Pavlicek V, Garzoni D, Urech P, Brändle M
Division of Endocrinology and Diabetes, Kantonsspital St. Gallen, St.Gallen, and Division of Nephrology, University Hospital of Basel, Switzerland.
Exp Clin Endocrinol Diabetes. 2006 Mar;114(3):124-6. doi: 10.1055/s-2006-924011.
Patients on chronic ambulant peritoneal dialysis (CAPD) are increasingly likely to be treated with a new solution of corn starch-derived glucose polymers called icodextrin. This solution involves a very low carbohydrate absorption leading to a better glycemic control in diabetic patients. However these glucose polymers pass to the blood and are metabolized to oligosaccharids which interfere with blood glucose in distinct capillary glucose analyzers leading to overestimation of glycemia. We assessed the accuracy of glucose measurements with the three most commonly used glucose analyzers compared to venous plasma glucose measurement at our institution in 8 patients (4 patients with type 2 diabetes) on CAPD using icodextrin. Glycemia was measured simultaneously in plasma of venous blood using a reference laboratory method and in capillary blood using Accu-Chek sensor (Rotkreuz, Switzerland) (glucose dehydrogenase method), Glucotrend 2 (Rotkreuz, Switzerland) (glucose-dye-oxyreductase method) and Ascensia elite (Zurich, Switzerland) (glucose oxidase method) glucose analyzers. Only glucose readings with Ascensia elite correspond correctly with venous plasma glucose results (+0.3 mmol/l; n. s.), whereas glycemia was significantly overestimated by Accu-Chek sensor (+4.3 mmol/l; p<0.0001) and Glucotrend 2 glucose analyzers (+3.7 mmol/l; p<0.0001). Thus we conclude that distinct glucose analyzers overestimate real blood glucose concentration and are not suitable for monitoring glycemia in patients on CAPD with icodextrin. On the basis of our results, these patients should use glucose analyzers using glucose oxidase methods. All glucose analyzers should be cross-checked with a laboratory reference method before the application in patients on CAPD with icodextrin is recommended.
接受持续性非卧床腹膜透析（CAPD）的患者越来越多地使用一种名为艾考糊精的新型玉米淀粉衍生葡萄糖聚合物溶液进行治疗。这种溶液的碳水化合物吸收非常低，从而能更好地控制糖尿病患者的血糖。然而，这些葡萄糖聚合物会进入血液并代谢为寡糖，这会干扰不同毛细血管血糖仪对血糖的检测，导致血糖被高估。我们评估了在我们机构中，8名使用艾考糊精进行CAPD治疗的患者（4名2型糖尿病患者）使用三种最常用的血糖仪测量血糖的准确性，并与静脉血浆葡萄糖测量结果进行比较。使用参考实验室方法同时测量静脉血血浆中的血糖，以及使用罗氏卓越血糖仪（瑞士罗特kreuz）（葡萄糖脱氢酶法）、罗氏活力型血糖仪（瑞士罗特kreuz）（葡萄糖染料氧化还原酶法）和雅培利舒坦血糖仪（瑞士苏黎世）（葡萄糖氧化酶法）测量毛细血管血中的血糖。只有雅培利舒坦血糖仪的血糖读数与静脉血浆葡萄糖结果正确对应（+0.3 mmol/l；无显著性差异），而罗氏卓越血糖仪（+4.3 mmol/l；p<0.0001）和罗氏活力型血糖仪（+3.7 mmol/l；p<0.0001）显著高估了血糖。因此，我们得出结论，不同的血糖仪会高估实际血糖浓度，不适用于监测使用艾考糊精进行CAPD治疗的患者的血糖。根据我们的结果，这些患者应使用采用葡萄糖氧化酶法的血糖仪。在建议将所有血糖仪应用于使用艾考糊精进行CAPD治疗的患者之前，应使用实验室参考方法进行交叉核对。
