TY - JOUR
T1 - Direct Evidence of Acetaminophen Interference with Subcutaneous Glucose Sensing in Humans
T2 - A Pilot Study
AU - Basu, Ananda
AU - Veettil, Sona
AU - Dyer, Roy
AU - Peyser, Thomas
AU - Basu, Rita
N1 - Funding Information:
We are deeply indebted to the research participants. Our sincere thanks to Barbara Norby, RN, and Cheryl Shonkwiler, RN, for the conduct of the studies, as well as the staff of the Mayo Clinic Center for Translational Science Activities Clinical Trials Research Unit, Pamela Reich (research assistant), Michael Slama, and Brent McConahey (both research technologists). All persons mentioned above are at the Endocrine Research Unit, Mayo Clinic, Rochester, MN. The work was supported by funding from the JDRF to R.B., grants DK29953 and DK90541 to R.B. and grants DK085516 and DK DP3 094331 to A.B. from the National Institutes of Health, and grant UL1 TR000135 from the National Center for Advancing Translational Science, a component of the National Institutes of Health.
Publisher Copyright:
© Copyright 2016, Mary Ann Liebert, Inc. 2016.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background: Recent advances in accuracy and reliability of continuous glucose monitoring (CGM) devices have focused renewed interest on the use of such technology for therapeutic dosing of insulin without the need for independent confirmatory blood glucose meter measurements. An important issue that remains is the susceptibility of CGM devices to erroneous readings in the presence of common pharmacologic interferences. We report on a new method of assessing CGM sensor error to pharmacologic interferences using the example of oral administration of acetaminophen. Materials and Methods: We examined the responses of several different Food and Drug Administration-approved and commercially available CGM systems (Dexcom [San Diego, CA] Seven® Plus™, Medtronic Diabetes [Northridge, CA] Guardian®, and Dexcom G4® Platinum) to oral acetaminophen in 10 healthy volunteers without diabetes. Microdialysis catheters were placed in the abdominal subcutaneous tissue. Blood and microdialysate samples were collected periodically and analyzed for glucose and acetaminophen concentrations before and after oral ingestion of 1 g of acetaminophen. We compared the response of CGM sensors with the measured acetaminophen concentrations in the blood and interstitial fluid. Results: Although plasma glucose concentrations remained constant at approximately 90 mg/dL (approximately 5 mM) throughout the study, CGM glucose measurements varied between approximately 85 to 400 mg/dL (from approximately 5 to 22 mM) due to interference from the acetaminophen. The temporal profile of CGM interference followed acetaminophen concentrations measured in interstitial fluid (ISF). Conclusions: This is the first direct measurement of ISF concentrations of putative CGM interferences with simultaneous measurements of CGM performance in the presence of the interferences. The observed interference with glucose measurements in the tested CGM devices coincided temporally with appearance of acetaminophen in the ISF. The method applied here can be used to determine the susceptibility of current and future CGM systems to interference from acetaminophen or other exogenous pharmacologic agents.
AB - Background: Recent advances in accuracy and reliability of continuous glucose monitoring (CGM) devices have focused renewed interest on the use of such technology for therapeutic dosing of insulin without the need for independent confirmatory blood glucose meter measurements. An important issue that remains is the susceptibility of CGM devices to erroneous readings in the presence of common pharmacologic interferences. We report on a new method of assessing CGM sensor error to pharmacologic interferences using the example of oral administration of acetaminophen. Materials and Methods: We examined the responses of several different Food and Drug Administration-approved and commercially available CGM systems (Dexcom [San Diego, CA] Seven® Plus™, Medtronic Diabetes [Northridge, CA] Guardian®, and Dexcom G4® Platinum) to oral acetaminophen in 10 healthy volunteers without diabetes. Microdialysis catheters were placed in the abdominal subcutaneous tissue. Blood and microdialysate samples were collected periodically and analyzed for glucose and acetaminophen concentrations before and after oral ingestion of 1 g of acetaminophen. We compared the response of CGM sensors with the measured acetaminophen concentrations in the blood and interstitial fluid. Results: Although plasma glucose concentrations remained constant at approximately 90 mg/dL (approximately 5 mM) throughout the study, CGM glucose measurements varied between approximately 85 to 400 mg/dL (from approximately 5 to 22 mM) due to interference from the acetaminophen. The temporal profile of CGM interference followed acetaminophen concentrations measured in interstitial fluid (ISF). Conclusions: This is the first direct measurement of ISF concentrations of putative CGM interferences with simultaneous measurements of CGM performance in the presence of the interferences. The observed interference with glucose measurements in the tested CGM devices coincided temporally with appearance of acetaminophen in the ISF. The method applied here can be used to determine the susceptibility of current and future CGM systems to interference from acetaminophen or other exogenous pharmacologic agents.
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U2 - 10.1089/dia.2015.0410
DO - 10.1089/dia.2015.0410
M3 - Article
C2 - 26784129
AN - SCOPUS:84955312457
SN - 1520-9156
VL - 18
SP - S243-S247
JO - Diabetes Technology and Therapeutics
JF - Diabetes Technology and Therapeutics
IS - S2
ER -