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Al-Hasani W, Ranasinghe R, Rogers H, Spanier W, Spears K, Gayle C, Long L, Dimitriadis GK, Hunt KF, Vincent RP. Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study. BJOG 2024; 131:1270-1278. [PMID: 38497098 DOI: 10.1111/1471-0528.17811] [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: 11/02/2022] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN Prospective cohort study. SETTING Antenatal clinics at King's College Hospital. POPULATION Women screened for GDM between March and June 2020. METHODS The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.
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Affiliation(s)
- Wiaam Al-Hasani
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Ruvini Ranasinghe
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - William Spanier
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Katie Spears
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Carol Gayle
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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2
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Shaw JLV, Arnoldo S, Shea JL, Leung F, Thakur V, Paul H, Beach L. Challenges with point of care glucose measurements for management of hypoglycemia in neonates. Paediatr Child Health 2024; 29:197-198. [PMID: 39045480 PMCID: PMC11261836 DOI: 10.1093/pch/pxad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 07/25/2024] Open
Affiliation(s)
- Julie L V Shaw
- Division of Biochemistry, The Ottawa Hospital and Eastern Ontario Regional Laboratories Association, Ottawa, Canada
- Department of Pathology and Laboratory Medicine, The University of Ottawa, Ottawa, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Genetic Program, Trillium Health Partners, Mississauga, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Felix Leung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, ON, Canada
| | - Vinita Thakur
- Department of Laboratory Medicine, Health Sciences Center, and Memorial University of Newfoundland, St John’s, NL, Canada
| | - Heather Paul
- Alberta Precision Laboratories, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Lori Beach
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
- Department of Pathology and Laboratory Medicine, Division of Chemistry, IWK Health, Halifax, NS, Canada
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3
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Kaufmann T, Slingerland RJ, Edens MA, Olthof CG. Glucose measurements with accu check inform II versus hexokinase plasma method during surgery under general anesthesia, an observational cohort study. J Clin Monit Comput 2024; 38:479-485. [PMID: 37688674 DOI: 10.1007/s10877-023-01072-8] [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: 12/19/2022] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Limited research exists on translation of in-vitro glucose measurement interfering compounds to the in-vivo situation. We investigated whether Point-of-Care glucose measurements by Accu Chek Inform II (ACI II) were accurate to monitor glucose concentrations during surgery with general anesthesia by comparing with the reference laboratory hexokinase plasma glucose test. METHOD Patients undergoing surgery with general anesthesia were included. Anesthesia was maintained with either Sevoflurane or Total intravenous anesthesia (TIVA). Prior to and after induction, blood glucose was measured with ACI II and the hexokinase test. Bland-Altman analysis was performed to assess method agreement. Subgroup analyses on glucose measurement differences per type of maintenance anesthesia were performed. RESULTS Thirty-nine patients were included, and 78 measurements were performed. All paired measurements had clinically acceptable agreement with a percentage error of 10.0% (95% CI 8.0 to 11.9). The mean difference (95% limits of agreement) between ACI II and hexokinase for all measurements was 0.0 mmol/L (-0.7 to 0.7 mmol/L). Before induction (n = 39), mean difference was -0.1 mmol/L (-0.6 to 0.4 mmol/L), and after induction (n = 39), mean difference was 0.1 mmol/L (-0.8 to 0.9 mmol/L). Further investigation showed the difference varied per test for patients receiving Sevoflurane compared to patients receiving TIVA (-0.2 ± 0.4 mmol/L vs. 0.4 ± 0.3 mmol/L, p < 0.001). Before and after induction, the difference between ACI II and hexokinase measurements increased for patients receiving Sevoflurane compared to patients receiving TIVA (0.4 ± 0.4 mmol/L vs. -0.4 ± 0.3 mmol/L, p < 0.001). CONCLUSION The agreement between glucose measurements using ACI II and the reference laboratory hexokinase test was clinically acceptable with a percentage error of 10.0% (95% CI 8.0 to 11.9). The use of TIVA may negatively affect the measurement performance of the ACI II.
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Affiliation(s)
- Thomas Kaufmann
- Department of Anesthesiology, Isala, Zwolle, The Netherlands
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Mireille A Edens
- Department of Innovation and Science, Isala, Zwolle, the Netherlands
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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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5
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Majewski J, Risler Z, Gupta K. Erroneous Causes of Point-of-Care Glucose Readings. Cureus 2023; 15:e36356. [PMID: 37082479 PMCID: PMC10112488 DOI: 10.7759/cureus.36356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Recognizing and treating reversible causes of lethargy and altered mental status is crucial for emergency department physicians. One such tool that can quickly help guide resuscitation and a patient's workup is a point-of-care glucose reading. This simple test is performed routinely; however, how much thought is given to the accuracy of these tests? What factors can alter these results? Here, we present a patient who was reported to be hyperglycemic in the field by emergency medical services (EMS) but was profoundly hypoglycemic during his workup in the emergency department. This case report highlights factors that can cause false hyper- and hypoglycemic readings on point-of-care glucose meters.
