Falsely Elevated Glucose Concentrations in Peritoneal Dialysis Patients Using Icodextrin

Monitoring and management of hyperglycemia in patients with advanced diabetic kidney disease

Diabetes mellitus is the leading cause of end-stage renal disease, and uncontrolled hyperglycemia is directly related to the increased mortality in this setting. As kidney function decreases, it becomes more challenging to control blood glucose since the risk of hypoglycemia increases. Decreased appetite, changes in glycaemia homeostasis, along with reduced renal excretion of anti-hyperglycemic drugs tend to facilitate the occurrence of hypoglycemia, despite the paradoxical occurrence of insulin resistance in advanced kidney disease. Thus, in patients using insulin and/or oral anti-hyperglycemic agents, dynamic adjustments with drug dose reduction or drug switching are often necessary. Furthermore, in addition to consider these pharmacokinetics alterations, it is of utmost importance to choose drugs with proven cardio-renal benefits in this setting, such as sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists. In this review, we summarize the indications and contraindications, titration of doses and side effects of the available anti-hyperglycemic agents in the presence of advanced diabetic kidney disease (DKD) and dialysis, highlighting the risks and benefits of the different agents. Additionally, basic renal function assessment and monitoring of glycemic control in DKD will be evaluated in order to guide the use of drugs and define the glycemic targets to be achieved.

Comparative study of i-SENS glucometers in neonates using capillary blood samples

OBJECTIVES

The accuracy of point-of-care blood glucometers in the detection and evaluation of neonatal hypoglycemia is a concern. This study compared the performance of three i-SENS glucometers with that of the YSI 2300 STAT Plus Analyzer, which was used as a reference.

METHODS

The leftover neonatal capillary blood samples of 319 patients were used in this study. The evaluation process and accuracy performance criteria were based on the International Organization for Standardization 15197:2013 guidelines. The evaluation involved three i-SENS glucometers (BAROzen H Expert plus, CareSens PRO, and CareSens H Beat) and the ACCU-CHEK^® Inform II glucometer.

RESULTS

The accuracy evaluation yielded acceptable results as follows: a) 100 and 100% for BAROzen H Expert plus; 99.8 and 100% for CareSens PRO; 98.7%, and 97.2% for CareSens H Beat glucometers were within the range of ±0.8 mmol/L (15 mg/dL) and ±15% of the average reference values at glucose concentrations <5.55 mmol/L (100 mg/dL) and ≥5.55 mmol/L (100 mg/dL), respectively, and b) all estimated glucose values (100%) were within the zones A and B of Consensus Error Grid for all three i-SENS glucometers. There was good correlation between the glucose values estimated by the glucometers and the reference values (R>0.990).

CONCLUSIONS

This study demonstrated that i-SENS glucometers exhibit acceptable performance and can be used as effective point-of-care devices in neonates.

Glucose measurement in body fluids: A ready reckoner for clinicians

BACKGROUND AND AIMS

Blood glucose measurement is central to the diagnosis and management of patients with diabetes. Considering that a clinician relies heavily on blood (or rarely other body fluid) glucose values for decision making, an understanding of the basic aspects of glucose measurement in body fluids is necessary.

METHODS

A literature search was conducted in PubMed for articles in English on measurement of glucose in body fluids.

RESULTS

Glucose can be measured in several body fluids, namely blood, interstitial fluid, urine, cerebrospinal fluid, pleural fluid and ascitic fluid in appropriate clinical settings. For blood glucose measurement, the present-day enzymatic methods have replaced the older reducing and condensation methods on account of their better accuracy. It is important to consider preanalytical factors such as sample collection, storage and transport when analyzing a laboratory blood glucose report. The measurement of glucose in interstitial fluid using continuous glucose monitoring system (CGMS) enables better understanding of glucose trends and fluctuations. The CGMS data should be reported using standard metrics which include parameters such as mean 24-h glucose, glycemic variability and time-in, below and above range. The measurement of glucose in urine sample is rarely ever used these days and should be reserved for exceptional circumstances.

CONCLUSION

This review provides a detailed account of various aspects of glucose measurement including their evolution, pitfalls, and their utility in current clinical practice.

PQQ-GDH - Structure, function and application in bioelectrochemistry

This review summarizes the basic features of the PQQ-GDH enzyme as one of the sugar converting biocatalysts. Focus is on the membrane -bound and the soluble form. Furthermore, the main principles of enzymatic catalysis as well as studies on the physiological importance are reviewed. A short overview is given on developments in protein engineering. The major part, however, deals with the different fields of application in bioelectrochemistry. This includes approaches for enzyme-electrode communication such as direct electron transfer, mediator-based systems, redox polymers or conducting polymers and holoenzyme reconstitution, and covers applied areas such as biosensing, biofuel cells, recycling schemes, enzyme competition, light-directed sensing, switchable detection schemes, logical operations by enzyme electrodes and immune sensing.