Evaluation of a Novel Glucose Area Under the Curve (AUC) Monitoring System: Comparison with the AUC by Continuous Glucose Monitoring

Abstract

BackgroundManagement of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration.MethodsTwenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels.ResultsAUC predicted by MIET correlated well with that measured by CGM (r=0.93). Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours), indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours.ConclusionOur system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.

Comparison of Glucose Area Under the Curve Measured Using Minimally Invasive Interstitial Fluid Extraction Technology with Continuous Glucose Monitoring System in Diabetic Patients

“…The mean percentage error of the regression analysis was 19.7%. These data are consistent with those previously performed for 2 hours during OGTT or after a meal [ 13 18 19 ].…”

“…However, frequent CGM can be burdensome for patients. We have previously evaluated IG AUC for 2 to 4 hours using this system [ 11 13 18 19 ] and found that this system was useful in detecting plasma glucose excursion and peak plasma glucose levels after 75-g OGTT [ 12 18 ]. We first applied this system to measure IG AUC for 8 hours.…”

“…Evaluating blood glucose excursion using these methods may deliver helpful hints for controlling blood glucose and for deciding appropriate treatment choices for patients with diabetes mellitus. We have already shown the usefulness of the analytical measurement performance using MIET during short-term periods (0.5, 1, 2, and 4 hours) [ 11 13 18 19 ]. However, there is not enough time to assess glucose profiles and usefulness of treatment by measuring IG AUC by MIET for as long as 8 hours.…”

“…The time and magnitude of hyperglycemia is particularly difficult to point out by SMBG and HbA1c. Previous studies showed its usefulness in evaluating IG AUC for short term (2 to 4 hours) [ 13 ]. In this study, in the patients with diabetes mellitus, we investigated whether extended time (8 hours) monitoring can be useful and accurate for IG AUC measurements by MIET compared with glucose AUC using CGM as a reference during daytime and nighttime periods.…”

Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen

“…The area under the curve (AUC) of glucose levels > 180 mg/dL (AUC 180 ) and < 70 mg/dL (AUC 70 ) was represented as hyperglycemic and hypoglycemic periods, respectively. AUC t and AUC n represent the total and normal (70–180 mg/dL) AUCs for glucose levels, respectively [ 18 ]. The low blood glucose index (LBGI) and high blood glucose index (HBGI) were calculated based on glucose levels and represented the risk of hypoglycemia and hyperglycemia, respectively [ 19 ].…”