Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, United Kingdom.
Diabetes Technol Ther. 2011 Nov;13(11):1121-7. doi: 10.1089/dia.2011.0059. Epub 2011 Jul 26.
Continuous glucose monitoring devices measure interstitial glucose and are commonly used to investigate hypoglycemia. The relationship between interstitial glucose and blood glucose is not completely understood, particularly at low blood glucose concentrations. Interstitial glucose during hypoglycemia is generally lower than blood glucose in young subjects without diabetes and those with type 1 diabetes, but the effect of insulin resistance and obesity in type 2 diabetes on this relationship has not been examined previously. We studied the relationship between blood and interstitial glucose during experimental hypoglycemia in subjects with type 2 diabetes treated with insulin or sulfonylureas and matched controls without diabetes.
Twenty subjects with type 2 diabetes (10 sulfonylurea-treated and 10 insulin-treated) and 10 controls without diabetes of similar age and weight underwent stepped hyperinsulinemic hypoglycemic clamps. We compared blood and interstitial glucose at different levels of hypoglycemia using random effects modeling.
Interstitial glucose was significantly higher than blood glucose at all levels of hypoglycemia (P<0.001), and this difference increased as glucose fell. For every 1 mmol/L drop in blood glucose, the difference increased by 0.32 mmol/L (P<0.001). This difference was not affected by presence of type 2 diabetes or by modality of treatment (P=0.10).
In older subjects with or without type 2 diabetes, interstitial glucose is significantly higher than blood glucose, and this difference increases with increasing severity of hypoglycemia. Continuous glucose monitors may underestimate hypoglycemia in this group, and this should be taken into account when interpreting results obtained using this technology.
连续血糖监测仪可测量间质葡萄糖，常用于研究低血糖。间质葡萄糖与血糖之间的关系尚未完全阐明，尤其是在血糖浓度较低时。在年轻的无糖尿病受试者和 1 型糖尿病患者中，低血糖期间的间质葡萄糖通常低于血糖，但之前尚未研究胰岛素抵抗和肥胖对 2 型糖尿病患者这种关系的影响。我们研究了接受胰岛素或磺酰脲类药物治疗的 2 型糖尿病患者和匹配的无糖尿病对照者在实验性低血糖期间血和间质葡萄糖之间的关系。
20 名 2 型糖尿病患者（10 名磺酰脲类治疗，10 名胰岛素治疗）和 10 名年龄和体重相似的无糖尿病对照者接受了逐步高胰岛素低血糖钳夹试验。我们使用随机效应模型比较了不同低血糖水平下的血和间质葡萄糖。
间质葡萄糖在所有低血糖水平均显著高于血糖（P<0.001），且随着血糖下降，这种差异增大。血糖每下降 1mmol/L，差异增加 0.32mmol/L（P<0.001）。这种差异不受 2 型糖尿病的存在或治疗方式的影响（P=0.10）。
在有或无 2 型糖尿病的老年受试者中，间质葡萄糖显著高于血糖，且这种差异随着低血糖严重程度的增加而增大。连续血糖监测仪可能低估该组患者的低血糖，在解释使用该技术获得的结果时应考虑到这一点。
