Correlations of Glucose Levels in Interstitial Fluid Estimated by Continuous Glucose Monitoring Systems and Venous Plasma

Byung-Joon Kim

doi:10.4093/kdj.2010.34.6.338

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Editorial Correlations of Glucose Levels in Interstitial Fluid Estimated by Continuous Glucose Monitoring Systems and Venous Plasma: Byung-Joon Kim; Korean Diabetes Journal 2010;34(6):338-339.
DOI: https://doi.org/10.4093/kdj.2010.34.6.338
Published online: December 31, 2010

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Division of Endocrinology and Metabolism, Department of Internal Medicine, Konyang University School of Medicine, Daejeon, Korea.

Corresponding author: Byung-Joon Kim. Division of Endocrinology and Metabolism, Department of Internal Medicine, Konyang University School of Medicine, 685 Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea. kbjoon4u@hanafos.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Continuous glucose monitoring systems (CGMS) are relatively new technology that measures interstitial glucose every 5 minute over a period of 72 hours [1]. Continuous glucose monitoring by CGMS provides accurate data to patients and physicians about blood glucose variability during the measurement period. Two types of CGMS devices, intended for professional and personal use, are available. Professional devices allow physicians to download and analyze data and for use in clinical decision making. Personal devices allow patients to monitor real time glucose data and use such data for self-monitoring and medication adjustments. For this reason, the American Association of Clinical Endocrinologists has recommended the use of personal devices for glucose control and prevention of hypoglycemia in patients with type 1 diabetes [2,3] and pregnancy with diabetes [4,5].

The article, "The correlation and accuracy of glucose levels between interstitial fluid and venous plasma by continuous glucose monitoring system" [6] clearly showed a glucose time lag between blood levels and subcutaneous interstitial levels. Blood and interstitial fluid had different peak times and peak values after meal loading, but the trends of glucose excursion were very similar. In addition, CGMS data showed delayed peaks and lowered peak values compared to venous blood sugar levels after the ingestion of different kinds of food. These lags between the two compartments did not differ by food. The use of CGMS devices, which provide accurate control and monitoring of blood glucose levels, is suitable for use in uncontrolled diabetic patients and to help physicians make decisions regarding treatment modalities.

In the treatment of diabetes, glucose variability, especially postprandial hyperglycemia, is a major risk factor for cardiovascular complications. By using CGMS devices, clinicians can easily access glucose variability in patients. Although patients more easily achieved target HbA1c levels when practicing self monitoring of glucose using the CGMS device than by other methods, systemic reviews comparing the results of CGMS use and intermittent fingertip glucose monitoring do not indicate significantly superior benefits of CGMS. However, they do support the improved detection of asymptomatic nocturnal hypoglycemia [7].

CGMS systems offer many advantages to patients and physicians. However, the sensitivity of glucose sensing decreases over time. After 3 to 5 days, the sensing amplitude of CGMS sensors becomes unreliable. The accuracy of sensors is affected by localized tissue reactions and fibrous encapsulation [8]. For these reasons, patients should calibrate sensing amplitudes through comparisons with fingertip glucose values regularly. Methods of blocking fibrous tissue aggregation and reducing tissue reactions, such as corticosteroid sprays or anticancer drug coatings, were used in attempts to address these problems [9,10]. Also, if we placed the sensor in subcutaneous space during continuous monitoring, small glucose diffusion gap from blood level to subcutaneous tissue fluid was another limitation.

Recently, ubiquitous health systems have been introduced to help outpatients to control their blood sugar levels. If patients send their blood glucose profiles to physicians over the internet, their physicians can provide advice to meet their patients' needs. The use of CGMS systems connected to Internet networks has the potential to provide effective, evidence-based support to clinicians in their daily efforts to optimize glycemic control [11].

The closed loop pump is a state of the art technology [12,13]. But major pitfall of this closed loop pump is sensing problems of glucose sensor and limited space of insulin reservoir in transplanted pump. Closed loop pumps are expected to replace open loop pumps and decrease the pain associated with insulin injections. Permanent usable blood glucose sensors and interstitial glucose sensors are also expected to be developed [9,10]. Rapid development of information technology devices and techniques will solve the relevant technological problems, and closed loop systems will be available to patients in the future.

