Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico

Detalhes bibliográficos
Autor(a) principal: Hissa, Marcelo Rocha Nasser
Data de Publicação: 2021
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
Texto Completo: http://www.repositorio.ufc.br/handle/riufc/59935
Resumo: The diabetic nephropathy is considered the main cause of end-stage renal disease. Glycemic control in dialysis patients presents difficulties because both uremia and dialysis affect tissue secretion and insulin sensitivity. Studies highlight the inaccuracy of glycated hemoglobin (HbA1c), and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, Libre Flash is the most used in daily practice in Brazil in 2021, but still lacks consensus on its use in dialysis. The objective was to compare blood glucose measurements by capillary measurement to those by interstitial measurement in diabetic dialysis patients. A prospective randomized study of 3 weeks was carried out with 12 patients for digital glycemic monitoring alone and 12 for digital puncture associated with an interstitial measurement sensor. The glycemic results were compared using the body mass index (BMI), the intradialytic fluid loss and the hemoglobin values of the patients as a comparison parameter. Analyzing the capillary and interstitial measurements in the same patient, similar values were observed in the capillary and interstitial measurements at the beginning of dialysis in the first seven days (184.1 ± 69.5mg/dl and 173.1 ± 78.9mg/dl respectively, p=0.303 ), similar as well in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2mg/dl and 201.3 ± 77.0mg/dl respectively, p=0.466), in dialysis water loss less than 2 liters (185.5 ± 82.6mg/dl and 183.1 ± 94.0mg/dl respectively and p=0.805) and in hemoglobin greater than 12g/dl (152.0 ± 35.5mg/dl and 129.5 ± 47.4mg/dl respectively, p=0.016). In the correlation of the capillary measure with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. When comparing the groups, there was no difference in the initial (200.7 ± 96.4mg/dl and 209.4 ± 66.6mg/dl, respectively) and final (200.5 ± 78.6mg/dl and 204) plasma glucose levels, 5 ± 65.2mg/dl respectively). In conclusion the interstitial blood glucose measurement system is flawed, but clinical decision-making based on measured values can be done with a good safety margin.
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spelling Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialíticoValidation of the use of the flash glucose continuous monitoring system in a diabetic patient with end-stage renal disease during dialysis treatmentDiabetesGlicemiaInsulinaThe diabetic nephropathy is considered the main cause of end-stage renal disease. Glycemic control in dialysis patients presents difficulties because both uremia and dialysis affect tissue secretion and insulin sensitivity. Studies highlight the inaccuracy of glycated hemoglobin (HbA1c), and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, Libre Flash is the most used in daily practice in Brazil in 2021, but still lacks consensus on its use in dialysis. The objective was to compare blood glucose measurements by capillary measurement to those by interstitial measurement in diabetic dialysis patients. A prospective randomized study of 3 weeks was carried out with 12 patients for digital glycemic monitoring alone and 12 for digital puncture associated with an interstitial measurement sensor. The glycemic results were compared using the body mass index (BMI), the intradialytic fluid loss and the hemoglobin values of the patients as a comparison parameter. Analyzing the capillary and interstitial measurements in the same patient, similar values were observed in the capillary and interstitial measurements at the beginning of dialysis in the first seven days (184.1 ± 69.5mg/dl and 173.1 ± 78.9mg/dl respectively, p=0.303 ), similar as well in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2mg/dl and 201.3 ± 77.0mg/dl respectively, p=0.466), in dialysis water loss less than 2 liters (185.5 ± 82.6mg/dl and 183.1 ± 94.0mg/dl respectively and p=0.805) and in hemoglobin greater than 12g/dl (152.0 ± 35.5mg/dl and 129.5 ± 47.4mg/dl respectively, p=0.016). In the correlation of the capillary measure with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. When comparing the groups, there was no difference in the initial (200.7 ± 96.4mg/dl and 209.4 ± 66.6mg/dl, respectively) and final (200.5 ± 78.6mg/dl and 204) plasma glucose levels, 5 ± 65.2mg/dl respectively). In conclusion the interstitial blood glucose measurement system is flawed, but clinical decision-making based on measured values can be done with a good safety margin.A de nefropatia diabética é considerada a principal causa de doença renal terminal. O controle glicêmico de pacientes em diálise apresenta dificuldades pois tanto a uremia quanto a diálise afetam a secreção e a sensibilidade tissular à insulina. Estudos destacam a imprecisão de hemoglobina glicada (HbA1c), e sugerem uso de monitorização contínua de glicose (CGM) como alternativa. Dos CGMs, o Libre Flash ® é o mais utilizado na prática diário no Brasil no ano de 2021, mas ainda carece de consenso sobre seu uso em diálise. Objetivou-se comparar as aferições glicêmicas por medida capilar das por medida intersticial em diabéticos dialíticos. Realizou-se um estudo prospectivo randomizado de 3 semanas com 12 pacientes para monitorização glicêmica digital isoladamente e 12 por punção digital associado ao sensor de medida intersticial. Comparou-se os resultados glicêmicos utilizando-se como parâmetro de comparação o índice de massa corpórea (IMC), a perda hídrica intradialítica e os valores de hemoglobina dos pacientes. Na análise da medida capilar com a intersticial em um mesmo paciente observaram-se valores semelhantes nas medidas capilar e intersticial do início de diálise na primeira semana (184,1 ± 69,5 mg/dl e 173,1 ± 78,9 mg/dl respectivamente, p=0,303), nos pacientes com índice de massa corpórea menor que 24,9 kg/m2 (214,2 ± 72,2 mg/dl e 201,3 ± 77,0 mg/dl respectivamente, p=0,466), perda hídrica