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Park S, Nam DY, Jeon HJ, Han JH, Jang D, Hwang J, Park YS, Han YG, Choy YB, Lee DY. Chromophoric cerium oxide nanoparticle-loaded sucking disk-type strip sensor for optical measurement of glucose in tear fluid. Biomater Res 2023; 27:135. [PMID: 38111009 PMCID: PMC10729336 DOI: 10.1186/s40824-023-00469-5] [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: 08/24/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Noninvasive monitoring of tear glucose levels can be convenient for patients to manage their diabetes mellitus. However, there are issues with monitoring tear glucose levels, such as the invasiveness of some methods, the miniaturization, inaccuracy, or the high cost of wearable devices. To overcome the issues, we newly designed a sucking disk-type (SD) strip biosensor that can quickly suck tear fluid and contains cerium oxide nanoparticle (CNP) that causes a unique color change according to the glucose level of the tear without complicated electronic components. METHODS The SD strip biosensor composed of three distinct parts (tip, channel, and reaction chamber) was designed to contain the sensing paper, onto which tear fluid can be collected and delivered. The sensing paper treated with CNP/APTS (aminopropyltriethoxysilane) /GOx (glucose oxidase) was characterized. Then we carried out the reliability of the SD strip biosensor in the diabetic rabbit animals. We quantitatively analyzed the color values of the SD strip biosensor through the colorimetric analysis algorithm. RESULTS We contacted the inferior palpebral conjunctiva (IPC) of a diabetic rabbit eye using an SD strip biosensor to collect tears without eye irritation and successfully verified the performance and quantitative efficacy of the sensor. An image processing algorithm that can optimize measurement accuracy is developed for accurate color change measurement of SD strip biosensors. The validation tests show a good correlation between glucose concentrations measured in the tear and blood. CONCLUSION Our findings demonstrate that the CNP-embedded SD strip biosensor and the associated image processing can simply monitor tear glucose to manage diabetes mellitus.
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Affiliation(s)
- Sijin Park
- Department of Bioengineering, College of Engineering, and BK FOUR Biopharmaceutical Innovation Leader for Education and Research Group, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Dong Yeon Nam
- College of Engineering, Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Hee-Jae Jeon
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1 Gangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Jae Hoon Han
- College of Engineering, Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Dawon Jang
- Department of Bioengineering, College of Engineering, and BK FOUR Biopharmaceutical Innovation Leader for Education and Research Group, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Juil Hwang
- Department of Physics, College of Natural Sciences, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Yeong-Seo Park
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1 Gangwondaehak-Gil, Chuncheon, 24341, Republic of Korea
| | - Young-Geun Han
- Department of Physics, College of Natural Sciences, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Young Bin Choy
- College of Engineering, Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro Gwanak-Gu, Seoul, 08826, Republic of Korea.
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Dong Yun Lee
- Department of Bioengineering, College of Engineering, and BK FOUR Biopharmaceutical Innovation Leader for Education and Research Group, Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea.
- Institute of Nano Science and Technology (INST) and Institute for Bioengineering and Biopharmaceutical Research (IBBR), Hanyang University, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea.
- Elixir Pharmatech Inc, 222 Wangsimni-Ro Seongdong-Gu, Seoul, 04763, Republic of Korea.
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2
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Kim SH, Park SH, Lee H. Machine learning for predicting hepatitis B or C virus infection in diabetic patients. Sci Rep 2023; 13:21518. [PMID: 38057379 PMCID: PMC10700585 DOI: 10.1038/s41598-023-49046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Highly prevalent hepatitis B and hepatitis C virus (HBV and HCV) infections have been reported among individuals with diabetes. Given the frequently asymptomatic nature of hepatitis and the challenges associated with screening in some vulnerable populations such as diabetes patients, we conducted an investigation into the performance of various machine learning models for the identification of hepatitis in diabetic patients while also evaluating the significance of features. Analyzing NHANES data from 2013 to 2018, machine learning models were evaluated; random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO) along with stacked ensemble model. We performed hyperparameter tuning to improve the performance of the model, and selected important predictors using the best performance model. LASSO showed the highest predictive performance (AUC-ROC = 0.810) rather than other models. Illicit drug use, poverty, and race were highly ranked as predictive factors for developing hepatitis in diabetes patients. Our study demonstrated that a machine-learning-based model performed optimally in the detection of hepatitis among diabetes patients, achieving high performance. Furthermore, models and predictors evaluated from the current study, we expect, could be supportive information for developing screening or treatment methods for hepatitis care in diabetes patients.
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Affiliation(s)
- Sun-Hwa Kim
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - So-Hyeon Park
- Department of Clinical Medicinal Sciences, Konyang University, Nonsan, Republic of Korea
| | - Heeyoung Lee
- College of Pharmacy, Inje University, Gimhae, Republic of Korea.
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3
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Rondanelli M, Barrile GC, Cavioni A, Donati P, Genovese E, Mansueto F, Mazzola G, Patelli Z, Pirola M, Razza C, Russano S, Sivieri C, Tartara A, Valentini EM, Perna S. A Narrative Review on Strategies for the Reversion of Prediabetes to Normoglycemia: Food Pyramid, Physical Activity, and Self-Monitoring Innovative Glucose Devices. Nutrients 2023; 15:4943. [PMID: 38068801 PMCID: PMC10707766 DOI: 10.3390/nu15234943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
In 2019, "Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report" was published. This consensus report, however, did not provide an easy way to illustrate to subjects with prediabetes (SwPs) how to follow a correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of SwPs and to provide a food pyramid for this population. The pyramid built shows that everyday consumption should consist of: whole-grain bread or potatoes eaten with their skins (for fiber and magnesium) and low glycemic index carbohydrates (GI < 55%) (three portions); fruit and vegetables (5 portions), in particular, green leafy vegetables (for fiber, magnesium, and polyphenols); EVO oil (almost 8 g); nuts (30 g, in particular, pistachios and almonds); three portions of dairy products (milk/yogurt: 300-400 g/day); mineral water (almost 1, 5 L/day for calcium intake); one glass of wine (125 mL); and three cups of coffee. Weekly portions should include fish (four portions), white meat (two portions), protein plant-based food (four portions), eggs (egg portions), and red/processed meats (once/week). At the top of the pyramid, there are two pennants: a green one means that SwPs need some personalized supplementation (if daily requirements cannot be satisfied through diet, vitamin D, omega-3, and vitamin B supplements), and a red one means there are some foods and factors that are banned (simple sugar, refined carbohydrates, and a sedentary lifestyle). Three to four times a week of aerobic and resistance exercises must be performed for 30-40 min. Finally, self-monitoring innovative salivary glucose devices could contribute to the reversion of prediabetes to normoglycemia.
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Affiliation(s)
- Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Gaetan Claude Barrile
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Alessandro Cavioni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Paolo Donati
- AICUBE srl, 20090 Trezzano sul Naviglio, Italy; (P.D.); (S.R.)
| | - Elisa Genovese
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Francesca Mansueto
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Giuseppe Mazzola
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Zaira Patelli
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Martina Pirola
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Claudia Razza
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Stefano Russano
- AICUBE srl, 20090 Trezzano sul Naviglio, Italy; (P.D.); (S.R.)
| | - Claudia Sivieri
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Alice Tartara
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Eugenio Marzio Valentini
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (G.C.B.); (A.C.); (E.G.); (F.M.); (G.M.); (Z.P.); (M.P.); (C.R.); (C.S.); (A.T.); (E.M.V.)
| | - Simone Perna
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, University of Milan, 20133 Milan, Italy;
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Mosaddequr K, Rahman T. A novel multipurpose device for dataset creation and on-device immediate estimation of blood glucose level from reflection ppg. Heliyon 2023; 9:e19553. [PMID: 37810055 PMCID: PMC10558790 DOI: 10.1016/j.heliyon.2023.e19553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/01/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
We propose a completely non-invasive and highly accurate portable blood glucose estimator, which is simple hardware that anyone, regardless of their prior experience or knowledge, can use to obtain an immediate reading of their blood sugar level. Glucose levels can be monitored in real time and displayed on the device thanks to its infrared LED light source, sensor with built-in amplification unit, processing unit with blood glucose regression model, power management unit for autonomous operation, and display. The device was initially used to create a dataset of photoplethysmography (PPG) signals collected from the fingertip of 50 subjects. The extracted signal features were correlated with the subject's glucose level, which was measured at the same time using a commercial glucometer, and several regression models were constructed. The models were evaluated using signals from up to 110 subjects across three datasets, and the most optimized model was implemented in the device to predict the subject's blood glucose level solely based on PPG in real-time. The device with the built-in model has been subjected to extensive testing to gauge its efficacy. The device's clinical accuracy is encouraging. The pricey strips and needles that must be purchased along with the hardware in the conventional method will no longer be necessary with this device.
