Microdialysis--a versatile technology to perform metabolic monitoring in diabetes and critically ill patients.

Continuous subcutaneous glucose monitoring has been tested in type 1 diabetes (T1D). Since in critically ill patients vascular access is granted vascular microdialysis may be preferential. To test this hypothesis comparative accuracy data for microdialysis applied for peripheral venous and subcutaneous glucose monitoring was obtained in experiments in T1D patients. Twelve T1D patients were investigated for up to 30 h. Extracorporeal vascular (MDv) and subcutaneous microdialysis (MDs) was performed. Microdialysis samples were collected in 15-60 min intervals, analyzed for glucose and calibrated to reference. MDv and MDs glucose levels were compared against reference. Median absolute relative difference was 14.0 (5.0; 28.0)% (MDv) and 9.2 (4.4; 18.4)% (MDs). Clarke Error Grid analysis showed that 100% (MDv) and 98.8% (MDv) were within zones A and B. Extracorporeal vascular and standard subcutaneous microdialysis indicated similar performance in T1D. We suggest microdialysis as a versatile technology for metabolite monitoring in subcutaneous tissue and whole blood.

[1]  Thomas R. Pieber,et al.  Microdialysis based device for continuous extravascular monitoring of blood glucose , 2010, Biomedical microdevices.

[2]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[3]  U. Ungerstedt,et al.  Microdialysis in the study of extracellular levels of amino acids in the rat brain. , 1986, Acta physiologica Scandinavica.

[4]  Harald Herkner,et al.  Real-Time Continuous Glucose Monitoring in Critically Ill Patients , 2009, Diabetes Care.

[5]  Roman Hovorka,et al.  A Stepwise Approach toward Closed-Loop Blood Glucose Control for Intensive Care Unit Patients: Results from a Feasibility Study in Type 1 Diabetic Subjects Using Vascular Microdialysis with Infrared Spectrometry and a Model Predictive Control Algorithm , 2011, Journal of diabetes science and technology.

[6]  E. Renard,et al.  Continuous glucose monitoring reduces both hypoglycaemia and HbA1c in hypoglycaemia-prone type 1 diabetic patients treated with a portable pump. , 2010, Diabetes & metabolism.

[7]  J. Wernerman,et al.  Continuous glucose monitoring by intravenous microdialysis , 2010, Acta anaesthesiologica Scandinavica.

[8]  S. Garg,et al.  Comparison of accuracy and safety of the SEVEN and the Navigator continuous glucose monitoring systems. , 2009, Diabetes technology & therapeutics.

[9]  Stephen D Patek,et al.  Hypoglycemia Prevention via Pump Attenuation and Red-Yellow-Green “Traffic” Lights Using Continuous Glucose Monitoring and Insulin Pump Data , 2010, Journal of diabetes science and technology.

[10]  D. B. Keenan,et al.  Delays in Minimally Invasive Continuous Glucose Monitoring Devices: A Review of Current Technology , 2009, Journal of diabetes science and technology.

[11]  Janet M. Allen,et al.  Overnight closed loop insulin delivery (artificial pancreas) in adults with type 1 diabetes: crossover randomised controlled studies , 2011, BMJ : British Medical Journal.

[12]  D. Cox,et al.  Evaluating the accuracy of continuous glucose-monitoring sensors: continuous glucose-error grid analysis illustrated by TheraSense Freestyle Navigator data. , 2004, Diabetes care.

[13]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[14]  M. Ellmerer,et al.  Assessment of different techniques for subcutaneous glucose monitoring in Type 1 diabetic patients during ‘real‐life’ glucose excursions , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[15]  S. Garg,et al.  Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy , 2011, Diabetes Care.

[16]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[17]  A. Nierich,et al.  Pre- and postoperative accuracy and safety of a real-time continuous glucose monitoring system in cardiac surgical patients: a randomized pilot study. , 2009, Diabetes technology & therapeutics.

[18]  P Wach,et al.  Plasma and interstitial glucose dynamics after intravenous glucose injection: evaluation of the single-compartment glucose distribution assumption in the minimal models. , 1999, Diabetes.

[19]  U. Ungerstedt,et al.  Microdialysis measurement of the absolute glucose concentration in subcutaneous adipose tissue allowing glucose monitoring in diabetic patients , 1992, Diabetologia.

[20]  David Rodbard,et al.  Responses to continuous glucose monitoring in subjects with type 1 diabetes using continuous subcutaneous insulin infusion or multiple daily injections. , 2009, Diabetes technology & therapeutics.

[21]  D. Cox,et al.  Evaluating Clinical Accuracy of Systems for Self-Monitoring of Blood Glucose , 1987, Diabetes Care.

[22]  L Heinemann,et al.  Glucose monitoring by microdialysis: performance in a multicentre study , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[23]  Gerd Köhler,et al.  Prediction of glucose concentration in post-cardiothoracic surgery patients using continuous glucose monitoring. , 2011, Diabetes technology & therapeutics.

[24]  L. Rydén,et al.  Glucose monitoring by means of an intravenous microdialysis catheter technique. , 2010, Diabetes technology & therapeutics.