1
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Hirsch IB, Tirosh A, Navon A. Noninvasive Real-Time Glucose Monitoring Is in the Near Future. Diabetes Technol Ther 2024. [PMID: 38417015 DOI: 10.1089/dia.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: Since the introduction of continuous glucose monitoring (CGM) technology, developers have rigorously researched the feasibility of creating a noninvasive glucose monitoring device. In a recent pilot study, investigators reported a strong correlation between glucose values obtained from novel noninvasive monitoring device (GWave) values to venous and capillary glucose measurements. Research Design and Methods: We investigated whether the level of accuracy observed in the pilot study could be reproduced in a larger cohort, using a smaller third-generation manufacturable device (Gen III GWave) containing a standardized sensor chip that can be mass produced for commercial use. The evaluation assessed concordance with capillary blood glucose, reproducibility between two Gen III devices, and accuracy during insulin-induced hypoglycemia. Results: Assessment of samples from 75 subjects (type 2 diabetes, n = 6; type 1 diabetes, n = 28; nondiabetic pregnant subjects, n = 10; and nondiabetic, n = 31) showed that 97% of values were in Zone A with 3% in Zone B of the Clarke Error Grid, with a mean absolute relative difference of 6.7% from reference blood glucose. Comparison between two independent Gen III GWave devices demonstrated reproducibility between the sensors (R2 = 0.95), with 100% of values within Zone A. In the hypoglycemia assessment, measurements from the Gen III sensor tightly followed the capillary glucose measurements down to 42 mg/dL (2.3 mmol/L), whereas the CGM measurements from two different CGM only converged with the GWave and capillary glucose readings after 90 min of decreasing glucose levels. Conclusion: Our results show promise as potentially the first noninvasive technology. Future studies will focus on larger number of people in all glucose ranges. Real-time noninvasive blood glucose monitoring is possible using GWave technology.
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Affiliation(s)
- Irl B Hirsch
- UW Medicine Diabetes Institute, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Amir Tirosh
- Division of Endocrinology, Diabetes, and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Ami Navon
- Department of Immunology and Regenerative Biology, The Weizmann Institute of Science, Rehovot, Israel
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2
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Shettigar L, Sivaraman S, Rao R, Arun SA, Chopra A, Kamath SU, Rana R. Correlational analysis between salivary and blood glucose levels in individuals with and without diabetes mellitus: a cross-sectional study. Acta Odontol Scand 2024; 83:101-111. [PMID: 37823574 DOI: 10.1080/00016357.2023.2267678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To estimate the association of patient-related demographic, socioeconomic status, physical activity, stress, and dietary factors influencing the relationship between salivary and blood glucose levels in individuals with and without diabetes mellitus (DM). METHOD This cross-sectional study was conducted on 166 participants with and without DM. Saliva and blood were collected to estimate the glucose levels. Age, gender, occupation, socioeconomic and education level, BMI, hip to waist circumference, stress, dietary pattern, lifestyle, physical activity, family history of diabetes, and type of diabetes were recorded. The association of saliva to predict blood glucose levels was analysed using Spearman Rank Correlation and how these patient-related factors influence the correlation was estimated for future machine learning models. The difference in medians for various groups was calculated using the Mann-Whitney U Test or Kruskal Wallis Test. RESULTS Blood glucose level is not significantly correlated to salivary glucose level. However, a statistically significant difference in the median blood glucose levels for diabetic participants (median = 137) compared to healthy controls (p-value < .05) was noted. The correlation between blood and salivary glucose was more positive for higher levels of glucose (Spearman 0.4). Age, alcohol consumption, monthly wages, intake of vegetables, and socioeconomic status affect blood glucose levels. CONCLUSION A correlation between saliva and blood glucose levels in healthy individuals was weak. Saliva should only be used as a monitoring tool rather than a diagnostic tool and is more reliable for patients with poorly controlled diabetes mellitus.
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Affiliation(s)
- Laasya Shettigar
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sanchita Sivaraman
- UBC School of Population and Public Health, British Columbia, Vancouver, Canada
| | - Rohini Rao
- Department of Data Science and Computer Applications, Manipal Institute of Technology (MIT), Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sanjana Akhila Arun
- Department of Data Science and Computer Applications, Manipal Institute of Technology (MIT), Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Shobha U Kamath
- Department of Biochemistry, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Raju Rana
- Department of Biochemistry, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, India
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3
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Ceylan HK, Kırbay FÖ, Yazgan İ, Elibol M. A colorimetric immunoassay for the detection of human vascular endothelial growth factor 165 (VEGF 165) based on anti-VEGF-iron oxide nanoparticle conjugation. Mikrochim Acta 2024; 191:133. [PMID: 38353782 PMCID: PMC10867064 DOI: 10.1007/s00604-024-06228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Vascular endothelial growth factor (VEGF) is an indispensable element in many physiological processes, while alterations in its level in the circulating system are signs of pathology-associated diseases. Therefore, its precise and selective detection is critical for clinical applications to monitor the progression of the pathology. In this study, an optical immunoassay biosensor was developed as a model study for detecting recombinant VEGF165. The VEGF165 sample was purified from recombinant Kluyveromyces lactis GG799 yeast cells. Indirect ELISA was used during the detection, wherein iron oxide nanoparticles (FeNPs) were utilized to obtain optical signals. The FeNPs were synthesized in the presence of lactose p-amino benzoic acid (LpAB). VEGF165 antibody was conjugated to the LpAB-FeNPs through EDC/NHS chemistry to convert the iron oxide nanoparticles into VEGF165 specific probes. The specificity of the prepared system was tested in the presence of potential serum-based interferents (i.e., glucose, urea, insulin, C-reactive protein, and serum amyloid A), and validation studies were performed in a simulated serum sample. The proposed immunoassay showed a wide detection range (0.5 to 100 ng/mL) with a detection limit of 0.29 ng/mL. These results show that the developed assay could offer a sensitive, simple, specific, reliable, and high-throughput detection platform that can be used in the clinical diagnostics of VEGF.
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Affiliation(s)
- Hülya Kuduğ Ceylan
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Tokat Gaziosmanpaşa University, 60250, Tokat, Turkey.
| | - Fatma Öztürk Kırbay
- Biochemistry Department, Faculty of Science, Ege University, Bornova, 35100, Izmir, Turkey.
| | - İdris Yazgan
- Center for Biosensors and Material Science, Department of Biology, Faculty of Science and Art, Kastamonu University, 37100, Kastamonu, Turkey
| | - Murat Elibol
- Bioengineering Department, Ege University, Bornova, 35100, Izmir, Turkey
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4
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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5
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Kuznowicz M, Jędrzak A, Jesionowski T. Nature-Inspired Biomolecular Corona Based on Poly(caffeic acid) as a Low Potential and Time-Stable Glucose Biosensor. Molecules 2023; 28:7281. [PMID: 37959700 PMCID: PMC10649105 DOI: 10.3390/molecules28217281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Herein, we present a novel biosensor based on nature-inspired poly(caffeic acid) (PCA) grafted to magnetite (Fe3O4) nanoparticles with glucose oxidase (GOx) from Aspergillus niger via adsorption technique. The biomolecular corona was applied to the fabrication of a biosensor system with a screen-printed electrode (SPE). The obtained results indicated the operation of the system at a low potential (0.1 V). Then, amperometric measurements were performed to optimize conditions like various pH and temperatures. The SPE/Fe3O4@PCA-GOx biosensor presented a linear range from 0.05 mM to 25.0 mM, with a sensitivity of 1198.0 μA mM-1 cm-2 and a limit of detection of 5.23 μM, which was compared to other biosensors presented in the literature. The proposed system was selective towards various interferents (maltose, saccharose, fructose, L-cysteine, uric acid, dopamine and ascorbic acid) and shows high recovery in relation to tests on real samples, up to 10 months of work stability. Moreover, the Fe3O4@PCA-GOx biomolecular corona has been characterized using various techniques such as Fourier transform infrared spectroscopy (FTIR), high-resolution transmission electron microscopy (HRTEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS), and Bradford assay.
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Affiliation(s)
| | - Artur Jędrzak
- Faculty of Chemical Technology, Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, PL-60965 Poznan, Poland;
| | - Teofil Jesionowski
- Faculty of Chemical Technology, Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, PL-60965 Poznan, Poland;
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6
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Tanniche I, Behkam B. Engineered live bacteria as disease detection and diagnosis tools. J Biol Eng 2023; 17:65. [PMID: 37875910 PMCID: PMC10598922 DOI: 10.1186/s13036-023-00379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
Sensitive and minimally invasive medical diagnostics are essential to the early detection of diseases, monitoring their progression and response to treatment. Engineered bacteria as live sensors are being developed as a new class of biosensors for sensitive, robust, noninvasive, and in situ detection of disease onset at low cost. Akin to microrobotic systems, a combination of simple genetic rules, basic logic gates, and complex synthetic bioengineering principles are used to program bacterial vectors as living machines for detecting biomarkers of diseases, some of which cannot be detected with other sensing technologies. Bacterial whole-cell biosensors (BWCBs) can have wide-ranging functions from detection only, to detection and recording, to closed-loop detection-regulated treatment. In this review article, we first summarize the unique benefits of bacteria as living sensors. We then describe the different bacteria-based diagnosis approaches and provide examples of diagnosing various diseases and disorders. We also discuss the use of bacteria as imaging vectors for disease detection and image-guided surgery. We conclude by highlighting current challenges and opportunities for further exploration toward clinical translation of these bacteria-based systems.