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Affiliation(s)
- Kazi Mosaddequr
- Department of Electrical & Computer Engineering, North South University, Dhaka 1229, Bangladesh
| | - Tanzilur Rahman
- Department of Electrical & Computer Engineering, North South University, Dhaka 1229, Bangladesh
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5
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Heinemann L, Nguyen KT, Xu NY, Gilbert GH, Klonoff DC. Treating an Unconscious Patient With Diabetes Wearing a Device Attached to Their Body. J Diabetes Sci Technol 2022; 16:583-586. [PMID: 35293265 PMCID: PMC9294582 DOI: 10.1177/19322968221081888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA,
USA
| | | | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula
Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow
AIMBE, Diabetes Research Institute, Mills-Peninsula Medical Center, 100 South San Mateo
Drive, Room 5147, San Mateo, CA 94401, USA.
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6
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Kimura M, Toyoda M, Saito N, Takahashi M, Isozumi K, Kato E, Kawanami D, Fukagawa M. The Importance of Patient and Family Engagement, the Needs for Self-Monitoring of Blood Glucose (SMBG) - Our Perspectives Learned Through a Story of SMBG Assistive Devices Made by a Husband of the Patient with Diabetes. Diabetes Metab Syndr Obes 2022; 15:1627-1638. [PMID: 35642182 PMCID: PMC9148577 DOI: 10.2147/dmso.s363762] [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: 03/01/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Despite some negative reports regarding the need for the self-monitoring of blood glucose (SMBG), including the issue of cost-effectiveness, there are still many users, and in diabetes treatment, which is largely dependent on the patient's self-care, SMBG remains an important tool in establishing such self-care habits, with several reports supporting this notion. In addition, devices are needed to assist in SMBG for patients with diabetes who have difficulty performing SMBG, such as the elderly or those with visual impairment. In current diabetes care, it is reported that patient-centered care that respects the preferences, needs, and values of individual patients and personalized care that consider the characteristics and comorbidities of each patient are important. Through a case study of a patient with diabetes who had difficulty performing SMBG due to visual impairment, we learned of the needs of SMBG and its assistive devices and the importance of patient and family engagement with emphasis on patient-centered and personalized care. We herein report what we learned through this case in the form of perspectives. Through this report, we hope that medical professionals involved in diabetes care will learn of the importance and needs of these issues and apply them to their actual clinical practice.
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Affiliation(s)
- Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Correspondence: Moritsugu Kimura, Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan, Tel +81-463-93-1121 (ext. 2490), Fax +81-463-91-3350, Email
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Makiko Takahashi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Konomi Isozumi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Eri Kato
- Seichi Clinic, Isehara, Kanagawa, Japan
| | - Daiji Kawanami
- Department of Endocrinology and Diabetes Mellitus, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Shang T, Zhang JY, Thomas A, Arnold MA, Vetter BN, Heinemann L, Klonoff DC. Products for Monitoring Glucose Levels in the Human Body With Noninvasive Optical, Noninvasive Fluid Sampling, or Minimally Invasive Technologies. J Diabetes Sci Technol 2022; 16:168-214. [PMID: 34120487 PMCID: PMC8721558 DOI: 10.1177/19322968211007212] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Conventional home blood glucose measurements require a sample of blood that is obtained by puncturing the skin at the fingertip. To avoid the pain associated with this procedure, there is high demand for medical products that allow glucose monitoring without blood sampling. In this review article, all such products are presented. METHODS In order to identify such products, four different sources were used: (1) PubMed, (2) Google Patents, (3) Diabetes Technology Meeting Startup Showcase participants, and (4) experts in the field of glucose monitoring. The information obtained were filtered by using two inclusion criteria: (1) regulatory clearance, and/or (2) significant coverage in Google News starting in the year 2016, unless the article indicated that the product had been discontinued. The identified bloodless monitoring products were classified into three categories: (1) noninvasive optical, (2) noninvasive fluid sampling, and (3) minimally invasive devices. RESULTS In total, 28 noninvasive optical, 6 noninvasive fluid sampling, and 31 minimally invasive glucose monitoring products were identified. Subsequently, these products were characterized according to their regulatory, technological, and consumer features. Products with regulatory clearance are described in greater detail according to their advantages and disadvantages, and with design images. CONCLUSIONS Based on favorable technological features, consumer features, and other advantages, several bloodless products are commercially available and promise to enhance diabetes management. Paths for future products are discussed with an emphasis on understanding existing barriers related to both technical and non-technical issues.
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Affiliation(s)
- Trisha Shang
- Diabetes Technology Society, Burlingame, California, USA
| | | | - Andreas Thomas
- AGDT (Working group of Diabetes Technology), Germany, Ulm, Germany
| | - Mark A. Arnold
- University of Iowa, Department of Chemistry, Iowa City, Iowa, USA
| | | | | | - David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, California, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo, California 94401, USA.
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8
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Duong Trong L, Nguyen Quang L, Hoang Anh D, Dang Tuan D, Nguyen Chi H, Nguyen Minh D. A Portable Band-shaped Bioimpedance System to Monitor the Body Fat and Fasting Glucose Level. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:54-65. [PMID: 36479359 PMCID: PMC9709820 DOI: 10.2478/joeb-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 06/17/2023]
Abstract
With better quality of life, obesity is becoming a worldwide disease due to over-eating and sedentary lifestyle. Therefore, daily monitoring of the glucose and body fat percentage (%) is vital to keep track of one's health. Currently, separated devices are required to monitor each parameter at home and some are still invasive to measure the glucose level. In this study, a portable band-shaped bioimpedance system is proposed to measure both parameters. The system is battery run with two main modules: the current source and the voltage recording, with minimal design to fit into a band of 150 mm x 40 mm in dimension. The impedance is measured at the frequency of 1 kHz at 30 kHz sampling frequency and in 1000 signal cycles to flatten noises. The final average impedance is calculated and evaluated in correlation with the body fat and the fasting glucose. The system was tested on 21 volunteers and 4 locations were picked for the impedance measurement: the arm under the triceps, the side of the belly, the back on one side and the thigh under the bicep femoris. The results show promising results with the arm being the best location for predicting the body fat (correlation coefficient: 0.89, 95% CI: 0.73-0.95), while the thigh impedance best correlated with the fasting glucose (correlation coefficient: 0.92, 95% CI: 0.81-0.97). These preliminary results indicate the feasibility and capacity of the proposed system as a home-based, portable and convenient system in monitoring the body fat and glucose. The system's performance will be verified and replicated in a future larger study.
