Marshall Jennifer, Jennings Peter, Scott Adrian, Fluck Richard J, McIntyre Christopher W
Department of Renal Medicine, andDiabetes Unit, South Derbyshire Acute Hospitals Trust, Derby, United Kingdom.
Kidney Int. 2003 Oct;64(4):1480-6. doi: 10.1046/j.1523-1755.2003.00209.x.
From 20% to 40% of all patients commencing dialysis are diabetic. The quality of glycemic control is an important determinant of outcome. The aims of this study were to investigate the use of the continuous glucose monitoring system (CGMS) to assess overall 24-hour glycemic control and the effects of both nonglucose containing and more biocompatible alternative peritoneal dialysis solutions in insulin-treated continuous ambulatory peritoneal dialysis (CAPD) patients.
We studied 8 insulin treated diabetic CAPD patients. A CGMS probe was inserted [allowing automatic measurement of interstitial fluid (ISF) glucose every 5 minutes, for a 72-hour period]. The patients were then allowed home with CGMS monitoring to assess the effect on glycemic control of three differing peritoneal dialysis regimes. Phase 1 consisted of three exchanges of 1.36% glucose and one of 3.86% glucose, utilizing a lactate/bicarbonate buffer. Phase 2 was identical but used lactate-buffered fluid alone. Phase 3 utilized a minimally glycemic combination of one amino acid, one icodextrin, and two 1.36% glucose lactate/bicarbonate-containing exchanges.
ISF glucose measured by CGMS correlated well with venous glucose measurements (r2 = 0.82, P < 0.0001). There was a statistically significant difference in the mean ISF glucose between all three phases (P < 0.0001). The variation in glycemic control was tighter during phase 3 [mean coefficient of variation (CV) 0.21 +/- 0.03].
CGMS appears to be a clinically useful tool to gain additional insights into the glycemic control of diabetic CAPD patients. More biocompatible and nonglucose-containing dialysis fluids seem to be associated with improvements in glycemic control in this group of patients.
开始透析的患者中，20%至40%为糖尿病患者。血糖控制质量是预后的重要决定因素。本研究的目的是调查连续血糖监测系统（CGMS）在评估24小时整体血糖控制方面的应用，以及不含葡萄糖且生物相容性更高的替代腹膜透析液对接受胰岛素治疗的持续性非卧床腹膜透析（CAPD）患者的影响。
我们研究了8名接受胰岛素治疗的糖尿病CAPD患者。插入CGMS探头[每5分钟自动测量一次组织间液（ISF）葡萄糖，持续72小时]。然后让患者带着CGMS监测回家，以评估三种不同腹膜透析方案对血糖控制的影响。第一阶段包括三次1.36%葡萄糖交换和一次3.86%葡萄糖交换，使用乳酸盐/碳酸氢盐缓冲液。第二阶段相同，但仅使用乳酸盐缓冲液。第三阶段采用一种氨基酸、一种艾考糊精和两次含1.36%葡萄糖乳酸盐/碳酸氢盐交换的最低血糖组合。
CGMS测量的ISF葡萄糖与静脉血糖测量结果相关性良好（r2 = 0.82，P < 0.0001）。所有三个阶段之间的平均ISF葡萄糖存在统计学显著差异（P < 0.0001）。在第三阶段，血糖控制的变化更严格[平均变异系数（CV）0.21 +/- 0.03]。
CGMS似乎是一种临床上有用的工具，可用于深入了解糖尿病CAPD患者的血糖控制情况。在这组患者中，生物相容性更高且不含葡萄糖的透析液似乎与血糖控制的改善有关。