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Affiliation(s)
- Imen Tanniche
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Bahareh Behkam
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, 24061, USA.
- School of Biomedical Engineered and Sciences, Virginia Tech, Blacksburg, VA, 24061, USA.
- Center for Engineered Health, Institute for Critical Technology and Applied Science, Virginia Tech, Blacksburg, VA, 24061, USA.
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7
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Hillebrandt D, Gurtoo A, Kupper T, Richards P, Schöffl V, Shah P, van der Spek R, Wallis N, Milledge J. UIAA Medical Commission Recommendations for Mountaineers, Hillwalkers, Trekkers, and Rock and Ice Climbers with Diabetes. High Alt Med Biol 2023; 24:110-126. [PMID: 30335516 PMCID: PMC10282971 DOI: 10.1089/ham.2018.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023] Open
Abstract
Hillebrandt, David, Anil Gurtoo, Thomas Kupper, Paul Richards, Volker Schöffl, Pankaj Shah, Rianne van der Spek, Nikki Wallis, and Jim Milledge. UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol. 24: 110-126.-The object of this advice article is not only to give the diabetic mountaineer general guidance but also to inform his or her medical team of practical aspects of care that may not be standard for nonmountaineers. The guidelines are produced in seven sections. The first is an introduction to the guidelines, and the second is an introduction to this medical problem and is designed to be read and understood by diabetic patients and their companions. The third section is for use in an emergency in mountains. The fourth is for rock, ice, and competition climbers operating in a less remote environment. These initial sections are deliberately written in simple language. The fifth and sixth sections are written for clinicians and those with skills to read more technical information, and the seventh looks at modern technology and its pros and cons in diabetes management in a remote area. Sections One and Two could be laminated and carried when in the mountains, giving practical advice.
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Affiliation(s)
- David Hillebrandt
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Derriton House, Holsworthy, England
| | - Anil Gurtoo
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Medicine, Lady Hardinge Medical College and Associated SSK Hospital, New Delhi, India
| | - Thomas Kupper
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
| | - Paul Richards
- Faculty of PreHospital Care, Basildon and Brentwood CCG, Essex, England
| | - Volker Schöffl
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Section Sportsmedicine, Department of Trauma and Orthopedic Surgery, Klinikum Bamberg, Bamberg, Germany
- Department of Trauma Surgery, University of Erlangen-Nuermebrg, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Pankaj Shah
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Rianne van der Spek
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Nikki Wallis
- Emergency Department, Ysbyty Gwynedd, Bangor, Wales
| | - Jim Milledge
- Union Internationale des Associations d'Alpinisme Medical Commission (UIAA MedCom), Bern, Switzerland
- Northwick Park Hospital, Harrow, United Kingdom
- Department of Medicine, Medical Research Council, United Kingdom
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8
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Twigg S, Lim S, Yoo SH, Chen L, Bao Y, Kong A, Yeoh E, Chan SP, Robles J, Mohan V, Cohen N, McGill M, Ji L. Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management. J Diabetes Sci Technol 2023:19322968231176533. [PMID: 37232515 DOI: 10.1177/19322968231176533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.
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Affiliation(s)
- Stephen Twigg
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Seung-Hyun Yoo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Liming Chen
- Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine, Affiliated Sixth People's Hospital, Shanghai, China
| | - Alice Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre and Division of Endocrinology, Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Jeremyjones Robles
- Section of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Chong Hua Hospital, Cebu, Philippines
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Neale Cohen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Margaret McGill
- Central Clinical School Faculty of Medicine and Health, Diabetes Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Linong Ji
- Peking University Diabetes Center, Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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9
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Cisuelo O, Stokes K, Oronti IB, Haleem MS, Barber TM, Weickert MO, Pecchia L, Hattersley J. Development of an artificial intelligence system to identify hypoglycaemia via ECG in adults with type 1 diabetes: protocol for data collection under controlled and free-living conditions. BMJ Open 2023; 13:e067899. [PMID: 37072364 PMCID: PMC10124264 DOI: 10.1136/bmjopen-2022-067899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Hypoglycaemia is a harmful potential complication in people with type 1 diabetes mellitus (T1DM) and can be exacerbated in patients receiving treatment, such as insulin therapies, by the very interventions aiming to achieve optimal blood glucose levels. Symptoms can vary greatly, including, but not limited to, trembling, palpitations, sweating, dry mouth, confusion, seizures, coma, brain damage or even death if untreated. A pilot study with healthy (euglycaemic) participants previously demonstrated that hypoglycaemia can be detected non-invasively with artificial intelligence (AI) using physiological signals obtained from wearable sensors. This protocol provides a methodological description of an observational study for obtaining physiological data from people with T1DM. The aim of this work is to further improve the previously developed AI model and validate its performance for glycaemic event detection in people with T1DM. Such a model could be suitable for integrating into a continuous, non-invasive, glucose monitoring system, contributing towards improving surveillance and management of blood glucose for people with diabetes. METHODS AND ANALYSIS This observational study aims to recruit 30 patients with T1DM from a diabetes outpatient clinic at the University Hospital Coventry and Warwickshire for a two-phase study. The first phase involves attending an inpatient protocol for up to 36 hours in a calorimetry room under controlled conditions, followed by a phase of free-living, for up to 3 days, in which participants will go about their normal daily activities unrestricted. Throughout the study, the participants will wear wearable sensors to measure and record physiological signals (eg, ECG and continuous glucose monitor). Data collected will be used to develop and validate an AI model using state-of-the-art deep learning methods. ETHICS AND DISSEMINATION This study has received ethical approval from National Research Ethics Service (ref: 17/NW/0277). The findings will be disseminated via peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT05461144.
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Affiliation(s)
- Owain Cisuelo
- School of Engineering, University of Warwick, Coventry, UK
| | - Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | | | | | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, UK
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - John Hattersley
- School of Engineering, University of Warwick, Coventry, UK
- Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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10
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S111-S127. [PMID: 36507635 PMCID: PMC9810474 DOI: 10.2337/dc23-s007] [Citation(s) in RCA: 116] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Weng H, Hettiarachchi C, Nolan C, Suominen H, Lenskiy A. Ensuring security of artificial pancreas device system using homomorphic encryption. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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12
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Tauschmann M, Forlenza G, Hood K, Cardona-Hernandez R, Giani E, Hendrieckx C, DeSalvo DJ, Laffel LM, Saboo B, Wheeler BJ, Laptev DN, Yarhere I, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes 2022; 23:1390-1405. [PMID: 36537528 PMCID: PMC10107687 DOI: 10.1111/pedi.13451] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregory Forlenza
- Pediatric Diabetes Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korey Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Elisa Giani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Daniel J DeSalvo
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lori M Laffel
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA.,Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Banshi Saboo
- Department of Diabetology, Diabetes Care and Hormone Clinic, Ambawadi, Ahmedabad, Gujarat, India
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics Department, Southern District Health Board, Dunedin, New Zealand
| | | | - Iroro Yarhere
- Endocrinology Unit, Paediatrics Department, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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González-Viveros N, Castro-Ramos J, Gómez-Gil P, Cerecedo-Núñez HH, Gutiérrez-Delgado F, Torres-Rasgado E, Pérez-Fuentes R, Flores-Guerrero JL. Quantification of glycated hemoglobin and glucose in vivo using Raman spectroscopy and artificial neural networks. Lasers Med Sci 2022; 37:3537-3549. [PMID: 36063232 PMCID: PMC9708775 DOI: 10.1007/s10103-022-03633-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/14/2022] [Indexed: 01/17/2023]
Abstract
Undiagnosed type 2 diabetes (T2D) remains a major public health concern. The global estimation of undiagnosed diabetes is about 46%, being this situation more critical in developing countries. Therefore, we proposed a non-invasive method to quantify glycated hemoglobin (HbA1c) and glucose in vivo. We developed a technique based on Raman spectroscopy, RReliefF as a feature selection method, and regression based on feed-forward artificial neural networks (FFNN). The spectra were obtained from the forearm, wrist, and index finger of 46 individuals. The use of FFNN allowed us to achieve an error in the predictive model of 0.69% for HbA1c and 30.12 mg/dL for glucose. Patients were classified according to HbA1c values into three categories: healthy, prediabetes, and T2D. The proposed method obtained a specificity and sensitivity of 87.50% and 80.77%, respectively. This work demonstrates the benefit of using artificial neural networks and feature selection techniques to enhance Raman spectra processing to determine glycated hemoglobin and glucose in patients with undiagnosed T2D.