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Affiliation(s)
- Luong Duong Trong
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Linh Nguyen Quang
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Duc Hoang Anh
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Diep Dang Tuan
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Hieu Nguyen Chi
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
| | - Duc Nguyen Minh
- School of Electrical and Electronics Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam
- School of Biomedical Engineering, University of Sydney, NSW, Australia
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9
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Han B, Liu W, Yang S, Wang S, Du J, Liu Y, Cui F. Association between self-monitoring of blood glucose and hepatitis B virus infection among people with diabetes mellitus: a cross-sectional study in Gansu Province, China. BMJ Open 2021; 11:e048463. [PMID: 34620657 PMCID: PMC8499280 DOI: 10.1136/bmjopen-2020-048463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose was to explore the association between self-monitoring of blood glucose (SMBG) and hepatitis B virus (HBV) infection among people with diabetes. DESIGN A cross-sectional comparative study. SETTING Six township hospitals in Gansu Province, China in October 2018. PARTICIPANTS 408 patients with diabetes were systematically recruited, and based on their characteristics 408 people without diabetes were randomly matched 1:1. INTERVENTIONS Venous blood was collected for HBV serological testing and blood glucose testing. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was comparison of hepatitis B surface antigen (HBsAg) positive rates between the two groups. The secondary outcome was the relationship between frequency of SMBG and HBsAg positivity. RESULTS HBsAg positive rate in people without diabetes was 2.0% and in those with diabetes was 4.2%. Whether in people without diabetes or patients with diabetes, higher frequency of SMBG was associated with higher HBsAg positive rate. Increases in the duration of diabetes were correlated with increasing rates of HBsAg. Compared with people without diabetes, logistic regression identified an association between diabetes and HBV infection (OR=2.8; 95% CI 1.0 to 7.6), but impaired fasting glucose was not (OR=2.3; 95% CI 0.5 to 9.9). CONCLUSION Routine blood glucose monitoring at home was associated with HBV infection, which meant people with diabetes may be at high risk of HBV infection. China is a country with high prevalence of both HBsAg and diabetes, and the increased risk of HBV infection in populations with diabetes needs more attention.
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Affiliation(s)
- Bingfeng Han
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Wu Liu
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shubo Yang
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
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Perez-Guzman MC, Shang T, Zhang JY, Jornsay D, Klonoff DC. Continuous Glucose Monitoring in the Hospital. Endocrinol Metab (Seoul) 2021; 36:240-255. [PMID: 33789033 PMCID: PMC8090458 DOI: 10.3803/enm.2021.201] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
Continuous glucose monitors (CGMs) have suddenly become part of routine care in many hospitals. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. The use of CGMs to automatically and remotely supplement or replace assisted monitoring of blood glucose by bedside nurses can decrease: the amount of necessary nursing exposure to COVID-19 patients with diabetes; the amount of time required for obtaining blood glucose measurements, and the amount of personal protective equipment necessary for interacting with patients during the blood glucose testing. The United States Food and Drug Administration (FDA) is now exercising enforcement discretion and not objecting to certain factory-calibrated CGMs being used in a hospital setting, both to facilitate patient care and to obtain performance data that can be used for future regulatory submissions. CGMs can be used in the hospital to decrease the frequency of fingerstick point of care capillary blood glucose testing, decrease hyperglycemic episodes, and decrease hypoglycemic episodes. Most of the research on CGMs in the hospital has focused on their accuracy and only recently outcomes data has been reported. A hospital CGM program requires cooperation of physicians, bedside nurses, diabetes educators, and hospital administrators to appropriately select and manage patients. Processes for collecting, reviewing, storing, and responding to CGM data must be established for such a program to be successful. CGM technology is advancing and we expect that CGMs will be increasingly used in the hospital for patients with diabetes.
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Affiliation(s)
- M. Citlalli Perez-Guzman
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University, Atlanta, GA,
USA
| | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA,
USA
| | | | - Donna Jornsay
- Diabetes Program, Mills-Peninsula Medical Center, Burlingame, CA,
USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA,
USA
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11
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Patel B, Priefer R. Infections associated with diabetic-care devices. Diabetes Metab Syndr 2021; 15:519-524. [PMID: 33668001 DOI: 10.1016/j.dsx.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS There are more than 463 million people living with diabetes with this number expected to increase to 700 million people by 2045. Diabetes is a risk factor for patients developing various comorbidities including, but not limited to, diabetic neuropathy, retinopathy, chronic kidney disease, vascular impediments, and infections. Due to the continuous invasiveness of monitoring and/or treatment of this disease, site for infections are elevated. METHODS Information was primarily gathered by employing various PubMed scholarly articles for real-world examples in addition to data extraction from supplementary manuscripts. Key search words employed were: diabetes, insulin site infection, lancing infections, insulin pump associated infections, and continuous glucose monitoring infections. RESULTS Diabetic care devices used for blood glucose monitoring and insulin administration are an integral part of the disease management and/or treatment in various settings including patient homes, assisted living facilities, community centers, and hospitals. These invasive devices leave a diabetic patient with a small open wound which may get infected or aid in blood borne pathogen transmission. Since diabetes itself has a morbidity and mortality burden, it is important to also study complications arising from the management of diabetes. CONCLUSION Although cases exist of infections, either by pathogen transmission or direct inoculation of the prick site, these are a very small percentage and thus should not undermine the confidence in diabetes management. This review highlights the instances of these infections and where they most often occur.
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Affiliation(s)
- Bansree Patel
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Ronny Priefer
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA.
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12
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Galindo RJ, Umpierrez GE, Rushakoff RJ, Basu A, Lohnes S, Nichols JH, Spanakis EK, Espinoza J, Palermo NE, Awadjie DG, Bak L, Buckingham B, Cook CB, Freckmann G, Heinemann L, Hovorka R, Mathioudakis N, Newman T, O’Neal DN, Rickert M, Sacks DB, Seley JJ, Wallia A, Shang T, Zhang JY, Han J, Klonoff DC. Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline. J Diabetes Sci Technol 2020; 14:1035-1064. [PMID: 32985262 PMCID: PMC7645140 DOI: 10.1177/1932296820954163] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.
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Affiliation(s)
| | | | | | - Ananda Basu
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Suzanne Lohnes
- University of California San Diego Medical Center, La Jolla, CA, USA
| | | | - Elias K. Spanakis
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, MD, USA
| | | | - Nadine E. Palermo
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Tonya Newman
- Neal, Gerber and Eisenberg LLP, Chicago, IL, USA
| | - David N. O’Neal
- University of Melbourne Department of Medicine, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | | | | | | | - Amisha Wallia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Julia Han
- Diabetes Technology Society, Burlingame, CA, USA
| | - David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 South San Mateo Drive Room 5147, San Mateo, CA 94401, USA.
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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14
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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15
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Dixit A, Miner EM, Wiehe SE, McHenry MS. Adolescent Burmese Refugees Perspectives on Determinants of Health. J Immigr Minor Health 2019; 20:370-379. [PMID: 28825219 DOI: 10.1007/s10903-017-0648-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Over 70,000 Burmese refugees have resettled in the United States in the past decade. While Burmese adolescents quickly acculturate into American society, their perspectives on health are not well-known. The purpose of this study was to identify adolescent Burmese refugee perspectives on determinants of health and health-related experiences after resettlement. In this qualitative study, Burmese adolescents took photographs depicting health-related experiences that were used as elicitation tools during focus groups. These discussions were recorded, transcribed, and analyzed for themes. Participants described positive determinants of health, including family and church. Rampant tobacco use was identified by the participants as a determinant of poor health within the Burmese community. Notably, the participants were proud to serve as liaisons within their community, despite the stressful nature of this role. Our results highlight the need to screen this population for anxiety, secondary to serving as a liaison for their community, as well as tobacco use.
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Affiliation(s)
- Avika Dixit
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Emily M Miner
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah E Wiehe
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, HS2000, Indianapolis, IN, 46202, USA
| | - Megan S McHenry
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, HS2000, Indianapolis, IN, 46202, USA.
