Ladd Jennifer M, Gandhi Kajal, Friesner-Gephart Kelly, Hoffman Robert P, Okafor Mary Joy, Heinzman Christie, Gariepy Cheryl E, Rasmussen Sara K, Nathan Jaimie D, Freeman A Jay
Section of Pediatric Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Abdominal Transplantation and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
Diabetes Technol Ther. 2025 Mar 18. doi: 10.1089/dia.2025.0010.
Total pancreatectomy with islet autotransplantation (TPIAT) requires strict glycemic management for islet survival using insulin pumps and continuous glucose monitors (CGMs). Hydroxyurea prevents reactive thrombocytosis but interferes with the accuracy of the Dexcom CGM. Hydroxyurea is reported to not interfere with the Libre CGM but has not been studied after TPIAT. Seven patients wore both Dexcom and Libre starting approximately a week after TPIAT. Dexcom and Libre values were obtained with point-of-care testing blood glucose (POCT BG) at 560 unique time points. Descriptive statistics included median, interquartile range (IQR), absolute difference between CGM and POCT, and mean absolute relative difference (MARD) for each Dexcom and Libre. Wilcoxon-Mann-Whitney tests were performed to compare parameters between Dexcom and Libre, with two-sided significance of < 0.05. Clarke error grids and boxplots were constructed. In the 9 h after hydroxyurea, median POCT BG was 110 mg/dL (IQR 88-143), median Dexcom BG was 172 mg/dL (135-219), and median Libre BG was 106 mg/dL (76-138). MARD for Dexcom was 59.5% and for Libre was 14.8% ( < 0.001). Median absolute difference between Dexcom and POCT BG (56 mg/dL [32-88]) was greater than that for Libre (12 mg/dL [6-23]; < 0.001). In Clarke error grids, 98.3% of values fell within clinically acceptable Zones A/B for Libre; 77.9% of values fell within these zones for Dexcom. At all other times, median POCT BG was 110 mg/dL (86-133), median Dexcom BG was 124 mg/dL (97-154), and median Libre BG was 104 mg/dL (76-128). MARD for Dexcom was 19.8% and for Libre was 14.7% ( < 0.001). Median absolute difference between Dexcom and POCT BG (18 mg/dL [9-30]) was clinically similar to that for Libre (13 mg/dL [6-23], < 0.001). Hydroxyurea does not seem to interfere with the accuracy of Libre in contrast to Dexcom. Use of Libre after TPIAT could facilitate improved glycemic management.
全胰切除术联合胰岛自体移植（TPIAT）需要使用胰岛素泵和持续葡萄糖监测仪（CGM）进行严格的血糖管理以确保胰岛存活。羟基脲可预防反应性血小板增多症，但会干扰德康CGM的准确性。据报道，羟基脲不会干扰利拉鲁肽CGM，但在TPIAT后尚未进行研究。7名患者在TPIAT后约一周开始同时佩戴德康和利拉鲁肽。在560个不同时间点通过即时检测血糖（POCT BG）获得德康和利拉鲁肽的值。描述性统计包括中位数、四分位数间距（IQR）、CGM与POCT之间的绝对差值，以及每个德康和利拉鲁肽的平均绝对相对差值（MARD）。进行Wilcoxon-Mann-Whitney检验以比较德康和利拉鲁肽之间的参数，双侧显著性<0.05。构建了克拉克误差网格和箱线图。在服用羟基脲后的9小时内（POCT），血糖中位数为110mg/dL（IQR 88 - 143），德康血糖中位数为172mg/dL（135 - 219），利拉鲁肽血糖中位数为106mg/dL（76 - 138）。德康的MARD为59.5%，利拉鲁肽为%14.8（<0.001）。德康与POCT BG之间的中位数绝对差值（56mg/dL [32 - 88]）大于利拉鲁肽（12mg/dL [6 - 23]；<0.001）。在克拉克误差网格中，98.3%的值落在利拉鲁肽临床可接受的A/B区；德康的77.9%的值落在这些区域。在所有其他时间，POCT BG中位数为110mg/dL（86 - 133），德康BG中位数为124mg/dL（97 - 154），利拉鲁肽BG中位数为104mg/dL（76 - 128）。德康的MARD为19.8%，利拉鲁肽为14.7%（<0.001）。德康与POCT BG之间的中位数绝对差值（18mg/dL [9 - 30]）在临床上与利拉鲁肽相似（13mg/dL [6 - 23]，<0.（此处原文可能有误，推测为<0.001））。与德康相比，羟基脲似乎不会干扰利拉鲁肽的准确性。TPIAT后使用利拉鲁肽可能有助于改善血糖管理。
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