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Affiliation(s)
- Naara González-Viveros
- Optics Coordination, National Institute of Astrophysics, Optics and Electronics (INAOE), 72840, Puebla, Mexico
| | - Jorge Castro-Ramos
- Optics Coordination, National Institute of Astrophysics, Optics and Electronics (INAOE), 72840, Puebla, Mexico
| | - Pilar Gómez-Gil
- Computer Science Coordination, National Institute of Astrophysics, Optics and Electronics (INAOE), 72840, Puebla, Mexico
| | | | | | - Enrique Torres-Rasgado
- Faculty of Medicine, Meritorious Autonomous University of Puebla (BUAP), 72589, Puebla, Mexico
| | - Ricardo Pérez-Fuentes
- Department of Chronic Disease Physiopathology, East Center of Biomedical Research, Mexican Social Security Institute (CIBIOR), 74360, Puebla, México
| | - Jose L Flores-Guerrero
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, WC1E 7HB, UK.
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14
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Hiebert K, Reich S, Allender MC. Evaluation of the Agreement Between 2 Point-Of-Care Glucometers and a Laboratory Automated Analyzer in North American Raptors. J Avian Med Surg 2022; 36:278-286. [DOI: 10.1647/21-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Parthasarathy S, Kalra S, Kurdi MS, Bajwa SJS. The battle against perioperative glycaemic control: Hard to win? Indian J Anaesth 2022; 66:753-756. [PMID: 36590185 PMCID: PMC9795503 DOI: 10.4103/ija.ija_923_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/12/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- S. Parthasarathy
- Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India,University Centre for Research and Development, Chandigarh University, Mohali, Punjab, India
| | - Madhuri S. Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India,Address for correspondence: Dr. Madhuri S. Kurdi, Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India. E-mail:
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
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16
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Albloui F, John J, Alghamdi O, Alseraye F, Alqahtani A, Tamimi W, Albloshi A, Aldakheel FM, Mateen A, Syed R. Effect of hematocrit, galactose and ascorbic acid on the blood glucose readings of three point-of-care glucometers. Scand J Clin Lab Invest 2022; 82:563-570. [PMID: 36332153 DOI: 10.1080/00365513.2022.2138779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Glucometers are commonly used in a variety of healthcare settings and use in critically ill patients should not be assumed without appropriate tool validation. The study objective was to evaluate the accuracy of three point-of-care glucometers (POCGs) to assess glucose concentration in human blood sample. The POCGs tested included three different instruments and utilized three factors (hematocrit [Hct], galactose and ascorbic acid) in glucose measurements to determine the glucometers' accuracy and compared to the reference laboratory biochemical analyzer (Cobs 8000, Roche, Basal, Switzerland). In this study, the Nova StatStrip glucometer showed no significant variation compared to the laboratory method at high glucose level with various Hct%. ACCU-Chek Inform II overestimated the glucose results at Hct 22% and underestimated at Hct 62%. The Freestyle glucometer showed lower glucose levels compared to the Cobas 8000 at Hct 62%. The ACCU-Check showed significant increase of blood glucose with low Hct% levels when compared to the laboratory method. The Freestyle showed a decreased level of glucose with high Hct 62% interference compared to the Cobas 8000. Galactose interference 100 and 200 mg/dL dramatically affected the accuracy of ACCU-Chek Inform II. Nevertheless, among all three POCGs in this study, the Nova StatStrip showed the most reliable and stable results for glucose level in the presence of interference. Especially, those in critical care units, whereas the Freestyle Precision Pro and ACCU-Chek Inform II were insufficiently accurate for critically ill patients.
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Affiliation(s)
- Fawaz Albloui
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - James John
- Department of Medical Laboratory Technology, School of Allied Health Science, Sathyabama Institute of Science and Technology, Chennai, India
| | - Osama Alghamdi
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Faisal Alseraye
- Department of Pathology and Laboratory Medicine, Kind Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Alqahtani
- Department of Pathology and Laboratory Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Waleed Tamimi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh,Saudi Arabia
| | - Abdullah Albloshi
- Department of Anatomy, College of Medicine, Al Baha University, Al Bahah, Saudi Arabia
| | - Fahad M Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ayesha Mateen
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Rabbani Syed
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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17
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Barclay K, Koysombat K, Padmagirison R, Kaplan F. Hypertriglyceridaemia in pregnancy: an unexpected diagnosis and its management. BMJ Case Rep 2022; 15:15/8/e249000. [PMID: 36038155 PMCID: PMC9438015 DOI: 10.1136/bcr-2022-249000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A woman in her 30s with gestational diabetes presented at 36 weeks’ gestation with reduced fetal movements and diminishing insulin requirements. In view of her gestation, she was induced and incidentally found to have profound hyponatraemia. Further biochemical investigations confirmed severe hypertriglyceridaemia and hypercholesterolaemia. This raises the possibility of secondary causes such as familial dysbetalipoproteinemia and polygenetic hypertriglyceridaemia. She was successfully managed by aggressive dietary modification. This involved a supervised fast followed by a fat-free diet. A fenofibrate was proposed but declined due to our patient’s wish to breastfeed. Management required considerable input from the multidisciplinary team. Treatment options to consider are aggressive dietary restriction of fat or the addition of a cholesterol-lowering medication, such as a fibrate. In refractory cases, a supervised fast may be required or, in cases where complications have arisen, apheresis. The patient and her baby made a good recovery with no long-lasting health implications.
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Affiliation(s)
- Kathryn Barclay
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
| | - Kanyada Koysombat
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
| | | | - Felicity Kaplan
- Department of Endocrinology and Diabetes Mellitus, Lister Hospital, Stevenage, UK
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18
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Adding eosinophil count to EMERALD rules predicts subarachnoid haemorrhage better in emergency department. Ir J Med Sci 2022:10.1007/s11845-022-03106-7. [PMID: 35877015 DOI: 10.1007/s11845-022-03106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) clinical decision rules can provide successful results in the differential diagnosis of non-traumatic headache. AIM The aim of this study is to investigate whether a laboratory parameter that can be added to clinical decision-making rules can better predict subarachnoid haemorrhages in patients presenting to the emergency department with headache. METHODS We conducted a retrospective cohort study between March 2017 and March 2019. Patients over the age of 18 who admitted to the emergency department with non-traumatic, acute headache last 14 days before admission and evaluated by imaging and laboratory studies were included in the study. RESULTS A total of 867 patients were included and 141 of them had SAH. In detecting the SAH, Ottawa SAH rule sensitivity (85.1%), specificity (47.1%), positive predictive value (PPV) (23.8%) and negative predictive value (NPV) (94.2%), and for EMERALD SAH, rule sensitivity (96.4%), specificity (43.2%), PPV (24.8%) and NPV (98.4%). In the regression analysis, statistically significant result was obtained to exclude the diagnosis of SAH with the decrease in the eosinophil value (cutoff < 0.085 10^3/µL, OR: 0.011, 95% CI: 0.001-0.213, p = 0.003). When eosinophil value was added to EMERALD SAH rule, it provided a 100% of sensitivity, a 38.4% of specificity, a 24% of PPV and a 100% of NPV in detecting the SAH. CONCLUSIONS EMERALD SAH rule plus eosinophil, which offers 100% sensitivity and NPV for predicting SAH in adult non-traumatic headaches, may be recommended as a successful and practical decision rule for clinical use according to the Ottawa and EMERALD SAH rule.
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19
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Radhakrishnan S, Lakshmy S, Santhosh S, Kalarikkal N, Chakraborty B, Rout CS. Recent Developments and Future Perspective on Electrochemical Glucose Sensors Based on 2D Materials. BIOSENSORS 2022; 12:bios12070467. [PMID: 35884271 PMCID: PMC9313175 DOI: 10.3390/bios12070467] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 05/09/2023]
Abstract
Diabetes is a health disorder that necessitates constant blood glucose monitoring. The industry is always interested in creating novel glucose sensor devices because of the great demand for low-cost, quick, and precise means of monitoring blood glucose levels. Electrochemical glucose sensors, among others, have been developed and are now frequently used in clinical research. Nonetheless, despite the substantial obstacles, these electrochemical glucose sensors face numerous challenges. Because of their excellent stability, vast surface area, and low cost, various types of 2D materials have been employed to produce enzymatic and nonenzymatic glucose sensing applications. This review article looks at both enzymatic and nonenzymatic glucose sensors made from 2D materials. On the other hand, we concentrated on discussing the complexities of many significant papers addressing the construction of sensors and the usage of prepared sensors so that readers might grasp the concepts underlying such devices and related detection strategies. We also discuss several tuning approaches for improving electrochemical glucose sensor performance, as well as current breakthroughs and future plans in wearable and flexible electrochemical glucose sensors based on 2D materials as well as photoelectrochemical sensors.
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Affiliation(s)
- Sithara Radhakrishnan
- Centre for Nano and Material Science, Jain University, Jain Global Campus, Jakkasandra, Ramanagara, Bangalore 562 112, Karnataka, India;
| | - Seetha Lakshmy
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
| | - Shilpa Santhosh
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
| | - Nandakumar Kalarikkal
- International and Inter University Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India; (S.L.); (S.S.); (N.K.)