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Increased risk of hepatitis B virus infection amongst individuals with diabetes mellitus. Biosci Rep 2019; 39:BSR20181715. [PMID: 30858308 PMCID: PMC6438870 DOI: 10.1042/bsr20181715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023] Open
Abstract
There have been reports of hepatitis B outbreaks amongst diabetics in long-term care facilities, suggesting that risk of hepatitis B virus (HBV) infection is higher in this population. However, the magnitude of the risk and the incidence of HBV infection amongst the general diabetic population in China remains unknown. Data from a cohort study conducted in Mianyang City, Sichuan Province, China, were retrospectively analyzed in order to address this question. Demographic information was collected using a custom-designed questionnaire, and blood samples were tested for HBV using ELISA. We used multivariate logistic regression to explore the relationship between HBV infection and diabetes, while adjusting for age, sex, region, medical insurance, exposure history, and HBV vaccination. During 2013-2014, a total of 189766 adults were surveyed, of which 7382 were newly infected with HBV, corresponding to an incidence of 3.89%. In this study population, there were 4982 diabetic patients and 182710 non-diabetic individuals. Amongst those with diabetes, 265 (5.32%) were newly infected with HBV. In contrast, 7038 (3.85%) in the non-diabetic population were newly infected with HBV. The relative risk (RR) of HBV infection was 43% higher amongst those diagnosed with diabetes than amongst those not diagnosed (RR 1.43, 95% confidence interval (CI) 1.26-1.63). These results suggest that the risk of HBV infection is higher amongst individuals diagnosed with diabetes mellitus in Mianyang City, Sichuan Province, China. Hepatitis B vaccination and continuous infection control practices may help to reduce HBV infection in diabetic patients, and should be considered for diabetes management.
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17
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Park JY, Kwon SK. Are there differences in hepatitis-B immunization status between diabetes and non-diabetes subjects in Korea? KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The American Diabetes Association (ADA) recommends hepatitis-B virusVIruS vaccination for unvaccinated adults with diabetes. However, the Korean Diabetes Association (KDA) did not recommend hepatitis-B vaccination for unvaccinated adults with diabetes. This study was performed to assess the differences in hepatitis-B virus antigen and antibody status between Korean patients with diabetes and those without by using national survey data. Methods We analyzed hepatitis-B virus antigen and antibody status in 9,771 South Korean people from the general population based on the Korean National Health and Nutrition Examination Survey. Diabetes patients were defined as those with a measured fasting plasma glucose over 126 mg/dL or those who had been previously diagnosed with diabetes by other health care centers. Results Subjects with diabetes accounted for 812 (8.3%) among the 9771 study subjects. The prevalence ofhepatitis-B (HBsAg) seropositive subjects was not significantly different (3.9% vs. 4.6%, P = 0.09) between subjects with diabetes and those without. The prevalence of hepatitis-B antibody (HBsAb) positive subjects and unimmunized subjects was not significantly different (55.2% vs. 58.2%, P = 0.09, 40.9% vs. 37.2%, P = 0.09) between the two groups. The prevalence of unimmunized subjects decreased by age (< 20 years 33.3 % vs. 33.0%, 20~29 years 49.1% vs. 41.2%, 30~39 years 41.9% vs. 37.7%, 40~49 years 35.1% vs. 33.5%, 50~59 years 39.0% vs. 38.0%, 60~69 years 41.2% vs. 39.8%, > 70 years 48.5% vs. 42.8%) but was not significantly different between the 2 groups. Conclusions From this study, we conclude that there are not sufficient grounds to recommend routine hepatitis-B virus vaccination for unvaccinated Korean subjects with diabetes at this point in time in Korea. Further prospective studies will be needed.
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18
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Li FF, Xie Y, Shi BY, Niu M, Guo H, Cao Y, Liu BL, Yan RN, Su XF, Wu JD, Zhang DF, Chen LM, Ma JH. The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital. Expert Rev Med Devices 2018; 15:445-451. [PMID: 29737214 DOI: 10.1080/17434440.2018.1473031] [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: 10/17/2022]
Abstract
BACKGROUND The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. METHODS The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting. RESULTS A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment. CONCLUSION Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.
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Affiliation(s)
- Feng-Fei Li
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Yun Xie
- b 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital & Tianjin Institute of Endocrinology , Tianjin Medical University , Tianjin , China
| | - Bing-Yin Shi
- c Department of Endocrinology , First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Min Niu
- d Department of Endocrinology , First Affiliated Hospital of Dalian Medical University , Dalian , China
| | - Hui Guo
- c Department of Endocrinology , First Affiliated Hospital of Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Yan Cao
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Bing-Li Liu
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Reng-Na Yan
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Xiao-Fei Su
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Jin-Dan Wu
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Dan-Feng Zhang
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
| | - Li-Ming Chen
- b 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital & Tianjin Institute of Endocrinology , Tianjin Medical University , Tianjin , China
| | - Jian-Hua Ma
- a Department of Endocrinology , Nanjing First Hospital, Nanjing Medical University , Nanjing , China
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19
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Jung DG, Jung D, Kong SH. A Lab-on-a-Chip-Based Non-Invasive Optical Sensor for Measuring Glucose in Saliva. SENSORS 2017; 17:s17112607. [PMID: 29137200 PMCID: PMC5713136 DOI: 10.3390/s17112607] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
A lab-on-a-chip (LOC)-based non-invasive optical sensor for measuring glucose in saliva was fabricated. Existing glucose sensors utilizing blood require acquisition of a blood sample by pricking the finger, which is painful and inconvenient. To overcome these limitations, we propose a non-invasive glucose sensor with LOC, micro-electro-mechanical system and optical measurement technology. The proposed sensor for measuring glucose in saliva involves pretreatment, mixing, and measurement on a single tiny chip. Saliva containing glucose and glucose oxidase for glucose oxidation are injected through Inlets 1 and 2, respectively. Next, H₂O₂ is produced by the reaction between glucose and glucose oxidase in the pretreatment part. The saliva and generated H₂O₂ are mixed with a colorizing agent injected through Inlet 3 during the mixing part and the absorbance of the colorized mixture is measured in the measurement part. The absorbance of light increases as a function of glucose concentration at a wavelength of 630 nm. To measure the absorbance of the colorized saliva, a light-emitting diode with a wavelength of 630 nm and a photodiode were used during the measurement part. As a result, the measured output current of the photodiode decreased as glucose concentration in the saliva increased.
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Affiliation(s)
- Dong Geon Jung
- Graduate School of Electronics Engineering, Kyungpook National University; Daegu 41566, Korea.
| | - Daewoong Jung
- Aircraft System Technology Group, Korea Institute of Industrial Technology (KITECH); Daegu 42994, Korea.
| | - Seong Ho Kong
- Graduate School of Electronics Engineering, Kyungpook National University; Daegu 41566, Korea.
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20
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Lin SP, Lin WY, Chang JT, Chu CF. Demonstration of disinfection procedure for the development of accurate blood glucose meters in accordance with ISO 15197:2013. PLoS One 2017; 12:e0180617. [PMID: 28683148 PMCID: PMC5500346 DOI: 10.1371/journal.pone.0180617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/18/2017] [Indexed: 11/18/2022] Open
Abstract
Despite measures to reduce disease transmission, a risk can occur when blood glucose meters (BGMs) are used on multiple individuals or by caregivers assisting a patient. The laboratory and in-clinic performance of a BGM system before and after disinfection should be demonstrated to guarantee accurate readings and reliable control of blood glucose (BG) for patients. In this study, an effective disinfection procedure, conducting wiping 10 times to assure a one minute contact time of the disinfectant on contaminated surface, was first demonstrated using test samples of the meter housing materials, including acrylonitrile butadiene styrene (ABS), polymethyl methacrylate (PMMA), and polycarbonate (PC), in accordance with ISO 15197:2013. After bench studies comprising 10,000 disinfection cycles, the elemental compositions of the disinfected ABS, PMMA, and PC samples were almost the same as in the original samples, as indicated by electron spectroscopy for chemical analysis. Subsequently, the validated disinfection procedure was then directly applied to disinfect 5 commercial BGM systems composed of ABS, PMMA, or PC to observe the effect of the validated disinfection procedure on meter accuracy. The results of HBsAg values after treatment with HBV sera and disinfectant wipes for each material were less than the LoD of each material of 0.020 IU/mL. Before and after the multiple disinfection cycles, 900 of 900 samples (100%) were within the system accuracy requirements of ISO 15197:2013. All of the systems showed high performance before and after the series of disinfection cycles and met the ISO 15197:2013 requirements. In addition, our results demonstrated multiple cleaning and disinfection cycles that represented normal use over the lifetime of a meter of 3-5 years. Our validated cleaning and disinfection procedure can be directly applied to other registered disinfectants for cleaning commercial BGM products in the future.
