Prevention of Hypoglycemia Using Risk Assessment With a Continuous Glucose Monitoring System

Abstract : Due to the lag between sugar intake and the beginning of recovery from hypoglycemia, it is necessary to intervene in an anticipatory way if one wants to prevent, not only detect, hypoglycemia. This article presents the principle of a hypoglycemia prevention system based on risk assessment. The risk situation can be defined as the moment when the system estimates that the glucose concentration is expected to reach a hypoglycemia threshold in less than a given time (e.g., 20 min). Since there are well-known discrepancies between blood and interstitial glucose concentrations, the aim of this experimental study performed in nondiabetic rats was first to validate this strategy, and second to determine whether it can work when the glucose concentration is estimated by a glucose sensor in subcutaneous tissue rather than in blood. We used a model of controlled decrease in blood glucose concentration. A glucose infusion, the profile of which mimicked the appearance of glucose from an intragastric load, was administered either when hypoglycemia was detected or on the basis of risk recognition. Despite the lag between the beginning of the load and that of the increase in blood glucose concentration, which was in all experiments 15–20 min, hypoglycemia was fully prevented without overshoot hyperglycemia in the groups of rats in which the glucose load was started when the hypoglycemia risk was detected, on the basis of either blood or interstitial glucose concentration. This was, of course, not the case when the same glucose load was infused at the detection of the hypoglycemia threshold. Detection of hypoglycemia is considered to be a major advance that can be expected from a continuous glucose monitoring system (1–4). However, it may be preferable to orient the general goal of the system toward prevention, rather than detection, of hypoglycemia. First, this is what the patients are waiting for (5). Second, the occurrence of hypoglycemia has per se harmful metabolic effects, inducing insulin resistance (6) and increasing the risk of future severe hypoglycemia (7). A hypoglycemia prevention system should generate in a timely fashion an alarm indicating that intake of sugar is necessary, i.e., taking into account the time necessary for sugar intestinal absorption. Rather than hypoglycemia itself, it should therefore detect a risk for hypoglycemia, defined as the moment when it estimates that the blood glucose concentration is expected to decrease below a hypoglycemic value (e.g., 70 mg/dl) within a given time (e.g., 20 min). The aim of this experimental study, performed in rats, was to validate this concept. First, the detection of a hypoglycemia risk, as defined above, was achieved on the basis of serial determinations of blood glucose concentration. We observed that administering glucose 20 min before the expected occurrence of hypoglycemia prevented its occurrence. Second, we used a continuous glucose monitoring system consisting of a subcutaneous glucose sensor and an electronic control unit (8,9) in which we implemented a new software that was able to trigger an alarm based on the detection of such a hypoglycemia risk. In this article, we demonstrate that, despite that the system monitored glucose concentration in interstitial fluid and not in blood, this approach made it possible to administer glucose in an anticipatory way, leading to full prevention of hypoglycemia without overshoot hyperglycemia.
Type de document :
Article dans une revue
Diabetes, American Diabetes Association, 2002, pp.3263-3273
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Contributeur : Petr Dokladal <>
Soumis le : mardi 5 janvier 2016 - 15:55:57
Dernière modification le : vendredi 27 octobre 2017 - 17:36:02

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  • HAL Id : hal-01251083, version 1

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Carine Choleau, Petr Dokládal, Jean-Claude Klein, W. Kenneth Ward, George S. Wilson, et al.. Prevention of Hypoglycemia Using Risk Assessment With a Continuous Glucose Monitoring System. Diabetes, American Diabetes Association, 2002, pp.3263-3273. 〈hal-01251083〉

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