The Clinical Use Of Real Time Continuous Glucose Monitoring System

Diabetes mellitus and its chronic complications have become one of the main diseases now,which affect human's health seriously.Researches showed that the main method of delaying or preventing the chronic diabetic complications is intensively controlling hyperglycemia.Recently,continuous glucose monitoring system(CGMS)has detected the glucose of interstitial fluid in order to reflect the blood glucose profile of diabetic patients.Based on the old CGMS,Guardian(?)RT CGMS can display glucose in real time and reflect the changing tendency of glucose.Diabetic clinicians can make individualized treatment plan by setting high and low glucose alert.In this study,we evaluate the accuracy of Guardian(?)RT CGMS in clinic and analyze the clinical use when being treated with total parenteral nutrition(TPN)and combined with continuous subcutaneous insulin infusion(CSⅡ)in diabetic patients.Objective1.To evaluate the accuracy of MiniMed Guardian(?)RT CGMS in blood glucose measurement.2.To compare the accuracy of MiniMed Guardian(?)RT CGMS and dynamic glucose monitoring system in blood glucose measurement.3.To investigate the characteristics of daily glucose profiles in diabetic patients using Guardian(?)RT CGMS with TPN and give more optimal instructon on diabetic treatment.4.To evaluate an influence on controlling blood glucose values with the combination of the Guardian(?)RT CGMS and CSⅡin diabetic patients.Methods1.60 diabetetic patients wore Guardian(?)RT CGMS for 3 days.Using EGA to assess the accuracy of Guardian(?)RT CGMS in different blood glucose level. 2.10 diabetetic patients wore Guardian(?)RT CGMS and DGMS simultaneously.Using EGA to compare the accuracy between Guardian(?)RT CGMS and DGMS.3.11 type 2 diabetic patients using TPN wore Guardian(?)RT CGMS for 72 hours.When using TPN,we observed the blood glucose profiles and the contribution of adjustment insulin on blood glucose by Guardian(?)RT CGMS.4.18 type 2 diabetic subjects were treated with the double C therapy.We observed the variation of MBG,MAGE and hypoglycemias.Results1.①The Guardian(?)RT CGMS examination was well accepted in all patients.②The correlation coefficient,between sensor glucose and capillary glucose values in general,higher and median glucose level were 0.97,0.95,0.91 respectively(P＜0.001).The Correlation was 0.61 in lower glucose level (P＜0.01).③The correlation coefficient,between sensor glucose and plasma glucose values were 0.95(P＜0.001).④The analysis results of EGA showed that 99.72%of the data fell in the A and B zones.⑤Setting the low alert threshold to 5.3mmol/L,results in 85%sensitivity,99.4%specificity.Setting the high alert threshold to 13.2mmol/L,results in 85%sensitivity,92%specificity.2.①The correlation coefficient,between Guardian(?)RT CGMS and DGMS sensor glucose and capillary glucose values were 0.98,0.95(P＜0.001),and the mean absolute difference and relative difference were increased more than DGMS group(P＜0.01).②The two group between sensor glucose and plasma glucose values were 0.97,(P＜0.001),and the mean absolute difference and relative difference of DGMS group were increased more than Guardian(?)RT CGMS group(P＜0.05).③The analysis results of EGA showed that 99%of the data fell in the A and B zones in both group.④Compared with DGMS group, the fluctuation of blood glucose in Guardian(?)RT CGMS group were dropped down after monitoring. 3.①The mean blood glucose,daily peak value,mean amplitude of glycemic excursion of the whole day and of using TPN were decreased (P＜0.05).②The dose of insulin daily and using TPN were increased,but the ratio of the dose of insulin using TPN to daily volume dose of insulin dropped out(P＜0.05).③The times and during times of hyper-and hypoglycemia were shortened.4.①The MBG,MAGE and MODD of the group were decresed(P＜0.01). The mean blood glucose for every hour were reduced significantly after the double C therapy(P＜0.01),especially for the mean glucose about two hours after meals.②The times of hypoglycemia each day and during times were shortened,but there was no difference.Hyperglycemia alert times and during times were shortened significantly(P＜0.05).Conclusion1.Guardian(?)RT CGMS has some predominances in blood glucose monitoring,such as offering blood glucose excursion in real time,setting low and high alerts.It can be used in clinic.2.Guardian(?)RT CGMS and DGMS has different predominances in blood glucose monitoring.3.In diabetic patients using TPN,Guardian(?)RT CGMS can instruct the use of insulin use and may control blood glucose more quickly,stably and perfectly.4.①Guardian(?)RT CGMS can reflect blood profiles,detect hypoglycemias, instruct the clinical use of insulin in CSⅡ,and it may control blood glucose more quickly,safely,efficiently.