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Ahmadian N, Manickavasagan A, Ali A. Comparative assessment of blood glucose monitoring techniques: a review. J Med Eng Technol 2023; 47:121-130. [PMID: 35895023 DOI: 10.1080/03091902.2022.2100496] [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: 01/25/2023]
Abstract
Monitoring blood glucose levels is a vital indicator of diabetes mellitus management. The mainstream techniques of glucometers are invasive, painful, expensive, intermittent, and time-consuming. The ever-increasing number of global diabetic patients urges the development of alternative non-invasive glucose monitoring techniques. Recent advances in electrochemical biosensors, biomaterials, wearable sensors, biomedical signal processing, and microfabrication technologies have led to significant research and ideas in elevating the patient's life quality. This review provides up-to-date information about the available technologies and compares the advantages and limitations of invasive and non-invasive monitoring techniques. The scope of measuring glucose concentration in other bio-fluids such as interstitial fluid (ISF), tears, saliva, and sweat are also discussed. The high accuracy level of invasive methods in measuring blood glucose concentrations gives them superiority over other methods due to lower average absolute error between the detected glucose concentration and reference values. Whereas minimally invasive, and non-invasive techniques have the advantages of continuous and pain-free monitoring. Various blood glucose monitoring techniques have been evaluated based on their correlation to blood, patient-friendly, time efficiency, cost efficiency, and accuracy. Finally, this review also compares the currently available glucose monitoring devices in the market.
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Affiliation(s)
- Nivad Ahmadian
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Annamalai Manickavasagan
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Amanat Ali
- School of Engineering, College of Engineering and Physical Sciences, University of Guelph, Guelph, Ontario, Canada
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7
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Tokuhira N, Uchiyama A, Hoshino T, Kubo N, Ishigaki S, Enokidani Y, Sakaguchi R, Koyama Y, Fujino Y. Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia. Artif Organs 2022:10.1111/aor.14472. [PMID: 36440971 PMCID: PMC9877914 DOI: 10.1111/aor.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many patients with severe coronavirus disease 2019 (COVID-19) pneumonia experience hyperglycemia. It is often difficult to control blood glucose (BG) levels in such patients using standard intravenous insulin infusion therapy. Therefore, we used an artificial pancreas. This study aimed to compare the BG status of the artificial pancreas with that of standard therapy. METHODS Fifteen patients were included in the study. BG values and the infusion speed of insulin and glucose by the artificial pancreas were collected. Arterial BG and administration rates of insulin, parenteral sugar, and enteral sugar were recorded during the artificial pancreas and standard therapy. The target BG level was 200 mg/dl. RESULTS Arterial BG was highly correlated with BG data from the artificial pancreas. A higher BG slightly increased the difference between the BG data from the artificial pancreas and arterial BS. No significant difference in arterial BG was observed between the artificial pancreas and standard therapy. However, the standard deviation with the artificial pancreas was smaller than that under standard therapy (p < 0.0001). More points within the target BG range were achieved with the artificial pancreas (180-220 mg/dl) than under standard therapy. The hyperglycemic index of the artificial pancreas (8.7 ± 15.6 mg/dl) was lower than that of standard therapy (16.0 ± 21.5 mg/dl) (p = 0.0387). No incidence of hypoglycemia occurred under the artificial pancreas. CONCLUSIONS The rate of achieving target BG was higher using artificial pancreas than with standard therapy. An artificial pancreas helps to control BG in critically ill patients.
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Affiliation(s)
- Natsuko Tokuhira
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Akinori Uchiyama
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Taiki Hoshino
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Naoko Kubo
- Department of AnesthesiaRinku General Medical CenterOsakaJapan
| | - Suguru Ishigaki
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yusuke Enokidani
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Ryota Sakaguchi
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yukiko Koyama
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yuji Fujino
- Department of Anesthesia and Intensive Care MedicineOsaka University Graduate School of MedicineOsakaJapan
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8
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Madimenos FC, Gildner TE, Eick GN, Sugiyama LS, Snodgrass JJ. Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts. Am J Hum Biol 2022; 34:e23808. [PMID: 36166487 DOI: 10.1002/ajhb.23808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.
