Kubiak T, Hermanns N, Schreckling H J, Kulzer B, Haak T
Research Institute of the Diabetes Academy Mergentheim, Th-Klotzbuecher-Strasse-12, D-97980 Bad Mergentheim, Germany.
Diabet Med. 2004 May;21(5):487-90. doi: 10.1111/j.1464-5491.2004.1136.x.
To investigate the possibility of assessing hypoglycaemia awareness in patients with Type 1 diabetes using continuous glucose monitoring.
Twenty patients with Type 1 diabetes were investigated. Ten patients with Type 1 diabetes and strongly impaired hypoglycaemia awareness were compared with 10 patients with intact hypoglycaemia awareness regarding quality of hypoglycaemia perception (number of undetected hypoglycaemic episodes per 24 h, glucose level < 3.3 mmol/l). Hypoglycaemia detection was assessed using the event function of the Continuous Glucose Monitoring System (CGMS; Medtronic MiniMed, Northridge, CA, USA). Patients were instructed to enter an event upon suspecting being hypoglycaemic.
Satisfactory CGMS performance could be achieved [mean r = 0.893 between calibration measurements and CGMS data, mean absolute difference (MAD) = 20.6%], although artefacts were observable and had to be controlled. Hypoglycaemia unaware patients showed a significantly higher total number of hypoglycaemic episodes (P < 0.05), number of undetected hypoglycaemic episodes (P < 0.01), and mean glucose levels (P < 0.05). Even in aware patients, undetected hypoglycaemia was observable. No significant differences regarding occurrence of nocturnal hypoglycaemia were observable.
The possibility of direct assessment of hypoglycaemia awareness using continuous glucose monitoring was demonstrated. Its application in clinical practice could be of use for assessing hypoglycaemia perception and evaluating the impact of treatment changes on hypoglycaemia awareness.
研究使用持续葡萄糖监测评估1型糖尿病患者低血糖意识的可能性。
对20例1型糖尿病患者进行研究。将10例低血糖意识严重受损的1型糖尿病患者与10例低血糖意识正常的患者在低血糖感知质量（每24小时未检测到的低血糖发作次数，血糖水平<3.3 mmol/l）方面进行比较。使用持续葡萄糖监测系统（CGMS；美敦力MiniMed，美国加利福尼亚州北岭）的事件功能评估低血糖检测情况。指导患者在怀疑低血糖时输入事件。
尽管可观察到伪迹且必须加以控制，但仍可实现令人满意的CGMS性能[校准测量与CGMS数据之间的平均r = 0.893，平均绝对差（MAD）= 20.6%]。低血糖无感知患者的低血糖发作总数显著更高（P < 0.05），未检测到的低血糖发作次数显著更高（P < 0.01），平均血糖水平也显著更高（P < 0.05）。即使在有感知的患者中，也可观察到未检测到的低血糖情况。夜间低血糖的发生率未观察到显著差异。
证明了使用持续葡萄糖监测直接评估低血糖意识的可能性。其在临床实践中的应用可用于评估低血糖感知并评估治疗变化对低血糖意识的影响。