- School of Pure and Applied Physics, Mahatma Gandhi University, Kottayam 686 560, Kerala, India
- School of Nanoscience and Nanotechnology, Mahatma Gandhi University, Kottayam 686 560, Kerala, India
| | - Brahmananda Chakraborty
- High Pressure and Synchroton Radiation Physics Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085, Maharashtra, India
- Homi Bhabha National Institute, Mumbai 400 094, Maharashtra, India
- Correspondence: (B.C.); or (C.S.R.)
| | - Chandra Sekhar Rout
- Centre for Nano and Material Science, Jain University, Jain Global Campus, Jakkasandra, Ramanagara, Bangalore 562 112, Karnataka, India;
- Correspondence: (B.C.); or (C.S.R.)
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20
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Microfluidic-Based Novel Optical Quantification of Red Blood Cell Concentration in Blood Flow. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9060247. [PMID: 35735490 PMCID: PMC9219653 DOI: 10.3390/bioengineering9060247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
The optical quantification of hematocrit (volumetric percentage of red blood cells) in blood flow in microfluidic systems provides enormous help in designing microfluidic biosensing platforms with enhanced sensitivity. Although several existing methods, such as centrifugation, complete blood cell count, etc., have been developed to measure the hematocrit of the blood at the sample preparation stage, these methods are impractical to measure the hematocrit in dynamic microfluidic blood flow cases. An easy-to-access optical method has emerged as a hematocrit quantification technique to address this limitation, especially for the microfluidic-based biosensing platform. A novel optical quantification method is demonstrated in this study, which can measure the hematocrit of the blood flow at a targeted location in a microchannel at any given instant. The images of the blood flow were shot using a high-speed camera through an inverted transmission microscope at various light source intensities, and the grayscale of the images was measured using an image processing code. By measuring the average grayscale of the images of blood flow at different luminous exposures, a relationship between hematocrit and grayscale has been developed. The quantification of the hematocrit in the microfluidic system can be instant and easy with this method. The innovative proposed technique has been evaluated with porcine blood samples with hematocrit ranging from 5% to 70%, flowing through 1000 µm wide and 100 µm deep microchannels. The experimental results obtained strongly supported the proposed optical technique of hematocrit measurement in microfluidic systems.
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21
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Pleus S, Freckmann G, Schauer S, Heinemann L, Ziegler R, Ji L, Mohan V, Calliari LE, Hinzmann R. Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus. Diabetes Ther 2022; 13:829-846. [PMID: 35416589 PMCID: PMC9076772 DOI: 10.1007/s13300-022-01254-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
For decades, self-monitoring of blood glucose (SMBG) has been considered a cornerstone of adequate diabetes management. Structured SMBG can follow different monitoring patterns, and it results in improved glycemic control, reduced hypoglycemia, and a better quality of life of people with diabetes. The technology, usability, and accuracy of SMBG systems have advanced markedly since their introduction a few decades ago. Current SMBG systems are small and easy to use, require small (capillary) blood sample volumes, and provide measurement results within seconds. In addition, devices are increasingly equipped with features such as connectivity to other devices and/or digital diaries and diabetes management tools. Although measurement quality can come close to or equal that of the glucose monitoring systems used by healthcare professionals, several available SMBG systems still do not meet internationally accepted accuracy standards, such as the International Organization for Standardization 15197 standard. Reports from China, India, and Brazil based on local experience suggest that in addition of the accuracy issues of SMBG systems, other obstacles also need to be overcome to optimize SMBG usage. Nonetheless, adequate usage of SMBG data is of high relevance for the management of people with type 2 diabetes mellitus.
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Affiliation(s)
- Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sebastian Schauer
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | - Linong Ji
- Peking University People's Hospital, Peking, China
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
- Madras Diabetes Research Foundation, Chennai, India
| | - Luis Eduardo Calliari
- Pediatric Endocrine Unit, Pediatric Department, Santa Casa School of Medical Department, Santa Casa School of Medical Sciences, Sao Paulo, Brazil
| | - Rolf Hinzmann
- Roche Diabetes Care GmbH, Sandhofer Straße 116, 68305, Mannheim, Germany.
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22
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Abstract
Reliable assessment of glycemia is central to the management of diabetes. The kidneys play a vital role in maintaining glucose homeostasis through glucose filtration, reabsorption, consumption, and generation. This review article highlights the role of the kidneys in glucose metabolism and discusses the benefits, pitfalls, and evidence behind the glycemic markers in patients with chronic kidney disease. We specifically highlight the role of continuous glucose monitoring as an emerging minimally invasive technique for glycemic assessment.
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Affiliation(s)
- Mohamed Hassanein
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA. .,Department of Population Health, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA. .,Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
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23
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Valero P, Salas R, Pardo F, Cornejo M, Fuentes G, Vega S, Grismaldo A, Hillebrands JL, van der Beek EM, van Goor H, Sobrevia L. Glycaemia dynamics in gestational diabetes mellitus. Biochim Biophys Acta Gen Subj 2022; 1866:130134. [PMID: 35354078 DOI: 10.1016/j.bbagen.2022.130134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 12/19/2022]
Abstract
Pregnant women may develop gestational diabetes mellitus (GDM), a disease of pregnancy characterised by maternal and fetal hyperglycaemia with hazardous consequences to the mother, the fetus, and the newborn. Maternal hyperglycaemia in GDM results in fetoplacental endothelial dysfunction. GDM-harmful effects result from chronic and short periods of hyperglycaemia. Thus, it is determinant to keep glycaemia within physiological ranges avoiding short but repetitive periods of hyper or hypoglycaemia. The variation of glycaemia over time is defined as 'glycaemia dynamics'. The latter concept regards with a variety of mechanisms and environmental conditions leading to blood glucose handling. In this review we summarized the different metrics for glycaemia dynamics derived from quantitative, plane distribution, amplitude, score values, variability estimation, and time series analysis. The potential application of the derived metrics from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in the potential alterations of pregnancy outcome in GDM are discussed.
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Affiliation(s)
- Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile.
| | - Rodrigo Salas
- Biomedical Engineering School, Engineering Faculty, Universidad de Valparaíso, Valparaíso 2362905, Chile; Instituto Milenio Intelligent Healthcare Engineering, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Metabolic Diseases Research Laboratory, Interdisciplinary Centre of Territorial Health Research (CIISTe), Biomedical Research Center (CIB), San Felipe Campus, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, San Felipe 2172972, Chile
| | - Marcelo Cornejo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta 02800, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Gonzalo Fuentes
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Sofía Vega
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil
| | - Adriana Grismaldo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, DC, Colombia
| | - Jan-Luuk Hillebrands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Eline M van der Beek
- Department of Pediatrics, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Nestlé Institute for Health Sciences, Nestlé Research, Societé des Produits de Nestlé, 1000 Lausanne 26, Switzerland
| | - Harry van Goor
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, 4029, Queensland, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León. Mexico.
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24
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Cavallari G, Mancini E. The Nephrologist's Role in the Collaborative Multi-Specialist Network Taking Care of Patients with Diabetes on Maintenance Hemodialysis: An Overview. J Clin Med 2022; 11:jcm11061521. [PMID: 35329847 PMCID: PMC8949004 DOI: 10.3390/jcm11061521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/22/2022] Open
Abstract
Diabetes mellitus is the leading cause of renal failure in incident dialysis patients in several countries around the world. The quality of life for patients with diabetes in maintenance hemodialysis (HD) treatment is in general poor due to disease complications. Nephrologists have to cope with all these problems because of the “total care model” and strive to improve their patients’ outcome. In this review, an updated overview of the aspects the nephrologist must face in the management of these patients is reported. The conventional marker of glycemic control, hemoglobin A1c (HbA1c), is unreliable. HD itself may be responsible for dangerous hypoglycemic events. New methods of glucose control could be used even during dialysis, such as a continuous glucose monitoring (CGM) device. The pharmacological control of diabetes is another complex topic. Because of the risk of hypoglycemia, insulin and other medications used to treat diabetes may need dose adjustment. The new class of antidiabetic drugs dipeptidyl peptidase 4 (DPP-4) inhibitors can safely be used in non-insulin-dependent end-stage renal disease (ESRD) patients. Nephrologists should take care to improve the hemodynamic tolerance to HD treatment, frequently compromised by the high level of ultrafiltration needed to counter high interdialytic weight gain. Kidney and pancreas transplantation, in selected patients with diabetes, is the best therapy and is the only approach able to free patients from both dialysis and insulin therapy.
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25
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Panda R, Hirolli D, Baidya DK. Point-of-care Glucose Monitoring in COVID-19 Intensive Care Unit: How's It Different? Indian J Crit Care Med 2022; 25:1465-1466. [PMID: 35027812 PMCID: PMC8693119 DOI: 10.5005/jp-journals-10071-24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Panda R, Hirolli D, Baidya DK. Point-of-care Glucose Monitoring in COVID-19 Intensive Care Unit: How's It Different? Indian J Crit Care Med 2021;25(12):1465-1466.