dialítica menor que 2 litros (185,5 ± 82,6 mg/dl e 183,1 ± 94,0 mg/dl respectivamente e p=0,805) e hemoglobina maior que 12g/dl (152,0 ± 35,5 mg/dl e 129,5 ± 47,4 mg/dl respectivamente, p=0,016). Na correlação da medida capilar com o sensor intersticial observou-se que as proporções na Grade de erro Clarke da zona A, zona B, zona C, zona D e zona E foram de 62,5%, 27,1%, 0,0%, 10,4% e 0,0%, respectivamente e na Grade de erro Parkes nas zona A, zona B, zona C, zona D e zona E foram de 80,6%, 9,7%, 9,7% 0,0% e 0,0%, respectivamente. Na comparação entre os grupos não houve diferença na glicemia plasmática inicial (200,7 ± 96,4mg/dl e 209,4 ± 66,6mg/dl, respectivamente) e final (200,5 ± 78,6mg/dl e 204,5 ± 65,2mg/dl respectivamente). Concluiu-se o sistema de medição de glicemia intersticial apresenta falhas, mas a tomada de decisão clínica baseada nos valores aferidos pode ser feita com boa margem de segurança.Guimarães, Sérgio BotelhoHissa, Marcelo Rocha Nasser2021-08-12T14:26:18Z2021-08-12T14:26:18Z2021-07-23info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfHISSA, M. R .N. Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico. 2021. 72. f. Tese (Doutorado em Ciências Médico-Cirúrgicas) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2021.http://www.repositorio.ufc.br/handle/riufc/59935porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2021-08-12T14:29:31Zoai:repositorio.ufc.br:riufc/59935Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:43:37.240472Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.none.fl_str_mv Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
Validation of the use of the flash glucose continuous monitoring system in a diabetic patient with end-stage renal disease during dialysis treatment
title Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
spellingShingle Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
Hissa, Marcelo Rocha Nasser
Diabetes
Glicemia
Insulina
title_short Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
title_full Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
title_fullStr Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
title_full_unstemmed Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
title_sort Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico
author Hissa, Marcelo Rocha Nasser
author_facet Hissa, Marcelo Rocha Nasser
author_role author
dc.contributor.none.fl_str_mv Guimarães, Sérgio Botelho
dc.contributor.author.fl_str_mv Hissa, Marcelo Rocha Nasser
dc.subject.por.fl_str_mv Diabetes
Glicemia
Insulina
topic Diabetes
Glicemia
Insulina
description The diabetic nephropathy is considered the main cause of end-stage renal disease. Glycemic control in dialysis patients presents difficulties because both uremia and dialysis affect tissue secretion and insulin sensitivity. Studies highlight the inaccuracy of glycated hemoglobin (HbA1c), and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, Libre Flash is the most used in daily practice in Brazil in 2021, but still lacks consensus on its use in dialysis. The objective was to compare blood glucose measurements by capillary measurement to those by interstitial measurement in diabetic dialysis patients. A prospective randomized study of 3 weeks was carried out with 12 patients for digital glycemic monitoring alone and 12 for digital puncture associated with an interstitial measurement sensor. The glycemic results were compared using the body mass index (BMI), the intradialytic fluid loss and the hemoglobin values of the patients as a comparison parameter. Analyzing the capillary and interstitial measurements in the same patient, similar values were observed in the capillary and interstitial measurements at the beginning of dialysis in the first seven days (184.1 ± 69.5mg/dl and 173.1 ± 78.9mg/dl respectively, p=0.303 ), similar as well in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2mg/dl and 201.3 ± 77.0mg/dl respectively, p=0.466), in dialysis water loss less than 2 liters (185.5 ± 82.6mg/dl and 183.1 ± 94.0mg/dl respectively and p=0.805) and in hemoglobin greater than 12g/dl (152.0 ± 35.5mg/dl and 129.5 ± 47.4mg/dl respectively, p=0.016). In the correlation of the capillary measure with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0 %, 10.4% and 0.0% respectively and in the Parkes Error Grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. When comparing the groups, there was no difference in the initial (200.7 ± 96.4mg/dl and 209.4 ± 66.6mg/dl, respectively) and final (200.5 ± 78.6mg/dl and 204) plasma glucose levels, 5 ± 65.2mg/dl respectively). In conclusion the interstitial blood glucose measurement system is flawed, but clinical decision-making based on measured values can be done with a good safety margin.
publishDate 2021
dc.date.none.fl_str_mv 2021-08-12T14:26:18Z
2021-08-12T14:26:18Z
2021-07-23
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv HISSA, M. R .N. Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico. 2021. 72. f. Tese (Doutorado em Ciências Médico-Cirúrgicas) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2021.
http://www.repositorio.ufc.br/handle/riufc/59935
identifier_str_mv HISSA, M. R .N. Validação do uso do Sistema de monitorização contínuo de glicose flash em paciente diabético com doença renal terminal durante o tratamento dialítico. 2021. 72. f. Tese (Doutorado em Ciências Médico-Cirúrgicas) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2021.
url http://www.repositorio.ufc.br/handle/riufc/59935
dc.language.iso.fl_str_mv por
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dc.source.none.fl_str_mv reponame:Repositório Institucional da Universidade Federal do Ceará (UFC)
instname:Universidade Federal do Ceará (UFC)
instacron:UFC
instname_str Universidade Federal do Ceará (UFC)
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reponame_str Repositório Institucional da Universidade Federal do Ceará (UFC)
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repository.name.fl_str_mv Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)
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