Post on 12-Jan-2016
Marta AlvesMarta Alves, Celestino Neves, Ana Varela, Cristina Arteiro, Luís Miguel Pereira, Davide Carvalho, , Celestino Neves, Ana Varela, Cristina Arteiro, Luís Miguel Pereira, Davide Carvalho, José Luís Medina.José Luís Medina.
Endocrinology Service, S. João Hospital, Faculty of Medicine, University of Porto, Endocrinology Service, S. João Hospital, Faculty of Medicine, University of Porto,
PortugalPortugal
2008
TRANSIENT INTERSTITIAL GLUCOSE MONITORING IMPROVES
GLYCAEMIC CONTROL11th Meeting of the Mediterranean Group for the Study
of DiabetesMalta, April 23–26, 2009
BackgroundBackground
Self-monitoring with a blood glucose meter is useful but limited:Self-monitoring with a blood glucose meter is useful but limited: Patient adherence/nocturnal glycaemia/post-prandial periodPatient adherence/nocturnal glycaemia/post-prandial period Isolated glycaemic valuesIsolated glycaemic values Does not access asymptomatic hypoglycaemiasDoes not access asymptomatic hypoglycaemias
HbA1c interpretation:HbA1c interpretation: Limited in some situations (ex: anaemia, haemolysis, haemoglobin variants, Limited in some situations (ex: anaemia, haemolysis, haemoglobin variants,
liver disease)liver disease) Reflexes the mean blood glucose levelsReflexes the mean blood glucose levels
Do not able us to correctly interpret the real metabolic controlDo not able us to correctly interpret the real metabolic control
We need a method that enables us to read the “whole story”We need a method that enables us to read the “whole story”
BackgroundBackground
The continuous glucose monitoring system The continuous glucose monitoring system (CGMS), detects fluctuations of glucose levels, (CGMS), detects fluctuations of glucose levels, informing about informing about direction, magnitude, duration, direction, magnitude, duration, frequency and its causes,frequency and its causes, allowing a more allowing a more realistic perception of glycaemic control.realistic perception of glycaemic control.
Continuous intersticial glucose Continuous intersticial glucose monitoringmonitoring
Glucoday® (A. Menarini Diagnostics) is na Glucoday® (A. Menarini Diagnostics) is na intersticial glucose monitoring device which intersticial glucose monitoring device which allows the knowledgment of continuous allows the knowledgment of continuous intersticial glucose concentrations in the intersticial glucose concentrations in the subcutaneous tissue.subcutaneous tissue.
It uses microdyalisis technique to access It uses microdyalisis technique to access intersticial glucose concentration.intersticial glucose concentration.
Reading of results:Reading of results: each second each second (record (record of the mean value each 3 minutes)of the mean value each 3 minutes)
Reading limits: 10-600 mg/dLReading limits: 10-600 mg/dL
Para PC
Microfibra
Pele
Sistema GlucoDay
Tubos de Nylon
RS-232 Porta IVPorta Serie
Desperdicio SoluçãoTampão
CPU
Microdiálise
Ecran
Bomba
Biosensor
GlucoDay
Continuous intersticial glucose Continuous intersticial glucose monitorizationmonitorization
This system was This system was validated in several validated in several studies. It was studies. It was shown a good shown a good correlation between correlation between intersticial and blood intersticial and blood glucose levelsglucose levels..
Boland EA, et al. Boland EA, et al. Diabetes CareDiabetes Care 24:1858–1862, 24:1858–1862, 2001.2001.
5 - Gross TM, et al. 5 - Gross TM, et al. Diabetes Technol TherDiabetes Technol Ther 2:49 2:49 – 56, 2000.– 56, 2000.
Chee W, et al. Chee W, et al. Endocrinol Metab Clin N Am Endocrinol Metab Clin N Am 33:175-195, 2004. 33:175-195, 2004.
Jeha GS, et al. Jeha GS, et al. Diabetes CareDiabetes Care 27:2881-2886, 27:2881-2886, 2004.2004.
ObjectivesObjectives
To evaluate To evaluate GlucoDayGlucoDay potentialities in clinical potentialities in clinical practice.practice.
To access monitoring parameters of glycaemic To access monitoring parameters of glycaemic control.control.
To compare A1c values before and after To compare A1c values before and after knowledgement of the results and consequent knowledgement of the results and consequent institution of adjusted therapeutical measures. institution of adjusted therapeutical measures.