REFERENCES

1. Mastrototaro J. The MiniMed continuous glucose monitoring system (CGMS). J Pediatr Endocrinol Metab 1999;12(Suppl 3):751-758. PubMed
2. Melki V, Hanaire-Broutin H. Indication of CGMS (Continuous Glucose Monitoring System) in the functionnal investigations of adult type 1 diabetic patients. Diabetes Metab 2001;27(5 Pt 1):618-623. PubMed
3. Schiaffini R, Ciampalini P, Fierabracci A, Spera S, Borrelli P, Bottazzo GF, Crino A. The Continuous Glucose Monitoring System (CGMS) in type 1 diabetic children is the way to reduce hypoglycemic risk. Diabetes Metab Res Rev 2002;18:324-329. Article PubMed
4. Buhling KJ, Winkel T, Wolf C, Kurzidim B, Mahmoudi M, Wohlfarth K, Wascher C, Schink T, Dudenhausen JW. Optimal timing for postprandial glucose measurement in pregnant women with diabetes and a non-diabetic pregnant population evaluated by the Continuous Glucose Monitoring System (CGMS). J Perinat Med 2005;33:125-131. PubMed
5. Kerssen A, De Valk HW, Visser GH. Validation of the Continuous Glucose Monitoring System (CGMS) by the use of two CGMS simultaneously in pregnant women with type 1 diabetes mellitus. Diabetes Technol Ther 2005;7:699-706. Article PubMed
6. Baek YH, Jin HY, Lee KA, Kang SM, Kim WJ, Kim MG, Park JH, Chae SW, Baek HS, Park TS. The correlation and accuracy of glucose levels between interstitial fluid and venous plasma by continuous glucose monitoring system. Korean Diabetes J 2010;34:350-358.Article PubMed PMC
7. Chetty VT, Almulla A, Odueyungbo A, Thabane L. The effect of continuous subcutaneous glucose monitoring (CGMS) versus intermittent whole blood finger-stick glucose monitoring (SBGM) on hemoglobin A1c (HBA1c) levels in type I diabetic patients: a systematic review. Diabetes Res Clin Pract 2008;81:79-87. Article PubMed
8. Gerritsen M. Problems associated with subcutaneously implanted glucose sensors. Diabetes Care 2000;23:143-145. Article PubMed PDF
9. Rowinski P, Rowinska M, Heller A. Liquid crystal membranes for serum-compatible diabetes management-assisting subcutaneously implanted amperometric glucose sensors. Anal Chem 2008;80:1746-1755. Article PubMed
10. Koschwanez HE, Yap FY, Klitzman B, Reichert WM. In vitro and in vivo characterization of porous poly-L-lactic acid coatings for subcutaneously implanted glucose sensors. J Biomed Mater Res A 2008;87:792-807. Article PubMed PMC
11. Salzsieder E, Augstein P, Vogt L, Kohnert KD, Heinke P, Freyse EJ, Azim Ahmed A, Metwali Z, Salman I, Attef O. Telemedicine-based KADIS combined with CGMS has high potential for improving outpatient diabetes care. J Diabetes Sci Technol 2007;1:511-521. Article PubMed PMC PDF
12. Hanaire H. Continuous glucose monitoring and external insulin pump: towards a subcutaneous closed loop. Diabetes Metab 2006;32(5 Pt 2):534-538. Article PubMed
13. Renard E. Implantable closed-loop glucose-sensing and insulin delivery: the future for insulin pump therapy. Curr Opin Pharmacol 2002;2:708-716. Article PubMed

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Correlations of Glucose Levels in Interstitial Fluid Estimated by Continuous Glucose Monitoring Systems and Venous Plasma

Korean Diabetes J. 2010;34(6):338-339. Published online December 31, 2010

DOI: https://doi.org/10.4093/kdj.2010.34.6.338

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