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Affiliation(s)
- Shu-Ping Lin
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan R.O.C
- Research Center for Sustainable Energy and Nanotechnology, National Chung Hsing University, Taichung, Taiwan R.O.C
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21
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Rajasekaran C, Nirmala M, Jayanthi KB. Glucose monitoring system using nanopellets. IET Nanobiotechnol 2017; 11:91-95. [PMID: 28476968 DOI: 10.1049/iet-nbt.2016.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The combination of the fields of software engineering, gadgets, and science has stood out among the most revolutionary future innovations. Health issues have been the focus of various engaging and explanatory studies. One such health-related dilemma is diabetes. Diabetes at its serious stage results in impaired vision. Increase in the glucose level is a critical parameter that could result in hyperglycaemia, hypoglycaemia, massive heart attack, strokes, and aneurysms. Monitoring the glucose level in blood is one of the control measures for diabetes in the affected population. A glucose monitoring framework interminably measures and screens the glucose level in blood. A novel framework for measuring the glucose level is proposed in this study. This study employs nanopellets that evaluate the glucose level. When the glucose level increases or decreases, it is continuously recorded and displayed using a microcontroller (mixed signal processor (MSP) 430). The data are then sent to the physician through global system for mobile communication. The typical blood glucose level of human being ranges from 70 to 110 mg/dl. When the insulin level builds up to certain point, hyperglycaemia occurs. When decreases, hypoglycaemia occurs. Hyperglycaemia leads to cataracts, oedema, hypertension, polyuria, and polydipsia. Hypoglycaemia causes perplexity, energy, insensateness, coma, and death.
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Affiliation(s)
- C Rajasekaran
- Department of ECE, K S Rangasamy College of Technology, Tiruchengode, Tamil Nadu, India.
| | - Madian Nirmala
- Department of ECE, K S Rangasamy College of Technology, Tiruchengode, Tamil Nadu, India
| | - K B Jayanthi
- Department of ECE, K S Rangasamy College of Technology, Tiruchengode, Tamil Nadu, India
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22
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Zhang Y, Zhu JM, Liang YB, Chen HB, Yin SM, Chen ZC. Non-invasive blood glucose detection system based on conservation of energy method. Physiol Meas 2017; 38:325-342. [PMID: 28107204 DOI: 10.1088/1361-6579/aa50cf] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The most common method used for minimizing the occurrence of diabetes complications is frequent glucose testing to adjust the insulin dose. However, using blood glucose (BG) meters presents a risk of infection. It is of great importance to develop non-invasive BG detection techniques. To realize high-accuracy, low-cost and continuous glucose monitoring, we have developed a non-invasive BG detection system using a mixed signal processor 430 (MSP430) microcontroller. This method is based on the combination of the conservation-of-energy method with a sensor integration module, which collects physiological parameters, such as the blood oxygen saturation (SPO2), blood flow velocity and heart rate. New methods to detect the basal metabolic rate (BMR) and BV are proposed, which combine the human body heat balance and characteristic signals of photoplethysmography as well dual elastic chambers theory. Four hundred clinical trials on real-time non-invasive BG monitoring under suitable experiment conditions were performed on different individuals, including diabetic patients, senior citizens and healthy adults. A multisensory information fusion model was applied to process these samples. The algorithm (we defined it as DCBPN algorithm) applied in the model combines a decision tree and back propagation neural network, which classifies the physiological and environmental parameters into three categories, and then establishes a corresponding prediction model for the three categories. The DCBPN algorithm provides an accuracy of 88.53% in predicting the BG of new samples. Thus, this system demonstrates a great potential to reliably detect BG values in a non-invasive setting.
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Affiliation(s)
- Yang Zhang
- School of Electronic Engineer and Automatic, Guilin University of Electronic Technology, GuiLin, People's Republic of China
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Wallia A, Umpierrez GE, Nasraway SA, Klonoff DC. Round Table Discussion on Inpatient Use of Continuous Glucose Monitoring at the International Hospital Diabetes Meeting. J Diabetes Sci Technol 2016; 10:1174-81. [PMID: 27286715 PMCID: PMC5032965 DOI: 10.1177/1932296816656380] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In May 2015 the Diabetes Technology Society convened a panel of 27 experts in hospital medicine and endocrinology to discuss the current and potential future roles of continuous glucose monitoring (CGM) in delivering optimum health care to hospitalized patients in the United States. The panel focused on 3 potential settings for CGM in the hospital, including (1) the intensive care unit (ICU), (2) non-ICU, and (3) continuation of use of home CGM in the hospital. The group reviewed barriers to use and solutions to overcome the barriers. They concluded that CGM has the potential to improve the quality of patient care and can provide useful information to help health care providers learn more about glucose management. Widespread adoption of CGM by hospitals, however, has been limited by added costs and insufficient outcome data.
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Affiliation(s)
- Amisha Wallia
- Northwestern University, Feinberg School of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Chicago, IL, USA
| | | | | | - David C Klonoff
- Mills-Peninsula Health Services, Diabetes Research Institute, San Mateo, CA, USA
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Liu J, Sun S, Shang H, Lai J, Zhang L. Electrochemical Biosensor Based on Bienzyme and Carbon Nanotubes Incorporated into an Os-complex Thin Film for Continuous Glucose Detection in Human Saliva. ELECTROANAL 2016. [DOI: 10.1002/elan.201501179] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jian Liu
- Department of Biomedical Engineering, School of Control Science and Engineering; Shandong University; Jinan 250061 China
| | - Shanhui Sun
- Jinan Central Hospital Affiliated to Shandong University; Jinan 250013 China
| | - Hui Shang
- Shandong Provincial Hospital Affiliated to Shandong University; Jinan 250021 China
| | - Jiahui Lai
- Department of Biomedical Engineering, School of Control Science and Engineering; Shandong University; Jinan 250061 China
| | - Lili Zhang
- School of Mechanical and Automotive Engineering; Qilu University of Technology; Jinan 250353 China
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Aytaman A, Ojike N, Zizi S, Pandi-Perumal SR, Lukolic I, Bhanvadia A, Nwamaghinna F, Kamran H, Akivis A, Bankole O, Salifu MO, McFarlane SI. Hepatitis B Vaccination Rate in Patients with Diabetes: Assessment of Racial and Socioeconomic Disparity. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2016; 2. [PMID: 28638894 PMCID: PMC5476310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Less hygienic use of blood glucose monitoring equipment such as blood glucose meters, lancets, finger stick devices or other diabetes-care equipment such as syringes or insulin pens by self-administration often exposes the diabetic patient to Hepatitis B infection. This study evaluates hepatitis B vaccination among individuals with diabetes. METHODS The study used data from the 2000-2013 National Health Interview Survey (NHIS). Vaccination rates among adult individuals with diabetes of various ethnic backgrounds was accessed and compared using chis-square tests. Multivariable logistic regression model was used to compare factors affecting hepatitis B vaccination among individuals with diabetes. RESULTS The crude rate of diabetes in this population was 5.4%. The rate of vaccination among individuals with diabetes differed across racial groups (Asians 31.8% vs. blacks 30.7%; and whites 26.5%; p<0.01). After multivariate regression, the leading factors affecting hepatitis B vaccination included Age (40-60 years) (OR=0.51, 95% CI=0.47-0.57, p<0.01), lack of college education (OR=0.71,95% CI=0.64-0.79, p<0.01), foreign birth (OR=0.83, 95% CI=0.72-0.95, p<0.01), and Hispanic ethnicity (OR=0.88, 95% CI=0.78-1.00, P<0.05). CONCLUSION Social and economic factors-education, insurance status, age, poverty level, and place of birth affect rates of vaccination among individuals with diabetes.
