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Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patients

  • Frederico F.R. Maia
    Correspondence
    Corresponding author. Tel.: +55 31 3296 3345; fax: +55 31 3283 9772.
    Affiliations
    Department of Physiology, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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  • Levimar R. Araújo
    Affiliations
    Department of Physiology, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Department of Endocrinology and Metabolism, Hospital Universitário São José, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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      Abstract

      Background

      To evaluate the efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetes mellitus (DM1) patients.

      Methods

      We studied 46 patients (43.4%M/56.6%F), average age of 25.9 ± 12.8 years, submitted to 72 h CGMS. It were analyzed: capillary glycemia (CG) and CGMS sensor's value, glycemic excursions, postprandial hyperglycemia, asymptomatic hypoglycemia and therapeutic management after CGMS. Correlation coefficient during hypo and hyperglycemia and sensitivity/specificity were determined.

      Results

      The mean capillary glucose values were 191.8 ± 46.2 mg/dl versus 190.9 ± 42.1 mg/dl by CGMS sensor, with no statistical difference by T-test (T = −0.6; p = 0.79). The CGMS was significantly more efficient in detection of glycemic excursion than CG (p = 0.001). The postprandial hyperglycemia was identified in 76.9% of diabetic patients and asymptomatic hypoglycemia was detected in 58.2% of these patients. The correlation coefficient presented no significance (p = 0.16) during hypoglycemia versus during hyperglycemia (p = 0.002). The CGMS sensor presented low sensitivity (79.1%) to detect hypoglycemia versus hyperglycemia (96.8%).

      Conclusions

      The CGMS showed to be a good method to identify postprandial hyperglycemia, to improve therapeutics management and confirmed the low sensitivity of CGMS to detect unrecognized hypoglycemia in DM1 patients.