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Affiliation(s)
- Rajesh Panda
- Department of Anesthesiology and Critical Care, AIIMS, Bhopal, Madhya Pradesh, India
| | - Divya Hirolli
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Dalim K Baidya
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
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26
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Pullano SA, Greco M, Bianco MG, Foti D, Brunetti A, Fiorillo AS. Glucose biosensors in clinical practice: principles, limits and perspectives of currently used devices. Am J Cancer Res 2022; 12:493-511. [PMID: 34976197 PMCID: PMC8692922 DOI: 10.7150/thno.64035] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022] Open
Abstract
The demand of glucose monitoring devices and even of updated guidelines for the management of diabetic patients is dramatically increasing due to the progressive rise in the prevalence of diabetes mellitus and the need to prevent its complications. Even though the introduction of the first glucose sensor occurred decades ago, important advances both from the technological and clinical point of view have contributed to a substantial improvement in quality healthcare. This review aims to bring together purely technological and clinical aspects of interest in the field of glucose devices by proposing a roadmap in glucose monitoring and management of patients with diabetes. Also, it prospects other biological fluids to be examined as further options in diabetes care, and suggests, throughout the technology innovation process, future directions to improve the follow-up, treatment, and clinical outcomes of patients.
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Ling J, Ng JKC, Chan JCN, Chow E. Use of Continuous Glucose Monitoring in the Assessment and Management of Patients With Diabetes and Chronic Kidney Disease. Front Endocrinol (Lausanne) 2022; 13:869899. [PMID: 35528010 PMCID: PMC9074296 DOI: 10.3389/fendo.2022.869899] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
In developed countries, diabetes is the leading cause of chronic kidney disease (CKD) and accounts for 50% of incidence of end stage kidney disease. Despite declining prevalence of micro- and macrovascular complications, there are rising trends in renal replacement therapy in diabetes. Optimal glycemic control may reduce risk of progression of CKD and related death. However, assessing glycemic control in patients with advanced CKD and on dialysis (G4-5) can be challenging. Laboratory biomarkers, such as glycated haemoglobin (HbA1c), may be biased by abnormalities in blood haemoglobin, use of iron therapy and erythropoiesis-stimulating agents and chronic inflammation due to uraemia. Similarly, glycated albumin and fructosamine may be biased by abnormal protein turnover. Patients with advanced CKD exhibited heterogeneity in glycemic control ranging from severe insulin resistance to 'burnt-out' beta-cell function. They also had high risk of hypoglycaemia due to reduced renal gluconeogenesis, frequent use of insulin and dysregulation of counterregulatory hormones. Continuous glucose monitoring (CGM) systems measure glucose in interstitial fluid every few minutes and provide an alternative and more reliable method of glycemic assessment, including asymptomatic hypoglycaemia and hyperglycaemic excursions. Recent international guidelines recommended use of CGM-derived Glucose Management Index (GMI) in patients with advanced CKD although data are scarce in this population. Using CGM, patients with CKD were found to experience marked glycemic fluctuations with hypoglycemia due to loss of glucose and insulin during haemodialysis (HD) followed by hyperglycemia in the post-HD period. On the other hand, during peritoneal dialysis, patients may experience glycemic excursions with influx of glucose from dialysate solutions. These undesirable glucose exposure and variability may accelerate decline of residual renal function. Although CGM may improve the quality of glycemic monitoring and control in populations with CKD, further studies are needed to confirm the accuracy, optimal mode and frequency of CGM as well as their cost-effectiveness and user-acceptability in patients with advanced CKD and dialysis.
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Affiliation(s)
- James Ling
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Jack K. C. Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
- *Correspondence: Elaine Chow,
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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29
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Byrd M, Arneson A, Soffa D, Stewart J, Rhoads M. Human continuous glucose monitors for measurement of glucose in dairy cows. JDS COMMUNICATIONS 2022; 3:78-83. [PMID: 36340679 PMCID: PMC9623707 DOI: 10.3168/jdsc.2021-0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/15/2021] [Indexed: 06/16/2023]
Abstract
If validated for use in dairy cattle, interstitial continuous glucose monitors (CGMs) could be easily implemented, informative tools for research, clinical, and perhaps even on-farm applications. To evaluate their efficacy, 2 experiments were conducted, during which lactating Holstein cows were fit with indwelling jugular catheters, as well as FreeStyle Libre (FSL; Abbott) and Dexcom G6 (DexCom Inc.) CGMs secured either behind their polls, lateral to their ears, or beneath their pin bones on their upper rear legs. During the first experiment, blood (measured with a handheld glucometer) and interstitial glucose measurements were collected from 13 cows every 4 h for 96 h. In the second experiment, the same measurements were collected from 8 cows every 15 min for 6 h. At the mid-point of the sampling period (3 h), cows received a bolus dose of dextrose to facilitate comparisons across a broad range of glucose concentrations. Results from both experiments determined that functional longevity of the sensors was greatest for those sensors secured near the ear. Likewise, interstitial measurements from the ear sensors were most closely correlated with blood glucose concentrations (r = 0.82 and r = 0.71 for FSL ear and Dexcom G6 ear, respectively). Unfortunately, accuracy calculated as absolute relative error was low, at 60.7% or less. As a result of the low accuracy, even though both ear sensors detected an increase in glucose concentrations following the bolus dose, neither produced results exactly matching blood glucose measurements. The results of this work indicate that the FSL and Dexcom G6 CGMs are not currently capable of replacing blood-based glucose measurements.
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30
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Xu J, Suo W, Goulev Y, Sun L, Kerr L, Paulsson J, Zhang Y, Lao T. Handheld Microfluidic Filtration Platform Enables Rapid, Low-Cost, and Robust Self-Testing of SARS-CoV-2 Virus. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2104009. [PMID: 34845827 PMCID: PMC8725168 DOI: 10.1002/smll.202104009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/27/2021] [Indexed: 05/17/2023]
Abstract
Here, a novel microfluidic test kit combining ultrahigh throughput hydrodynamic filtration and sandwich immunoassay is reported. Specifically, nano and microbeads coated with two different, noncompetitive antibodies, are used to capture the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) proteins simultaneously, forming larger complexes. Microfluidic filtration discards free nanobeads but retains antigen-bridged complexes in the observation zone, where a display of red color indicates the presence of antigen in the sample. This testing platform exhibits high throughput separation (<30 s) and enrichment of antigen that exceeds the traditional lateral flow assays or microfluidic assays, with a low limit of detection (LoD) < 100 copies mL-1 . In two rounds of clinical trials conducted in December 2020 and August 2021, the assays demonstrate high sensitivities of 95.4% and 100%, respectively, which proves this microfluidic test kit is capable of detecting SARS-CoV-2 virus variants evolved over significant periods of time. Furthermore, the mass-produced chip can be fabricated at a cost of $0.98/test and the robust design allows the chip to be reused for over 50 times. All of these features make the microfluidic test kit particularly suitable for areas with inadequate medical infrastructure and a shortage of laboratory resources.
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Affiliation(s)
- Jiang Xu
- Department of Systems Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Wenhao Suo
- Department of Pathology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Youlian Goulev
- Department of Systems Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Lei Sun
- Department of Systems Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Liam Kerr
- Department of Mechanical Engineering, Center for Intelligent Machines, McGill University, Montreal, QC, H3A0C3, Canada
| | - Johan Paulsson
- Department of Systems Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Yan Zhang
- Tianjin Key Laboratory for Modern Drug Delivery and High-Efficiency, Collaborative Innovation Center of Chemical Science and Engineering, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
- Frontiers Science Center for Synthetic Biology (Ministry of Education), Tianjin University, Tianjin, 300072, China
| | - Taotao Lao
- Boston Molecules Inc., 564 Main Street, Waltham, MA 02452, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02114, USA
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31
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Aitchison RT, Kennedy GJ, Shu X, Mansfield DC, Kir R, Hui J, Shahani U. Measuring the foveal avascular zone in diabetes: A study using optical coherence tomography angiography. J Diabetes Investig 2021; 13:668-676. [PMID: 34783201 PMCID: PMC9017621 DOI: 10.1111/jdi.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 10/24/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction Diabetes is a global issue that currently affects 425 million people worldwide. One observable microvascular complication of this condition is a change in the foveal avascular zone (FAZ). In this study, we used optical coherence tomography angiography to investigate the effect of diabetes on the FAZ. Materials and Methods A total of 11 participants with diabetes and 11 participants without diabetes took part in this study. Participants in both groups were matched for age (P = 0.217) and sex (P = 0.338), and had no history of ocular disease. Macular optical coherence tomography angiography (OCT‐A) scans of participants’ right and left eyes were taken. Glycosylated hemoglobin (HbA1c) and blood glucose levels were also measured. The FAZ area was manually segmented at the levels of the superficial capillary plexus (FAZSCP) and deep capillary plexus (FAZDCP). Results There was a strong relationship between the FAZ area of participants’ right and left eyes (P ≤ 0.001) in both diabetes and non‐diabetes groups. In the diabetes group, the FAZSCP (P = 0.047) and FAZDCP (P = 0.011) areas was significantly larger than in the non‐diabetes group. Moreover, multiple linear regression analysis predicted a 0.07‐mm2 increase in the FAZSCP and FAZDCP areas of individuals with diabetes for every 1% increase in their HbA1c level. Conclusions Our findings show that there is enlargement of the FAZ in individuals with diabetes compared with individuals without diabetes. In the diabetes group, this enlargement appears to be correlated with HbA1c level. OCT‐A imaging could, therefore, be a useful tool to monitor the FAZ and identify potential early microvasculopathy in diabetes.