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Affiliation(s)
- Ayse Aytaman
- VA NY Harbor Healthcare System, Brooklyn, NY, USA
| | - Nwakile Ojike
- Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA
| | - Samantha Zizi
- Department of Population Health, NYU School of Medicine, NYU Langone Medical Center, New York, USA
| | | | - Ismet Lukolic
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Amit Bhanvadia
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Felix Nwamaghinna
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Haroon Kamran
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Alla Akivis
- Department of Family Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Olusegun Bankole
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Moro O Salifu
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA
| | - Samy I McFarlane
- Department of Medicine, State University of New York-Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA,Corresponding author: Samy I McFarlane, MD, MPH, MBA, FACP, Distinguished Teaching Professor of Medicine, Division of Endocrinology, State University of New York-Downstate Medical Center, 450 Clarkson Avenue, Box 50, Brooklyn, NY 11203, USA,
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Hermayer KL, Loftley AS, Reddy S, Narla SN, Epps NA, Zhu Y. Challenges of inpatient blood glucose monitoring: standards, methods, and devices to measure blood glucose. Curr Diab Rep 2015; 15:10. [PMID: 25644818 DOI: 10.1007/s11892-015-0582-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Glucose control in the hospital setting is very important. There is a high incidence of hyperglycemia, hypoglycemia, and glycemic variability in hospitalized patients. Safe insulin delivery and glucose control is dependent on reliable glucose meters and monitoring systems in the hospital. Different glucose monitoring systems use arterial, venous, central venous, and capillary blood samples. It is important for clinicians to be aware that there are limitations of specific point-of-care (POC) glucose meters and that situations exist whereby POC glucose meters as the sole measurement device should be avoided. POC meter devices are not approved by the Food and Drug Administration for use in critical care, although POC meter devices are commonly used in critical care settings and elsewhere. This review focuses on glucose assay principles, instrument technology, influences on glucose measurement, standards for glucose measurement, and an evaluation of different methods to measure blood glucose in the hospital setting.
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Affiliation(s)
- Kathie L Hermayer
- Division of Endocrinology, Diabetes, and Medical Genetics, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 624, Charleston, SC, 29425, USA,
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Kossover RA, Chi CJ, Wise ME, Tran AH, Chande ND, Perz JF. Infection prevention and control standards in assisted living facilities: are residents' needs being met? J Am Med Dir Assoc 2013; 15:47-53. [PMID: 24239014 DOI: 10.1016/j.jamda.2013.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/16/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. OBJECTIVES Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. METHODS We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. RESULTS Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. CONCLUSIONS There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents.
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Affiliation(s)
- Rachel A Kossover
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Carolyn J Chi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew E Wise
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alvin H Tran
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Neha D Chande
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph F Perz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Pérez-Ayala M, Oliver P, Rodríguez Cantalejo F. Prevalence of bacterial contamination of glucose test strips in individual single-use packets versus multiple-use vials. J Diabetes Sci Technol 2013; 7:854-62. [PMID: 23911166 PMCID: PMC3879749 DOI: 10.1177/193229681300700407] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glucose measurement is the cornerstone of diabetes control. In the hospital setting, the same device and package of test strips (50 or 100 strips) can be used to monitor glucose in several patients, which can increase cross contamination. The objective of our study is to measure bacterial contamination in glucose test strips, comparing results in individual single-use packets (one hospital) versus multi-use vials (two hospitals) in Spain. METHODS Test strips were collected from five different wards. Each hospital also collected two unopened vials from a single ward as controls. They were sent to a reference laboratory for microbiologic study. A number equal or higher than two colony forming units per strip was considered as a positive result. RESULTS Out of 423 glucose test strips collected and cultured, 146 were contaminated (34%); only 7% of individually packed strips were contaminated versus 45% of strips packed in multi-use vials, with a high statistical significance (p < .001). CONCLUSIONS In the strips from multi-use vials, a high contamination rate was found and highly pathogenic organisms were identified, such as methicillin-resistant Staphylococcus epidermidis or Staphylococcus hemolyticus. In contrast, in strips packed individually, there was a much lower contamination rate and no such pathogen organisms were found. Therefore, in the hospital setting, the use of blood glucose test strips in individual packages would be more advantageous (mainly from a clinical point of view, but also from a financial one) than those packed in multi-use vials.
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Affiliation(s)
- Millán Pérez-Ayala
- Department of Analisis Clinicos, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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MacRury S, Srinivasan A, Mahoney JJ. Performance of a new meter designed for assisted monitoring of blood glucose and point-of-care testing. J Diabetes Sci Technol 2013; 7:389-98. [PMID: 23566997 PMCID: PMC3737640 DOI: 10.1177/193229681300700215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood glucose (BG) meters used for assisted monitoring of blood glucose (AMBG) require different attributes compared with meters designed for home use. These include safety considerations (i.e., minimized risk of blood-borne pathogen transmission), capability for testing multiple blood sample types, and enhanced performance specifications. The OneTouch® Verio™Pro+ BG meter is designed to incorporate all of these attributes. METHODS Meter accuracy was assessed in clinical studies with arterial, venous, and capillary blood samples with a hematocrit range of 22.9-59.8%. The effect of interferents, including anticoagulants, on accuracy was evaluated. The meter disinfection protocol was validated, and instructions for use and user acceptance of the system were assessed. RESULTS A total of 97% (549/566) of BG measures from all blood sample types and 95.5% (191/200) of arterial blood samples were within ±12 mg/dl or 12.5% of reference measurements. The system was unaffected by 4 anticoagulants and 57 of 59 endogenous and exogenous compounds; it was affected by 2 compounds: pralidoxime iodide and xylose. Bleach wipes were sufficient to disinfect the meter. Users felt that the meter's quality control (QC) prompts would help them to comply with regulatory requirements. CONCLUSION The meter provided accurate measurements of different blood samples over a wide hematocrit range and was not affected by 57 physiologic and therapeutic compounds. The QC prompts and specific infection-mitigating design further aid to make this meter system practical for AMBG in care facilities.
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Bender TJ, Wise ME, Utah O, Moorman AC, Sharapov U, Drobeniuc J, Khudyakov Y, Fricchione M, White-Comstock MB, Thompson ND, Patel PR. Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility-Virginia, 2010. PLoS One 2012; 7:e50012. [PMID: 23300520 PMCID: PMC3530571 DOI: 10.1371/journal.pone.0050012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 10/15/2012] [Indexed: 12/12/2022] Open
Abstract
Introduction In January 2010, the Virginia Department of Health received reports of 2 hepatitis B virus (HBV) infections (1 acute, 1 chronic) among residents of a single assisted living facility (ALF). Both infected residents had diabetes and received assisted monitoring of blood glucose (AMBG) at the facility. An investigation was initiated in response. Objective To determine the extent and mechanism of HBV transmission among ALF residents. Design Retrospective cohort study. Setting An ALF that primarily housed residents with neuropsychiatric disorders in 2 adjacent buildings in Virginia. Participants Residents of the facility as of March 2010. Measurements HBV serologic testing, relevant medical history, and HBV genome sequences. Risk ratios (RR) and 95% confidence intervals (CIs) were used to identify risk factors for HBV infection. Results HBV serologic status was determined for 126 (91%) of 139 residents. Among 88 susceptible residents, 14 became acutely infected (attack rate, 16%), and 74 remained uninfected. Acute HBV infection developed among 12 (92%) of 13 residents who received AMBG, compared with 2 (3%) of 75 residents who did not (RR = 35; 95% CI, 8.7, 137). Identified infection control breaches during AMBG included shared use of fingerstick devices for multiple residents. HBV genome sequencing demonstrated 2 building-specific phylogenetic infection clusters, each having 99.8–100% sequence identity. Limitations Transfer of residents out of the facility prior to our investigation might have contributed to an underestimate of cases. Resident interviews provided insufficient information to fully assess behavioral risk factors for HBV infection. Conclusions Failure to adhere to safe practices during AMBG resulted in a large HBV outbreak. Protection of a growing and vulnerable ALF population requires improved training of staff and routine facility licensing inspections that scrutinize infection control practices.