      Keywords

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      References

        • Ferraz D.P.
        • Maia F.F.R.
        • Araújo L.R.
        Glicemia capilar em ponta do dedo versus lóbulo de orelha: estudo comparativo dos valores resultantes e preferências dos pacientes.
        Arq. Bras. Endocrinol. Metab. 2004; 48: 389-393
        • Glasgow R.E.
        • Ruggiero I.
        • Eakin E.G.
        Quality of life and associated characteristics in a large national sample of adults with diabetes.
        Diab. Care. 1997; 20: 562-567
        • The DCCT Research Group
        Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial.
        J. Pediatr. 1994; 125: 177-188
        • The Diabetes Control, Complications Trial Research Group (DCCT)
        The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus.
        N. Engl. J. Med. 1993; 329: 977-986
        • Maia F.F.R.
        • Araújo L.R.
        Aspectos psicológicos e controle glicêmico de um grupo de pacientes com diabetes mellitus tipo 1 de Minas Gerais.
        Arq. Bras. Endocrinol. Metab. 2004; 48: 261-266
        • The Diabetes Research in Children Network (DirecNet) Study Group
        Accuracy of the GlucoWatch G2 biographer and the continuous glucose monitoring system during hypoglycemia. Experience of the diabetes research in children network (DirecNet).
        Diab. Care. 2004; 27: 722-726
        • Maia F.F.R.
        • Araújo L.R.
        Accuracy, utility and complications of continuous glucose monitoring system (CGMS) in pediatric patients with type 1 diabetes.
        J. Pediatr. (Rio J). 2005; 81: 293-297
        • The DCCT Research Group
        Epidemiology of severe hypoglycemia in the Diabetes Control and Complications Trial.
        Am. J. Med. 1991; 90: 450-459
        • Anderson R.J.
        • Freedland K.E.
        • Clouse R.E.
        • Iustman P.J.
        The prevalence of comorbid depression in adults with diabetes: a meta-analysis.
        Diab. Care. 2001; 24: 1069-1078
        • Kaufman F.R.
        Role of continuous glucose monitoring in pediatric patients.
        Diab. Technol. Ther. 2000; 2: S49-S52
        • Boland E.A.
        • Tamborlane V.W.
        Continuous glucose monitoring in youth with type 2 diabetes: overcoming barriers to successful treatment.
        Diab. Technol. Ther. 2000; 2: S53-S59
        • Caduff A.
        • Hirt E.
        • Feldman Y.
        • Ali Z.
        • Heinemann L.
        First human experiments with a non-invasive, non-optical continuous glucose monitoring system.
        Biosens. Bioelectron. 2003; 19: 207-209
        • Aussedat B.
        • Dupire-Angel M.
        • Gifford R.
        • et al.
        Interstitial glucose concentration and glycemia: implications for continuous subcutaneous glucose monitoring.
        Endocrinol. Metab. 2000; 278: E716-E728
        • Kovatchev B.P.
        • Gonder-Frederick L.A.
        • Cox D.J.
        • Clarke W.L.
        Evaluating the accuracy of continuous glucose-monitoring sensors.
        Diab. Care. 2004; 27: 1922-1928
        • McGowan K.
        • Tomas W.
        • Moran A.
        Spurious reporting of nocturnal hypoglycemia by CGMS in patients with tightly controlled diabetes.
        Diab. Care. 2002; 25: 1499-1503
        • Ludvigsson J.
        • Hanas R.
        Continuous subcutaneous glucose monitoring improved metabolic control in pediatric patients with type 1 diabetes: a controlled crossover study.
        Pediatrics. 2003; 111: 933-938
        • Desouza C.
        • Salazar H.
        • Cheong B.
        • Murgo J.
        • Fonseca V.
        Association of hypoglycemia and cardiac ischemia: a study based on continuous monitoring.
        Diab. Care. 2003; 26: 1485-1489
        • Weinzimer S.A.
        • DeLucia M.C.
        • Boland E.A.
        • Steffen A.
        • Tamborlane W.V.
        Analysis of continuous glucose monitoring data from non-diabetic and diabetic children: a tale of two algorithms.
        Diab. Technol. Ther. 2003; 5: 375-380
        • Schaepelynck-Belicar P.
        • Bague P.
        • Simonin G.
        • Lassmann-Vague V.
        Improved metabolic control in diabetic adolescents using the continuous glucose monitoring system (CGMS).
        Diab. Metab. 2003; 29: 608-612
        • Hay L.C.
        • Wilmshurst E.G.
        • Fulcher G.
        Unrecognized hypo- and hyperglycemia in well-controlled patients with type 2 diabetes mellitus: the results of continuous glucose monitoring.
        Diab. Technol. Ther. 2003; 5: 19-26
        • Sachedina N.
        • Pickup J.C.
        Performance assessment of the Medtronic-Minimed continuous glucose monitoring system and its use for measurement of glycemic control in Type 1 diabetic subjects.
        Diab. Metab. 2003; 20: 1012-1015
        • Djakoure-Platonoff C.
        • Radermercker R.
        • Reach G.
        • Slama G.
        • Selam J.I.
        Accuracy of the continuous glucose monitoring system in inpatient and outpatient conditions.
        Diab. Metab. 2003; 29: 159-162
        • Guerci B.
        • Floriot M.
        • Bohme P.
        • et al.
        Clinical performance of CGMS in type 1 diabetic patients treated by continuous subcutaneous insulin infusion using insulin analogs.
        Diab. Care. 2003; 26: 582-589
      1. The accuracy of the CGMS in children with type 1 diabetes: results of the Diabetes Research in Children Network (DirecNet).
        Diab. Technol. Ther. 2003; 5: 781-789
        • Steil G.M.
        • Rebrin K.
        • Mastrototaro J.
        • Bernaba B.
        • Saad M.F.
        Determination of plasma glucose during rapid glucose excursions with a subcutaneous glucose sensor.
        Diab. Technol. Ther. 2003; 5: 27-31
        • Metzger M.
        • Leibowitz G.
        • Waistein J.
        • et al.
        Reproductibility of glucose measurements using the glucose sensor.
        Diab. Care. 2002; 25: 1185-1191
        • Boland E.
        • Monsod T.
        • Delucia M.
        • Brandt C.A.
        • Fernando S.
        • Tamborlane V.W.
        Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes.
        Diab. Care. 2001; 24: 1858-1862
        • Chico A.
        • Vidal-Rios P.
        • Subira M.
        • Novials A.
        The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but is not better than frequent capillary glucose measurements for improving metabolic control.
        Diab. Care. 2003; 26: 1153-1157
        • Fiallo-Scharer R.
        • Diabetes Research in Children Network Study Group
        Eight point glucose testing versus the continuous glucose monitoring system in evaluation of glycemic control in type 1 diabetes.
        J. Clin. Endocrinol. Metab. 2005; 90: 3387-3391