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      Postprandial capillary–venous glucose gradient in Type 1 diabetes: magnitude and clinical associations in a real world setting

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          Abstract

          Aims

          To determine the magnitude of the peripheral glucose gradient in patients with Type 1 diabetes in a real world setting and to explore its relationship with insulin dose and macronutrient intake.

          Methods

          All patients used mealtime analogue insulin. The glucose gradient was assessed using antecubital fossa venous and finger‐stick capillary samples, collected concurrently at room temperature. Baseline sampling occurred before the administration of an insulin dose and breakfast of the patient's choosing. Breakfast was consumed an average of 15 min after baseline. The macronutrient content of breakfast was documented. Sampling was repeated 1 and 2 h after baseline.

          Results

          The mean (95% CI) plasma capillary–venous glucose gradient values for 43 patients were: pre‐breakfast, 0.21 (0.08–0.34) mmol/l; 1 h after baseline, 0.87 (0.66–1.07) mmol/l; and 2 h after baseline, 0.52 (0.33–0.71) mmol/l. Glucose gradient and dietary carbohydrate intake (g/kg body weight) were positively correlated at both 1 h ( P < 0.01) and 2 h after baseline ( P < 0.01). No relationship was observed between this gradient and mealtime insulin dose, or the glucose concentration at either time point.

          Conclusions

          In patients with Type 1 diabetes, a clinically significant glucose gradient is present after the ingestion of a carbohydrate‐rich meal. As postprandial capillary and venous plasma glucose concentrations are not equivalent, defining the site of sample collection is important.

          What's new?

          • This report details the magnitude of the postprandial capillary–venous glucose gradient and its clinical associations, in patients with Type 1 diabetes.

          • At 1 h from baseline, the capillary–venous glucose gradient was 0.87 mmol/l.

          • A positive association was seen between the postprandial glucose gradient and carbohydrate intake.

          • No association was seen with either preprandial insulin dose or baseline glucose concentration.

          • Study findings suggest that when a postprandial glucose concentration is within the biochemical hypoglycaemia range, the site of glucose sampling should be clarified to allow appropriate clinical interpretation of the result.

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          Most cited references12

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          Role of glucose effectiveness in the determination of glucose tolerance.

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            The discovery of type 1 diabetes.

            The etiological heterogeneity of idiopathic diabetes has been recognized for 25 years, and subdivision into type 1 and type 2 diabetes is fundamental to the way we think about the disease. Review of the literature suggests that the concept of type 1 diabetes as an immunemediated disease emerged rapidly over the period from 1974 to 1976 and showed many of the features of a classic paradigm shift. A few key observations triggered recognition and acceptance of the new paradigm, but the necessary context was provided by scientific developments in areas mainly unrelated to diabetes. The disease paradigm established by 1976 is still widely accepted, and its essential features have been modified only in detail by the revolution in molecular biology that has occurred over the intervening period. Notwithstanding, some of the underlying assumptions remain imprecise, unchallenged, or unconfirmed. Appreciation of the historical origin and subsequent evolution of these fundamental concepts could stimulate critical analysis and help prepare the way for a new paradigm.
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              Estimating Plasma Glucose from Interstitial Glucose: The Issue of Calibration Algorithms in Commercial Continuous Glucose Monitoring Devices

              Evaluation of metabolic control of diabetic people has been classically performed measuring glucose concentrations in blood samples. Due to the potential improvement it offers in diabetes care, continuous glucose monitoring (CGM) in the subcutaneous tissue is gaining popularity among both patients and physicians. However, devices for CGM measure glucose concentration in compartments other than blood, usually the interstitial space. This means that CGM need calibration against blood glucose values, and the accuracy of the estimation of blood glucose will also depend on the calibration algorithm. The complexity of the relationship between glucose dynamics in blood and the interstitial space, contrasts with the simplistic approach of calibration algorithms currently implemented in commercial CGM devices, translating in suboptimal accuracy. The present review will analyze the issue of calibration algorithms for CGM, focusing exclusively on the commercially available glucose sensors.
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                Author and article information

                Journal
                Diabet Med
                Diabet. Med
                10.1111/(ISSN)1464-5491
                DME
                Diabetic Medicine
                John Wiley and Sons Inc. (Hoboken )
                0742-3071
                1464-5491
                24 December 2015
                July 2016
                : 33
                : 7 ( doiID: 10.1111/dme.2016.33.issue-7 )
                : 998-1003
                Affiliations
                [ 1 ] School of MedicineUniversity of Otago ChristchurchNew Zealand
                [ 2 ] Department of MedicineUniversity of Otago ChristchurchNew Zealand
                [ 3 ] Canterbury District Health BoardChristchurch Diabetes Centre ChristchurchNew Zealand
                Author notes
                [*] [* ] Correspondence to: Huan Chan. E‐mail: huan.chan@ 123456cdhb.health.nz
                Article
                DME13025
                10.1111/dme.13025
                5064751
                26536491
                4c879b3c-561e-4ba7-b1c5-7ec81df360e4
                © 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 28 October 2015
                Page count
                Pages: 6
                Funding
                Funded by: Diabetes Education and Research Trust
                Categories
                Research: Care Delivery
                Research Articles
                Care Delivery
                Custom metadata
                2.0
                dme13025
                July 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:14.10.2016

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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