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Affiliation(s)
- Ross T Aitchison
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Graeme J Kennedy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Xinhua Shu
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - David C Mansfield
- Department of Ophthalmology, Inverclyde Royal Hospital, Greenock, UK
| | - Rachel Kir
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jasmine Hui
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Uma Shahani
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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32
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Wang LR, Morein J, McCudden C, Sorisky A. Artifactual hypoglycemia in a patient with sickle cell anemia. CMAJ 2021; 193:E1660-E1662. [PMID: 34725113 PMCID: PMC8565976 DOI: 10.1503/cmaj.210191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Linda R Wang
- Division of Endocrinology and Metabolism, Department of Medicine (Wang, Morein, Sorisky), The Ottawa Hospital and University of Ottawa; Department of Pathology and Laboratory Medicine (McCudden), The Ottawa Hospital and University of Ottawa; Eastern Ontario Regional Laboratory Association (McCudden); Ottawa Hospital Research Institute (Sorisky), The Ottawa Hospital, Ottawa, Ont
| | - Justin Morein
- Division of Endocrinology and Metabolism, Department of Medicine (Wang, Morein, Sorisky), The Ottawa Hospital and University of Ottawa; Department of Pathology and Laboratory Medicine (McCudden), The Ottawa Hospital and University of Ottawa; Eastern Ontario Regional Laboratory Association (McCudden); Ottawa Hospital Research Institute (Sorisky), The Ottawa Hospital, Ottawa, Ont
| | - Christopher McCudden
- Division of Endocrinology and Metabolism, Department of Medicine (Wang, Morein, Sorisky), The Ottawa Hospital and University of Ottawa; Department of Pathology and Laboratory Medicine (McCudden), The Ottawa Hospital and University of Ottawa; Eastern Ontario Regional Laboratory Association (McCudden); Ottawa Hospital Research Institute (Sorisky), The Ottawa Hospital, Ottawa, Ont
| | - Alexander Sorisky
- Division of Endocrinology and Metabolism, Department of Medicine (Wang, Morein, Sorisky), The Ottawa Hospital and University of Ottawa; Department of Pathology and Laboratory Medicine (McCudden), The Ottawa Hospital and University of Ottawa; Eastern Ontario Regional Laboratory Association (McCudden); Ottawa Hospital Research Institute (Sorisky), The Ottawa Hospital, Ottawa, Ont.
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33
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Ward HJ, Ward RA, Lawrence NS, Wadhawan JD. Unravelling the Occurrence of Mediator‐Blood Protein Interactions via the Redox Catalysis of the Physiological Gasotransmitter Hydrogen Sulfide. ChemistrySelect 2021. [DOI: 10.1002/slct.202102974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Haydn J. Ward
- Department of Chemistry The University of Hull Cottingham Road Kingston-upon-Hull HU6 7RX United Kingdom
| | - Rhys A. Ward
- Department of Chemical Engineering The University of Hull Cottingham Road Kingston-upon-Hull HU6 7RX United Kingdom
| | - Nathan S. Lawrence
- Department of Chemical Engineering The University of Hull Cottingham Road Kingston-upon-Hull HU6 7RX United Kingdom
| | - Jay D. Wadhawan
- Department of Chemistry The University of Hull Cottingham Road Kingston-upon-Hull HU6 7RX United Kingdom
- Department of Chemical Engineering The University of Hull Cottingham Road Kingston-upon-Hull HU6 7RX United Kingdom
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34
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Aun TT, Salleh NM, Ali UFM, Manan NSA. Non-Enzymatic Glucose Sensors Involving Copper: An Electrochemical Perspective. Crit Rev Anal Chem 2021; 53:537-593. [PMID: 34477020 DOI: 10.1080/10408347.2021.1967720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Non-enzymatic glucose sensors based on the use of copper and its oxides have emerged as promising candidates to replace enzymatic glucose sensors owing to their stability, ease of fabrication, and superior sensitivity. This review explains the theories of the mechanism of glucose oxidation on copper transition metal electrodes. It also presents an overview on the development of among the best non-enzymatic copper-based glucose sensors in the past 10 years. A brief description of methods, interesting findings, and important performance parameters are provided to inspire the reader and researcher to create new improvements in sensor design. Finally, several important considerations that pertain to the nano-structuring of the electrode surface is provided.
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Affiliation(s)
- Tan Tiek Aun
- Faculty of Science, Department of Chemistry, Universiti Malaya, Kuala Lumpur, Malaysia.,University Malaya Centre for Ionic Liquids (UMCiL), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noordini Mohamad Salleh
- Faculty of Science, Department of Chemistry, Universiti Malaya, Kuala Lumpur, Malaysia.,Faculty of Science, Department of Chemistry, Centre for Fundamental and Frontier Sciences in Nanostructure Self-Assembly, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Umi Fazara Md Ali
- Chemical Engineering Programme, Faculty of Chemical Engineering & Technology, Universiti Malaysia Perlis, Arau, Malaysia.,Centre of Excellence for Biomass Utilization (COEBU), Universiti Malaysia Perlis, Arau, Malaysia
| | - Ninie Suhana Abdul Manan
- Faculty of Science, Department of Chemistry, Universiti Malaya, Kuala Lumpur, Malaysia.,University Malaya Centre for Ionic Liquids (UMCiL), Universiti Malaya, Kuala Lumpur, Malaysia
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35
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Mambelli E, Cristino S, Mosconi G, Göbl C, Tura A. Flash Glucose Monitoring to Assess Glycemic Control and Variability in Hemodialysis Patients: The GIOTTO Study. Front Med (Lausanne) 2021; 8:617891. [PMID: 34395456 PMCID: PMC8360859 DOI: 10.3389/fmed.2021.617891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Flash glucose monitoring (FGM) is a technology with considerable differences compared to continuous glucose monitoring (CGM), but it has been scarcely studied in hemodialysis patients. Thus, we aimed assessing the performance of FGM in such patients by comparison to self-monitoring of blood glucose (SMBG). We will also focus on estimation of glycemic control and variability, and their relationships with parameters of glucose homeostasis. Methods: Thirty-one patients (20 with type 2 diabetes, T2DM, 11 diabetes-free, NODM) collected readings by FGM and SMBG for about 12 days on average. Readings by FGM and SMBG were compared by linear regression, Clarke error grid, and Bland-Altman analyses. Several indices of glycemic control and variability were computed. Ten patients also underwent oral glucose tolerance test (OGTT) for assessment of insulin sensitivity/resistance and insulin secretion/beta-cell function. Results: Flash glucose monitoring and SMBG readings showed very good agreement in both T2DM and NODM (on average, 97 and 99% of readings during hemodialysis in A+B Clarke regions, respectively). Some glycemic control and variability indices were similar by FGM and SMBG (p = 0.06–0.9), whereas others were different (p = 0.0001–0.03). The majority of control and variability indices were higher in T2DM than in NODM, according to both FGM and SMBG (p = 0.0005–0.03). OGTT-based insulin secretion was inversely related to some variability indices according to FGM (R < −0.72, p < 0.02). Conclusions: Based on our dataset, FGM appeared acceptable for glucose monitoring in hemodialysis patients, though partial disagreement with SMBG in glycemic control/variability assessment needs further investigations.