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Kesavadev J, Misra A, Das AK, Saboo B, Basu D, Thomas N, Joshi SR, Unnikrishnan AG, Shankar A, Krishnan G, Unnikrishnan R, Mohan V. Suggested use of vaccines in diabetes. Indian J Endocrinol Metab 2012; 16:886-93. [PMID: 23226631 PMCID: PMC3510956 DOI: 10.4103/2230-8210.102982] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Diabetes has emerged as a disease of major public health importance in India affecting the rich and the poor alike. Conventionally, comprehensive diabetes management is aimed at preventing micro and macro vascular complications. However, morbidity and mortality due to infections are also significant. In developing countries like India, the concept of adult immunization is far from reality. Recently the H1N1 pandemic has triggered the necessity for considering immunization in all age groups for the prevention of vaccine-preventable fatal infectious diseases. Considering the economics of immunization in a developing country, providing free vaccines to all adults may not be a practical solution, although the free universal immunization program for children is in existence for several decades. There is no consensus on the use of vaccines in diabetes subjects in India. However, there are some clinics offering routine pneumococcal, influenza and other vaccinations. Patients with diabetes have a deranged immune system making them more prone for infections. Hospitalization and death due to pneumococcal disease and influenza are higher in diabetes patients. They, like other healthy individuals, have a normal humoral response to vaccination with clinically significant benefits. The American Diabetes Association, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, World Health Organization, United Kingdom Guidelines and a number of other scientific organizations have well defined guidelines for vaccination in diabetes. In this article we make some suggestions for clinicians in India, regarding use of vaccines in subjects with diabetes.
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Affiliation(s)
- Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes and Research Centre (JDC), Trivandrum, Kerala, India
| | - Anoop Misra
- Department of Diabetes, Metabolic Diseases and Endocrinology, Fortis Hospital, Vasant Kunj, New Delhi, India
| | | | - Banshi Saboo
- Department of Diabetology, Dia Care Clinic, Ahmedabad, Gujarat, India
| | - Debasis Basu
- Department of Diabetology, Apollo Gleneagles Sugar and Heart Clinic, Kolkata, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Shashank R. Joshi
- Department of Endocrinology, Joshi Clinic & Lilavati & Bhatia Hospital, Mumbai, India
| | - A. G. Unnikrishnan
- Department of Endocrinology, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Arun Shankar
- Department of Diabetology, Jothydev's Diabetes and Research Centre (JDC), Trivandrum, Kerala, India
| | - Gopika Krishnan
- Department of Diabetology, Jothydev's Diabetes and Research Centre (JDC), Trivandrum, Kerala, India
| | - Ranjit Unnikrishnan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, Gopalapuram, Chennai, India
| | - Viswanathan Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, Gopalapuram, Chennai, India
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Schaffzin JK, Southwick KL, Clement EJ, Konings F, Ganova-Raeva L, Xia G, Khudyakov Y, Johnson GS. Transmission of hepatitis B virus associated with assisted monitoring of blood glucose at an assisted living facility in New York State. Am J Infect Control 2012; 40:726-31. [PMID: 22284938 DOI: 10.1016/j.ajic.2011.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) transmission has been reported after patient-to-patient blood exposure during assisted monitoring of blood glucose (AMBG). Three assisted-living facility (ALF) residents who underwent AMBG developed acute HBV infection (HBVI) within 10 days. We investigated HBV transmission and implemented preventive measures. METHODS A retrospective cohort study was conducted. Infection control practices were assessed. HBVI screening was conducted for all staff and epidemiologically linked residents. Viral DNA sequences were compared for a subset of isolates. RESULTS Lancing devices and glucometers were shared among residents without proper sanitization. Serologic testing of all 34 residents with diabetes and 12 epidemiologically linked residents present during the exposure period detected 6 residents with diabetes with current HBVI and 4 residents with diabetes and 1 epidemiologically linked resident with previous HBVI. A cohort study of 32 individuals with diabetes identified AMBG as a significant risk factor for HBVI (relative risk, 6.7; 95% confidence interval, 1.7-26.3). Viral DNA sequences for 5 AMBG-exposed residents' isolates were identical, suggesting a common source. CONCLUSIONS AMBG was significantly associated with HBVI in ALF residents with diabetes. Despite clear preventive recommendations, bloodborne pathogen transmission continues to occur in the setting of AMBG. Strengthening direct care provider, infection preventionist, and health department partnerships with ALFs is crucial to ensure safe AMBG practices and prevent HBV transmission.
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Affiliation(s)
- Joshua K Schaffzin
- Bureau of Communicable Disease Control, New York State Department of Health, Albany, NY, USA.
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Schillie SF, Xing J, Murphy TV, Hu DJ. Prevalence of hepatitis B virus infection among persons with diagnosed diabetes mellitus in the United States, 1999-2010. J Viral Hepat 2012; 19:674-6. [PMID: 22863272 DOI: 10.1111/j.1365-2893.2012.01616.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The prevalence of hepatitis B virus (HBV) infection among persons with diabetes has not been assessed among the US population, despite increasing reports of HBV transmission in institutional care settings. Using national survey data, we found a 60% higher prevalence of HBV infection among persons with (vs without) diagnosed diabetes.
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Affiliation(s)
- S F Schillie
- Division of Viral Hepatitis, Vaccine Research and Policy Team, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
BACKGROUND Monitoring blood glucose levels is an integral part of routine diabetes management. To minimize the risk of transmission of bloodborne pathogens during monitoring, the Centers for Disease Control and Prevention (CDC) recommends that glucose meters be disinfected after each use whenever they are used to test multiple patients. The objective of this study is to assess the compatibility of some common disinfectants with certain blood glucose meter systems. METHODS We tested six disinfectants for adverse impact on meter performance or the exterior meter surfaces. The disinfectants tested were 0.525% sodium hypochlorite, 20% 2-propanol and 10% ethanol, 17.2% isopropanol, 55% isopropanol, 70% isopropanol, and hydrogen peroxide. To assess meter performance, we tested OneTouch® Ultra® blood glucose monitoring systems with control solution before and after application of either water or disinfectant. To assess the effect on exterior meter surfaces, we performed a soaking test to simulate long-term exposure to disinfectant. RESULTS Paired t-test results showed that the control solution data associated with disinfectant and with water application were not significantly different for each meter type. However, most of the meter types were adversely affected by hydrogen peroxide and/or by the higher concentrations of alcohol-based disinfectants. CONCLUSIONS Although none of the six disinfectants affected meter performance, hydrogen peroxide and isopropanol >20% adversely affected the exterior surfaces of the tested meters. When complying with CDC instructions for meter disinfection, users should use caution and choose disinfectants that have been validated by the meter manufacturer.
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Affiliation(s)
- John J Mahoney
- Research and Development, LifeScan, Inc., Milpitas, California 95035, USA.
