intravascular glucose levels than reported in previous animal studies.This study may provide a benchmark for future, rapid IP glucose sensors.

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“…While beneficial for profiling overall glycaemic management, considerable CGM error was noted when glucose levels were changing rapidly ( Fig. 3), as has previously been documented [30][31][32].…”

Section: Glycaemic Responses and Change In Glucagon Levelsmentioning

confidence: 65%

Glucagon responses to exercise-induced hypoglycaemia are improved by somatostatin receptor type 2 antagonism in a rat model of diabetes

et al. 2016

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Aims/hypothesis Regular exercise is at the cornerstone of care in type 1 diabetes. However, relative hyperinsulinaemia and a blunted glucagon response to exercise promote hypoglycaemia. Recently, a selective antagonist of somatostatin receptor 2, PRL-2903, was shown to improve glucagon counterregulation to hypoglycaemia in resting streptozotocin-induced diabetic rats. The aim of this study was to test the efficacy of PRL-2903 in enhancing glucagon counterregulation during repeated hyperinsulinaemic exercise. Methods Diabetic rats performed daily exercise for 1 week and were then exposed to saline (154 mmol/l NaCl) or PRL-2903, 10 mg/kg, before hyperinsulinaemic exercise on two separate occasions spaced 1 day apart. In the following week, animals crossed over to the alternate treatment for a third hyperinsulinaemic exercise protocol. Results Liver glycogen content was lower in diabetic rats compared with control rats, despite daily insulin therapy (p < 0.05). Glucagon levels failed to increase during exercise with saline but increased three-to-six fold with PRL-2903 (all p < 0.05). Glucose concentrations tended to be higher during exercise and early recovery with PRL-2903 on both days of treatment; this difference did not achieve statistical significance (p > 0.05). Conclusions/interpretation PRL-2903 improves glucagon counterregulation during exercise. However, liver glycogen stores or other factors limit the prevention of exercise-induced hypoglycaemia in rats with streptozotocin-induced diabetes.

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A Tale of Two Compartments: Interstitial Versus Blood Glucose Monitoring

Cited by 319 publications

References 59 publications

CGM, Pregnancy, and Remote Monitoring

CGM, Pregnancy, and Remote Monitoring

Intraperitoneal Glucose Sensing is Sometimes Surprisingly Rapid

Glucagon responses to exercise-induced hypoglycaemia are improved by somatostatin receptor type 2 antagonism in a rat model of diabetes

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