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Affiliation(s)
- Emanuele Mambelli
- Nephrology and Dialysis, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefania Cristino
- Nephrology and Dialysis, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giovanni Mosconi
- Nephrology and Dialysis, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Christian Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrea Tura
- CNR Institute of Neuroscience, Padova, Italy
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36
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Heifler O, Borberg E, Harpak N, Zverzhinetsky M, Krivitsky V, Gabriel I, Fourman V, Sherman D, Patolsky F. Clinic-on-a-Needle Array toward Future Minimally Invasive Wearable Artificial Pancreas Applications. ACS NANO 2021; 15:12019-12033. [PMID: 34157222 PMCID: PMC8397432 DOI: 10.1021/acsnano.1c03310] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 05/28/2023]
Abstract
In order to reduce medical facility overload due to the rise of the elderly population, modern lifestyle diseases, or pandemics, the medical industry is currently developing point-of-care and home medical device systems. Diabetes is an incurable and lifetime disease, accountable for a significant mortality and socio-economic public health burden. Thus, tight glucose control in diabetic patients, which can prevent the onset of its late complications, is of enormous importance. Despite recent advances, the current best achievable management of glucose control is still inadequate, due to several key limitations in the system components, mainly related to the reliability of sensing components, both temporally and chemically, and the integration of sensing and delivery components in a single wearable platform, which is yet to be achieved. Thus, advanced closed-loop artificial pancreas systems able to modulate insulin delivery according to the measured sensor glucose levels, independently of patient supervision, represent a key requirement of development efforts. Here, we demonstrate a minimally invasive, transdermal, multiplex, and versatile continuous metabolites monitoring system in the subcutaneous interstitial fluid space based on a chemically modified SiNW-FET nanosensor array on microneedle elements. Using this technology, ISF-borne metabolites require no extraction and are measured directly and continuously by the nanosensors. Due to their chemical sensing mechanism, the nanosensor response is only influenced by the specific metabolite of interest, and no response is observed in the presence of potential exogenous and endogenous interferents known to seriously affect the response of current electrochemical glucose detection approaches. The 2D architecture of this platform, using a single SOI substrate as a top-down multipurpose material, resulted in a standard fabricated chip with 3D functionality. After proving the ability of the system to act as a selective multimetabolites sensor, we have implemented our platform to reach our main goal for in vivo continuous glucose monitoring of healthy human subjects. Furthermore, minor adjustments to the fabrication technique allow the on-chip integration of microinjection needle elements, which can ideally be used as a drug delivery system. Preliminary experiments on a mice animal model successfully demonstrated the single-chip capability to both monitor glucose levels as well as deliver insulin. By that, we hope to provide in the future a cost-effective and reliable wearable personalized clinical tool for patients and a strong tool for research, which will be able to perform direct monitoring of clinical biomarkers in the ISF as well as synchronized transdermal drug delivery by this single-chip multifunctional platform.
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Affiliation(s)
- Omri Heifler
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ella Borberg
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nimrod Harpak
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Marina Zverzhinetsky
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Vadim Krivitsky
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Itay Gabriel
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Victor Fourman
- School
of Mechanical Engineering, the Iby and Aladar Fleischman Faculty of
Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Dov Sherman
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- School
of Mechanical Engineering, the Iby and Aladar Fleischman Faculty of
Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Fernando Patolsky
- Department
of Materials Science and Engineering, the Iby and Aladar Fleischman
Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- School
of Chemistry, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Israel
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37
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Hinzmann R, Militz D, Zima T, Špaček M, Storm H, Chapanduka Z, Hauss O. Real-world data from Europe and Africa suggest that accuracy of systems for self-monitoring of blood glucose is frequently impaired by low hematocrit. Diabetes Res Clin Pract 2021; 177:108860. [PMID: 33989667 DOI: 10.1016/j.diabres.2021.108860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS Certain systems for self-monitoring of blood glucose (SMBG) demonstrate inaccuracy at low and high hematocrit (HCT). Manufacturers define HCT ranges for accurate performance. Our objective was to assess the frequency of HCT values that can lead to clinically relevant errors. METHODS In this cross-sectional study, we collected real-world data representing over 360,000 outpatients from the Netherlands (NL), the Czech Republic (CZ), and South Africa (ZA). These were subsequently stratified by sex and age and compared to commonly specified HCT range limits, reference intervals, and data from 1780 healthy Czech subjects. RESULTS HCT values were comparably distributed in NL and CZ. Outpatients had a higher dispersion of values than healthy subjects. Low HCT values in Europe were common in age groups with a high prevalence of diabetes. All ZA age groups showed a higher prevalence of low HCT than in Europe. CONCLUSIONS Real-world data indicate that SMBG systems specified to perform only within the frequently used 30-55% HCT range would leave 3% of outpatients in Europe and 18% in South Africa at risk of false SMBG results, with individual age strata being substantially higher. This could affect their diabetes management. Adequate SMBG systems should thus be chosen.
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Affiliation(s)
| | | | - Tomáš Zima
- 1st Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Špaček
- 1st Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Huib Storm
- Certe Medical Diagnostics and Advice, Leeuwarden, the Netherlands
| | - Zivanai Chapanduka
- Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Oliver Hauss
- Dr. Hauss Training & Consulting, Maxdorf, Germany
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38
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Velmurugan G, Mohanraj S, Dhivakar M, Veerasekar G, Brag-Gresham J, He K, Alexander T, Cherian M, Saran R, Pradeep T, Swaminathan K. Differential risk factor profile of diabetes and atherosclerosis in rural, sub-urban and urban regions of South India: The KMCH-Non-communicable disease studies. Diabet Med 2021; 38:e14466. [PMID: 33236348 DOI: 10.1111/dme.14466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/05/2020] [Accepted: 11/14/2020] [Indexed: 01/23/2023]
Abstract
AIMS South Asia has emerged rapidly as an epicentre of non-communicable diseases (NCDs) specifically diabetes and cardiovascular diseases. The prevalence rate, risk factors and aetiology of NCDs in different socio-demographic settings are not clearly understood. This study was performed to assess the prevalence of diabetes and atherosclerosis and their risk factors in urban, sub-urban and rural communities of South India. METHODS Three communities [Nallampatti (rural), Thadagam (sub-urban) and Kalapatti (urban)] in South India were selected for participation in the KMCH-NCD Studies. Study volunteers were administered a detailed questionnaire, underwent anthropometric measurements, clinical measurements including blood pressure, glycated haemoglobin (HbA1c ), non-fasting lipid profile and serum creatinine. Carotid intima-media thickness was measured using B-mode ultrasound. Multiple logistic regression analyses were performed to understand the association of risk factors with diabetes and atherosclerosis. RESULTS A total of 2976 native participants, ≥20 years of age were screened. The prevalence of diabetes was 16%, 26% and 23% respectively in the rural, sub-urban and urban study populations. Association of obesity with diabetes was observed in only urban population while hypertension and dyslipidaemia showed association in both urban and semi-urban populations. Association of diabetes with atherosclerosis was observed in urban and semi-urban populations. Hypertension in semi-urban and obesity and dyslipidaemia in urban population showed association with atherosclerosis. CONCLUSIONS Diabetes and atherosclerosis burden reported in the three different communities were higher than previous reports, especially in rural and sub-urban regions. No traditional risk factor is identified to be associated with prevalence of diabetes and atherosclerosis in rural population. These findings suggest an urgent need for investigation into the role of non-traditional risk factors like environmental or occupational exposures may help to better understand the aetiology of diseases in non-urbanized communities.
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Affiliation(s)
- Ganesan Velmurugan
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
- DST Unit of Nanoscience and Thematic Unit of Excellence in Water Research, Department of Chemistry, Indian Institute of Technology, Chennai, Tamilnadu, India
| | - Sundaresan Mohanraj
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
| | - Mani Dhivakar
- DST Unit of Nanoscience and Thematic Unit of Excellence in Water Research, Department of Chemistry, Indian Institute of Technology, Chennai, Tamilnadu, India
| | - Ganesh Veerasekar
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
| | - Jennifer Brag-Gresham
- Department of Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin He
- Department of Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Alexander
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
| | - Mathew Cherian
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
| | - Rajiv Saran
- Department of Internal Medicine and Molecular and Integrative Physiology, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Thalappil Pradeep
- DST Unit of Nanoscience and Thematic Unit of Excellence in Water Research, Department of Chemistry, Indian Institute of Technology, Chennai, Tamilnadu, India
| | - Krishnan Swaminathan
- KMCH Research Foundation, Kovai Medical Centre and Hospital, Coimbatore, Tamilnadu, India
- DST Unit of Nanoscience and Thematic Unit of Excellence in Water Research, Department of Chemistry, Indian Institute of Technology, Chennai, Tamilnadu, India
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Lee I, Probst D, Klonoff D, Sode K. Continuous glucose monitoring systems - Current status and future perspectives of the flagship technologies in biosensor research -. Biosens Bioelectron 2021; 181:113054. [DOI: 10.1016/j.bios.2021.113054] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022]
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Kim HN, Yoon SY. Comparative study of i-SENS glucometers in neonates using capillary blood samples. Clin Chem Lab Med 2021; 59:1133-1141. [PMID: 33915605 DOI: 10.1515/cclm-2020-1367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Ha Nui Kim
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Soo-Young Yoon
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
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Dahman LSB, Daakeek AM, Alghazali HS, Kaity AM, Obbed MS. Evaluation of the Three Glucometer Devices Performance in Comparison with the Cobas Integra 400 Plus Autoanalyzer in Measuring Blood Glucose Levels: A Comparative Cross-Sectional Study. JOURNAL OF DIABETES MELLITUS 2021; 11:132-142. [DOI: https:/doi.org/10.4236/jdm.2021.114010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
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Oparah S, Ukweh O, Ukweh I, Iya-Benson J. Undiagnosed hypertension and diabetes: concordance between self-reported and actual profile among traders in Nigerian market. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_175_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Casagrande SS, Lessem SE, Orchard TJ, Bullard KM, Geiss LS, Saydah SH, Menke A, Imperatore G, Rust KF, Cowie CC. Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes. BMJ Open Diabetes Res Care 2020; 8:8/2/e001917. [PMID: 33298431 PMCID: PMC7733112 DOI: 10.1136/bmjdrc-2020-001917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Defining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms. RESEARCH DESIGN AND METHODS This study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016-2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics. RESULTS The percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m2, respectively) and percentage using oral hypoglycemics (16.1%, 11.1%, and 19.0%, respectively) were lower than for all other algorithms assessed. Among those defined by continuous insulin use alone (algorithm 1), the estimates for mean age and age of diagnosis (54.3 and 30.9 years, respectively) and BMI (30.9 kg/m2) were higher than for other algorithms. CONCLUSIONS Estimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.
