Self-monitoring of blood glucose in type I diabetic patients: comparison with continuous microdialysis measurements of glucose in subcutaneous adipose tissue during ordinary life conditions.
OBJECTIVE
To evaluate whether frequent self-monitoring of blood glucose (SMBG) sufficiently reflects the true diurnal glucose control during ordinary daily life in type I diabetic patients.


METHODS
By using a microdialysis technique, continuous monitoring of adipose tissue glucose was performed in 24 type I diabetic patients during ambulatory conditions. A microdialysis probe was implanted subcutaneously and perfused by a portable microinfusion pump. Dialysate fractions were collected in 1- to 2-h samples during 3 consecutive days. The diurnal microdialysis glucose profiles were compared with those obtained by SMBG recordings performed seven times a day.


RESULTS
In seven patients, the SMBG profiles showed marked aberrations as compared to the continuous microdialysis glucose recordings; during the 3-day study period, 5-6 inconsistencies were registered. In only 4 patients (17%) did SMBG provide a valid reflection (0-2 inconsistencies) of the diurnal glucose profile, whereas in 13 patients the SMBG recordings paralleled the diurnal adipose tissue glucose profiles in an intermediate way (3-4 major inconsistencies). The inaccuracy of the SMBG data was due more often to the fact that wide glucose swings remained unrecognized, rather than to erroneous testing techniques (P < 0.05), and it was more evident during the night (P < 0.05).


CONCLUSIONS
In many type I diabetic patients, the true diurnal variability in glycemia is too great to be accurately reflected even by frequent self-monitoring of blood glucose.
Bolinder
J
J
Department of Medicine, Karolinska Institute, Stockholm, Sweden.
Hagström-Toft
E
E
Ungerstedt
U
U
Arner
P
P
D000273:Adipose Tissue / Q000737:chemistry*; D000328:Adult; D015190:Blood Glucose Self-Monitoring; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005947:Glucose / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors
D007328:Insulin; D005947:Glucose