Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Copenhagen, Denmark.
Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Front Endocrinol (Lausanne). 2024 Apr 15;15:1352829. doi: 10.3389/fendo.2024.1352829. eCollection 2024.
Hypoglycemia is common in individuals with type 1 diabetes, especially during exercise. We investigated the accuracy of two different continuous glucose monitoring systems during exercise-related hypoglycemia in an experimental setting.
Fifteen individuals with type 1 diabetes participated in two separate euglycemic-hypoglycemic clamp days (Clamp-exercise and Clamp-rest) including five phases: 1) baseline euglycemia, 2) plasma glucose (PG) decline ± exercise, 3) 15-minute hypoglycemia ± exercise, 4) 45-minute hypoglycemia, and 5) recovery euglycemia. Interstitial PG levels were measured every five minutes, using Dexcom G6 (DG6) and FreeStyle Libre 1 (FSL1). Yellow Springs Instruments 2900 was used as PG reference method, enabling mean absolute relative difference (MARD) assessment for each phase and Clarke error grid analysis for each day.
Exercise had a negative effect on FSL1 accuracy in phase 2 and 3 compared to rest (ΔMARD = +5.3 percentage points [(95% CI): 1.6, 9.1] and +13.5 percentage points [6.4, 20.5], respectively). In contrast, exercise had a positive effect on DG6 accuracy during phase 2 and 4 compared to rest (ΔMARD = -6.2 percentage points [-11.2, -1.2] and -8.4 percentage points [-12.4, -4.3], respectively). Clarke error grid analysis showed a decrease in clinically acceptable treatment decisions during Clamp-exercise for FSL1 while a contrary increase was observed for DG6.
Physical exercise had clinically relevant impact on the accuracy of the investigated continuous glucose monitoring systems and their ability to accurately detect hypoglycemia.
1 型糖尿病患者常发生低血糖，尤其是在运动时。我们在实验环境下研究了两种不同的连续血糖监测系统在运动相关低血糖时的准确性。
15 名 1 型糖尿病患者参与了两次单独的正常血糖-低血糖钳夹日（Clamp-exercise 和 Clamp-rest），包括五个阶段：1）基础正常血糖，2）血糖（PG）下降±运动，3）15 分钟低血糖±运动，4）45 分钟低血糖，5）恢复正常血糖。使用 Dexcom G6（DG6）和 FreeStyle Libre 1（FSL1）每五分钟测量一次间质 PG 水平。使用 Yellow Springs Instruments 2900 作为 PG 参考方法，能够评估每个阶段的平均绝对相对差异（MARD）和每个日的 Clarke 误差网格分析。
与休息相比，运动对 FSL1 在第 2 阶段和第 3 阶段的准确性有负面影响（ΔMARD = +5.3 个百分点[95%CI：1.6，9.1]和+13.5 个百分点[6.4，20.5]）。相比之下，运动对 DG6 在第 2 阶段和第 4 阶段的准确性有正面影响，与休息相比（ΔMARD = -6.2 个百分点[-11.2，-1.2]和-8.4 个百分点[-12.4，-4.3]）。Clarke 误差网格分析显示，在 Clamp-exercise 期间，FSL1 的临床可接受治疗决策减少，而 DG6 则相反，增加。
体力活动对所研究的连续血糖监测系统的准确性及其准确检测低血糖的能力有临床相关影响。