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Affiliation(s)
- Sarah S Casagrande
- Social & Scientific Systems, Public Health Research, Silver Spring, Maryland, USA
| | - Sarah E Lessem
- Division of Health Interview Statistics, National Center for Health Statistics, Hyattsville, Maryland, USA
| | - Trevor J Orchard
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda S Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon H Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andy Menke
- Social & Scientific Systems, Public Health Research, Silver Spring, Maryland, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Govind G, Akhtar MJ. Design of an ELC resonator-based reusable RF microfluidic sensor for blood glucose estimation. Sci Rep 2020; 10:18842. [PMID: 33139802 PMCID: PMC7606440 DOI: 10.1038/s41598-020-75716-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023] Open
Abstract
Design of a reusable microfluidic sensor for blood glucose estimation at microwave frequencies is presented. The sensing unit primarily comprises a complementary electric LC (CELC) resonator, which is made reusable by filling the test sample in a glass capillary before mounting it inside a groove cut in the central arm of the resonator. The use of glass capillary in the present situation to contain the blood sample actually eliminates the possibility of any direct contact of the sensor with the test sample, and hence wards off any coincidental contamination of the sensor. Usage of the capillary provides additional benefits as only microliters of the sample are required, besides offering sterile measuring environment since these capillaries are disposable. The capillary made of borosilicate glass is highly biocompatible and exhibits exceptionally high chemical resistance in corrosive environments. Apart from reusability, the novelty of the proposed sensor also lies in its enhanced sensitivity which is quite an essential factor when it comes to the measurement of glucose concentration in the human physiological range. The applicability of the proposed scheme for glucose sensing is demonstrated by performing RF measurements of aqueous glucose solutions and goat blood samples using the fabricated sensor.
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Affiliation(s)
- Greeshmaja Govind
- Department of Electrical Engineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, 208016, India.
| | - M Jaleel Akhtar
- Department of Electrical Engineering, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, 208016, India
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Bas E. STPA methodology in a socio-technical system of monitoring and tracking diabetes mellitus. APPLIED ERGONOMICS 2020; 89:103190. [PMID: 32854823 DOI: 10.1016/j.apergo.2020.103190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 05/25/2023]
Abstract
In this paper, an adaptation of the system-theoretic process analysis (STPA) approach to a sociotechnical system of monitoring and tracking diabetes mellitus (DM) is proposed. Several human controllers such as the patient, physicians, other healthcare providers, and people in the social environment were considered in the hierarchical safety control structure. During the identification of the causal factors (causal scenarios) for the unsafe control actions of the human controllers, the three-phase approach proposed by France (2017) as well as the interaction problems between the subsystems in the hierarchical safety control structure were considered, and the implementation of the basic safety design procedure was included in the methodology for the improvement of system. A dynamic STPA methodology is also proposed as an extension to the basic methodology.
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Affiliation(s)
- Esra Bas
- Istanbul Technical University, Department of Industrial Engineering, Macka, 34367, Istanbul, Turkey.
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Baines CR, Cooper PD, O'Rourke GA, Miller C. Evaluation of the Abbot FreeStyle Optium Neo H blood glucose meter in the hyperbaric oxygen environment. Diving Hyperb Med 2020; 50:144-151. [PMID: 32557416 DOI: 10.28920/dhm50.2.144-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 12/06/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This study investigated the effects of hyperbaric oxygen treatment (HBOT) on the accuracy and reliability of point-of-care fingertip capillary blood glucose values in euglycaemic non-diabetic participants compared against venous serum blood glucose samples processed in an accredited pathology laboratory. METHOD Ten non-diabetic hyperbaric staff members (age 35-55 years) underwent a standard 243 kPa HBOT exposure for 95 minutes. Blood glucose levels were measured via (i) finger-prick capillary test using the FreeStyle Optium™ Neo H glucometer and (ii) venous serum test using the Cobas 6000 laboratory analyser. Samples were taken at (T1) 0 minutes (pre-HBOT), (T2) 25 minutes, and (T3) 55 minutes into HBOT. RESULTS All participants were euglycaemic at T1 (BGL 3.8-5.4 mmol·L⁻¹). The highest venous serum value was 5.90 mmol·L⁻¹ at T3 and the highest capillary value was 6.30 mmol·L⁻¹ at T1. Post hoc tests showed a statistically significant difference between the mean capillary result pre-dive (T1) and readings at T2 (P = 0.001) and T3 (P < 0.001) while differences between T2 and T3 capillary results were not statistically significant, illustrating the effect of HBOT on capillary beds. Differences in venous values across the time points were not significant. CONCLUSION Venous serum glucose samples processed in an accredited laboratory may be more consistently accurate, but capillary point-of-care testing avoids delays in sample processing and provides glucose data that are of clinical relevance. The FreeStyle Optium™ Neo H glucometer is safe to use and provides a reliable measurement of blood glucose in the HBOT environment.
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Affiliation(s)
- Carol R Baines
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Corresponding author: Carol R Baines, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Liverpool Street, Hobart, Tasmania, Australia 7000,
| | - P David Cooper
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Geraldine A O'Rourke
- Office of the Chief Nurse and Midwife, Health Professional Policy and Advisory Services, Department of Health, Tasmania, Australia
| | - Charne Miller
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia
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Inman M, Lyon AW, Lyon OAS, Lyon ME. Estimated Risk for Insulin Dose Error Among Hospital Patients Due to Glucose Meter Hematocrit Bias in 2020. Arch Pathol Lab Med 2020; 144:1204-1208. [PMID: 33002153 DOI: 10.5858/arpa.2020-0101-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. OBJECTIVE.— To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. DESIGN.— Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. RESULTS.— Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the "95% within ±12%" for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. CONCLUSIONS.— The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.
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Affiliation(s)
- Mark Inman
- From the Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Inman)
| | - Andrew W Lyon
- The Department of Pathology & Laboratory Medicine, Division of Clinical Biochemistry, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada (AW Lyon, ME Lyon)
| | - Oliver A S Lyon
- School of Computing, Queen's University, Kingston, Ontario, Canada (OAS Lyon)
| | - Martha E Lyon
- The Department of Pathology & Laboratory Medicine, Division of Clinical Biochemistry, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada (AW Lyon, ME Lyon)
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Novak C, Johnson S, Rinholm G, Foulds J. A 4 year-old Girl with Diabetic Ketoacidosis and Lipemic Blood. Pediatr Rev 2020; 41:S89-S90. [PMID: 33004593 DOI: 10.1542/pir.2018-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Graeme Rinholm
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Mondal H, Mondal S. Usefulness of YouTube™ videos in training patients for blood glucose self-monitoring in current coronavirus disease-19 pandemic. INDIAN JOURNAL OF MEDICAL SCIENCES 2020. [PMCID: PMC7485635 DOI: 10.25259/ijms_150_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: During the coronavirus disease-19 pandemic, due to restricted health-care access, patients may not get hands-on training for self-monitoring of blood glucose (SMBG) from physicians. YouTube™ is a popular video-sharing web platform that can be used as a source of information for SMBG. This study aimed to assess the usefulness of YouTube™ videos on SMBG. Material and Methods: We searched the keywords “blood glucose self-monitoring,” “home blood glucose monitoring,” “blood glucose test,” and “blood sugar test” on YouTube™. The first 40 videos of each search were listed. After the two-stage screening, 49 videos were included for final data analysis. General characteristics and SMBG-specific characteristics (namely, strip handling, lancing device handling, measurement, and post- measurement action) were observed with pre-defined criteria having “yes” and “no” closed option. Data were tested statistically by the binomial test. Results: Average duration of 49 videos was 244.20 ± 72.61 s and those were online since 35.14 ± 20.52 months on YouTube™. Information about strip handling was mostly deficient, major being checking the expiry date (16.33% videos had the information). The handling of the lancing device was correct in the majority of the videos except for the disinfection of the tip of the lancing device (6.12% videos had the information). The measurement procedure was also correct in the majority of the videos except for the instruction to dry the hands (38.78% videos had the information) after washing. The post-measurement logbook entry was found in 48.98% videos. Conclusion: YouTube™ videos can be used as a potential source of information for patients’ education for SMBG. However, there are various levels of the incompleteness of the tutorials. Primary care physicians may suggest YouTube™ videos after exploring the videos and selecting the most appropriate one for their patients.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India,
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India,
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