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Hellinger WC, Grant RL, Hernke DA, Shalev JA, Barber BW, Meek SE, Jones AD, Thompson KM. Glucose meters and opportunities for in-hospital transmission of infection: Quantitative assessment and management with and without patient assignment. Am J Infect Control 2011; 39:752-6. [PMID: 21700364 DOI: 10.1016/j.ajic.2010.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/21/2010] [Accepted: 12/29/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing use of glucose meters in hospitals has increased opportunities for infection transmission that have not been quantitatively assessed or managed. METHODS Before-and-after study of the effects of augmentation of glucose meter inventory and of assignment of glucose meters to individual patients on the sequential use of glucose meters on different patients in a 214-bed hospital. RESULTS During October 2008, 11,665 measurements were performed using 38 glucose meters on 803 patients. A total of 9,302 tests (79.7%) was performed sequentially within 24 hours on different patients. From October 28 through November 27, 2009, the glucose meter inventory on 3 high-use units glucose meters was increased (from 22 to 87) with meters assigned to individual patients; on 4 low-use units, glucose meter inventory was increased (from 16 to 28) without assignment to individual patients. Sequential glucose meter use on different patients within 24 hours decreased by 95.1% on high-use units and increased by 17% on low-use units. CONCLUSION Use of glucose meters was associated with a high number of opportunities to transmit infections, and those opportunities were reduced only when glucose meters were assigned to individual patients. Recent guidance from the Centers for Disease Control and Prevention and the US Food and Drug Administration to assign glucose meters to individual persons whenever possible is relevant to inpatient care.
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Thompson ND, Schaefer MK. "Never events": hepatitis B outbreaks and patient notifications resulting from unsafe practices during assisted monitoring of blood glucose, 2009-2010. J Diabetes Sci Technol 2011; 5:1396-402. [PMID: 22226257 PMCID: PMC3262706 DOI: 10.1177/193229681100500611] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite sustained public health efforts to publicize the risk of hepatitis B virus (HBV) infection outbreaks during assisted monitoring of blood glucose (AMBG), outbreaks continue to occur. Here, we highlight several outbreaks and patient notifications due to AMBG, discuss prevention initiatives, and highlight gaps that remain. METHODS We reviewed available data and information from investigations of health care-associated HBV infection outbreaks and patient notification events associated with AMBG in the United States between 2009 and 2010. RESULTS Four HBV infection outbreaks were reported, all in assisted living facilities. Common infection control breaches included use of reusable finger stick devices, which are intended for personal use, on multiple persons; use of BG meters for more than one person without cleaning and disinfection between each use; and comingling of contaminated and clean equipment and supplies. Twenty-nine (88%) of the 33 residents who acquired acute HBV infection as part of these outbreaks received AMBG. Compared with those who did not, residents undergoing AMBG had significantly increased risk of acquiring acute HBV infection (relative risk: 27.7, 95% confidence interval: 10.3 to 74.4). During two patient notifications, approximately 320 persons were recommended to undergo bloodborne pathogen testing after being placed at risk for exposure to another person's blood when personal-use multilancet finger stick devices were selected for use on multiple persons. CONCLUSIONS Misperception on the risk for bloodborne pathogen transmission and confusion regarding selection and appropriate use of BG monitoring devices for AMBG remain a problem. In addition to public health outreach and infection control recommendations, clear labeling, packaging, instructions for device use, and appropriate device marketing will assist in infection prevention efforts.
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Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Krisiunas E. Disinfected so it is safe and works. J Diabetes Sci Technol 2011; 5:1453-4. [PMID: 22226264 PMCID: PMC3262713 DOI: 10.1177/193229681100500618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been an upsurge in interest in monitoring the cleanliness of the health care environment as it relates to disease transmission. Cleaning and disinfecting practices are nothing new in health care facilities. However, continued development of analytical medical products such as point-of-care devices or, as in this review, glucose meters, has created potential risks to patients on a number of levels. Examples are (1) inappropriate disinfection of glucose meters so that the risk of disease transmission is increased and (2) cleaning agents potentially affecting glucose reading accuracy. Cleaning and disinfection recommendations have become available to address these issues. In this issue of Journal of Diabetes Science and Technology, Sarmaga and colleagues discuss the impact of a disinfecting agent on results generated from a particular device, which suggests that not all equipment are created equal and not all practices/products used to clean and disinfect are the same. It appears that more interaction must take place between vendors of these technologies as well as vendors of cleaning/disinfecting agents and the end users who will be performing all the requisite tasks to ensure a high quality product as well as care.
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Affiliation(s)
- Ed Krisiunas
- WNWN International - Waste Not, Want Not, Burlington, Connecticut 06013, USA.
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Klonoff DC, Blonde L, Cembrowski G, Chacra AR, Charpentier G, Colagiuri S, Dailey G, Gabbay RA, Heinemann L, Kerr D, Nicolucci A, Polonsky W, Schnell O, Vigersky R, Yale JF. Consensus report: the current role of self-monitoring of blood glucose in non-insulin-treated type 2 diabetes. J Diabetes Sci Technol 2011; 5:1529-48. [PMID: 22226276 PMCID: PMC3262725 DOI: 10.1177/193229681100500630] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Coalition for Clinical Research--Self-Monitoring of Blood Glucose Scientific Board convened a meeting in San Francisco, CA, July 20-21, 2011, to discuss the current practice of self-monitoring of blood glucose (SMBG) in non-insulin-treated (NIT) type 2 diabetes mellitus (T2DM). Twelve physician panel members from academia, practice, and government attended this meeting. These experts came from the United States, Brazil, Canada, France, Germany, Italy, and the United Kingdom. In addition, three consultants from Australia, Germany, and the United States contributed to the group's final report. This coalition was organized by Diabetes Technology Society. Self-monitoring of blood glucose was studied from eight perspectives related to patients with NIT T2DM: (1) epidemiological studies; (2) randomized controlled trials (RCT)s and meta-analyses; (3) targets, timing, and frequency of SMBG use; (4) incidence and role of SMBG in preventing hypoglycemia with single-drug regimens and combination regimens consisting of antihyperglycemic agents other than secretagogues and insulin; (5) comparison of SMBG with continuous glucose monitoring; (6) technological capabilities and limitations of SMBG; (7) barriers to appropriate use of SMBG; and (8) methods and end points for appropriate future clinical trials. The panel emphasized recent studies, which reflect the current approach for applying this intervention. Among the participants there was consensus that: SMBG is an established practice for patients with NIT T2DM, and to be most effective, it should be performed in a structured format where information obtained from this measurement is used to guide treatment; New, high-quality efficacy data from RCTs have demonstrated efficacy of SMBG in NIT T2DM in trials reported since 2008; Both patients and health care professionals require education on how to respond to the data for SMBG to be effective; and Additional well-defined studies are needed to assess the benefits and costs of SMBG with end points not limited to hemoglobin A1c.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California 94401, USA.
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Abstract
Glucose testing in the hospital with point-of-care devices presents multiple opportunities for error. Any device can fail under the right conditions. For glucose monitoring in the hospital, with thousands of operators, hundreds of devices, and dozens of locations involved, there is ample opportunity for errors that can impact the quality of test results. Errors can occur in any phase of the testing process: preanalytic, analytic, or postanalytic. Common sources of meter error include patient or methodology interferences, operator mistakes, environmental exposure, and device malfunction. Early models of glucose meters had few internal checks or capability to warn the operator of meter problems. The latest generation of glucose monitors has a number of internal checks and controls engineered into the testing process to prevent serious errors or warn the operator by suppressing test results. Some of these control processes are built into the software and data management system of the meters, others require the hospital to do something, such as regularly clean the meter or analyze control samples of known glucose concentration, to verify meter performance. Hospitals need to be aware of the potential for errors by understanding weaknesses in the testing process that could lead to erroneous results and take steps to prevent errors from occurring or to minimize the harm to patients when errors do occur. The reliability of a glucose result will depend on the balance of internal control features available from manufacturers in conjunction with the liquid control analysis and other control processes (operator training, device validation, and maintenance) utilized by the hospitals.
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Affiliation(s)
- James H Nichols
- Tufts University School of Medicine Boston, Massachusetts, USA.
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