PatientsPatients andand methodsmethods
The continuous glucose The continuous glucose monitoring with the monitoring with the GlucoDay® system, of GlucoDay® system, of the A. Menarini the A. Menarini Diagnostics was Diagnostics was performed in 53 type 1 performed in 53 type 1 diabetic patients with:diabetic patients with:
Bad glucose controlBad glucose control Nocturnal/asymptomatic Nocturnal/asymptomatic
hypoglycaemiashypoglycaemias
Age (years) Age (years) (mean±SD)(mean±SD)
37,7±12,337,7±12,3
Men (n/%)Men (n/%) 19 (35,8)19 (35,8)
Women (n/%)Women (n/%) 34 (64,2)34 (64,2)
Diabetes duration Diabetes duration (years) (mean±SD)(years) (mean±SD)
15,5±9,515,5±9,5
HbA1c % (mean±SD)HbA1c % (mean±SD) 8,6±1,9 (5-8,6±1,9 (5-12,9)12,9)
Patients and methodsPatients and methods
We evaluated: We evaluated: the number of episodes of hypoglycaemia <60 the number of episodes of hypoglycaemia <60
mg/dl (3.3 mmol/L) mg/dl (3.3 mmol/L) The number of episodes of hyperglycaemia The number of episodes of hyperglycaemia
(values above 200 mg/dl (11.1mmol/L))(values above 200 mg/dl (11.1mmol/L)) the percentage of time in hypoglycaemia the percentage of time in hypoglycaemia the percentage of time in hyperglycaemia the percentage of time in hyperglycaemia
• during the period of monitorization (~ 48 hours)during the period of monitorization (~ 48 hours)
ResultsResults
0
2
4
6
8
10
12
14
16
Episódios dehipoglicemia
Episódios dehiperglicemia
Hypoglycaemic episodes: 8,5 9,5
Hyperglycaemic episodes: 14,6 10,3
0
5
10
15
20
25
30
35
% tempo emhipoglicemia
% tempo emhiperglicemia
% of time in hypoglycaemia: 11,3 15
% of time in hyperglycaemia: 35 23,1
n %
0
50
100
150
200
250
300
350
12
.56
14
.01
15
.06
16
.11
17
.15
18
.20
19
.25
20
.30
21
.34
22
.39
23
.44
0.4
9
1.5
4
2.5
8
4.0
3
5.0
8
6.1
3
7.1
7
8.2
2
9.2
7
10
.32
11
.36
12
.41
Tempo (h)
Glu
co
se
(m
g/d
l)
Regular 8U
Regular 6U
NPH 12U
Regular 8U
Nocturnal hypoglycaemiasNocturnal hypoglycaemiasL.M.C., 35 Anos, DM1HbA1c=7,4%, Duração 25 Anos
Nocturnal hyperglycaemiasNocturnal hyperglycaemias
Bad glycaemic controlBad glycaemic control
Persistent hyperglycaemiasPersistent hyperglycaemias
MONITORIZAÇÃO CONTÍNUA DA GLUCOSE48 HORAS
0
100
200
300
400
500
600
700
800
Horas
Valo
res d
e G
luco
se m
g/d
l
Glucose Amostra Capilar
R.C.P.T., 74 Anos, DM1, Duração 40 Anos, HbA1c 12,4%
AssymptomaticAssymptomatic hypoglycaemiashypoglycaemias
MONITORIZAÇÃO CONTÍNUA DA GLUCOSE48 HORAS
0
50
100
150
200
250
300
350
400
Horas
Val
ore
s d
e G
luco
se m
g/d
l
Glucose Amostra Capilar
P.M.P.L.M., 48 AnosDM1, Duração 20 AnosHbA1c 12,9%
Average A1c before and 4 to 10 Average A1c before and 4 to 10 months after monitorizationmonths after monitorization
Before: Before: A1c 8,6A1c 8,6±±1,9%1,9%
After:After: A1c 7,6A1c 7,6±±1,2%1,2%
7,2
7,4
7,6
7,8
8
8,2
8,4
HbA1c prévia HbA1c após monitorização
8,6%
7,6%
ConclusionsConclusions Glycaemic profile obtained with CGMS gives us much Glycaemic profile obtained with CGMS gives us much
more information than conventional methods of blood more information than conventional methods of blood glucose control assessment. glucose control assessment.
With continuous intersticial glucose monitoring we can With continuous intersticial glucose monitoring we can know the patient glycaemic profile which allows:know the patient glycaemic profile which allows: better therapeutical approachesbetter therapeutical approaches,,
• improvement of metabolic controlimprovement of metabolic control essential for reduction of acute and chronic complications of essential for reduction of acute and chronic complications of
diabetes.diabetes.
We believe that TRANSIENT INTERSTITIAL GLUCOSE MONITORING IMPROVES GLYCAEMIC CONTROL