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Affiliation(s)
- Felicia C Madimenos
- Department of Anthropology, Queens College (CUNY), New York, USA.,New York Consortium of Evolutionary Primatology (NYCEP), CUNY Graduate Center, New York, USA
| | - Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | | | - James J Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA.,Global Station for Indigenous Studies and Cultural Diversity, Hokkaido University, Sapporo, Japan
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Ong YQ, Harith S, Shahril MR, Shahidan N, Hapidin H. Acute effect of Melon Manis Terengganu peel powder on glycemic response, perceived satiety, and food intake: a randomized, placebo-controlled crossover trial in adults at risk of type 2 diabetes. BMC Nutr 2022; 8:75. [PMID: 35941609 PMCID: PMC9358903 DOI: 10.1186/s40795-022-00572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melon Manis Terengganu (MMT) peel has a high dietary fiber content, but there is no data examining its health benefits in adults at risk of type 2 diabetes. The objective of the study was to evaluate whether consumption of MMT peel powder improves glycemic response, satiety, and food intake in adults at risk of type 2 diabetes. METHODS An open-label, randomized, placebo-controlled, crossover design trial was conducted among adults (n = 30, ages 18-59 y) at risk of type 2 diabetes. They consumed Formulation 3 (formulated MMT peel powder) [A] and control (glucose) [B] with study breakfast based on randomly assigned treatment sequences (AB, BA) established by Research Randomizer ( www.randomizer.org ). Capillary blood glucose and perceived satiety were determined at baseline (0 min), 30, 60, 90 and 120 min, followed by a post-intervention food intake measurement. RESULTS The repeated measures analysis of variance (ANOVA) revealed significant time (F = 84.37, p < 0.001, ηp2 = 0.744), condition (F = 22.89, p < 0.001, ηp2 = 0.441), and time*condition effects (F = 24.40, p < 0.001, ηp2 = 0.457) in blood glucose levels. Respondents (n = 30) who consumed Formulation 3 also had a significantly lower blood glucose 2-hour incremental area under the curve (iAUC) of 134.65 ± 44.51 mmol/L*min and maximum concentration (CMax) of 7.20 (7.10, 8.20) mmol/L with relative reduction of 26.8 and 13.3% respectively, when compared with control (p < 0.001). Besides, significantly greater perceived satiety, lower energy and fat intake as well as higher dietary fiber intake were also observed in the intervention group compared with the placebo group (p < 0.05). There were no marked side effects associated with the ingestion of the test products. CONCLUSIONS Short-term consumption of formulated MMT peel powder may improve glycemic response, increase perceived satiety and reduce food intake in adults at risk of type 2 diabetes with the potential to be utilized as a functional beverage. Medium-to long-term clinical trial is warranted to determine whether taking this formulated MMT peel powder on a daily basis has an influence on health outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05298111. Registered 28/03/2022.
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Affiliation(s)
- Ying Qian Ong
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia
| | - Sakinah Harith
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia.
| | - Mohd Razif Shahril
- Nutrition Program, Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Norshazila Shahidan
- Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, Tembila Campus, 22200, Besut, Terengganu, Malaysia
| | - Hermizi Hapidin
- Biomedicine Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
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10
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Mertens J, Haddad M. Artifactual hypoglycemia in a patient with systemic sclerosis. Acta Clin Belg 2022; 77:400-405. [PMID: 33074796 DOI: 10.1080/17843286.2020.1837575] [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: 10/23/2022]
Abstract
Artifactual hypoglycemia, defined as a discrepancy between different laboratory measurements and actual blood glucose levels, can occur due to clinical conditions affecting the capillary microcirculation leading to falsely low blood glucose assessment. Systemic sclerosis, hallmarked by auto-immunity, fibrosis of the skin and/or internal organs and small vessel vasculopathy, can interfere with capillary point-of-care (POC) glycemia measurements, leading to the misdiagnosis of hypoglycemia. We report an 87-year-old woman with recurrent, asymptomatic hypoglycemia of unknown cause. Clinical examination revealed multiple features of limited cutaneous systemic sclerosis causing microvascular damage leading to artifactual hypoglycemia. Artifactual hypoglycemia is rarely considered by physicians and knowledge of its causes is generally lacking. Early identification of causes of inaccurate glycemia assessment can prevent unnecessary investigations and treatment. In the future, continuous glucose monitoring (CGM) could become a reliable alternative for inpatient glucose monitoring.
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Affiliation(s)
- Jonathan Mertens
- Department of Internal Medicine, University Hospital Antwerp, Antwerp, Belgium
| | - Maryam Haddad
- Department of Geriatrics, ZNA Stuivenberg, Antwerp, Belgium
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11
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Parker K, Lyon ME, Kyle BD, Strueby L, Inman M. The clinical effect of glucose meter selection upon the detection of neonatal hypoglycemia. Paediatr Child Health 2022; 27:12-14. [PMID: 35273667 DOI: 10.1093/pch/pxab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/15/2021] [Indexed: 11/14/2022] Open
Abstract
Neonatal hypoglycemia is a common, transitional metabolic state that may lead to poor neurodevelopmental outcomes if unrecognized or managed inadequately. Given its frequency of presentation and immense clinical significance, a myriad of clinical practice guidelines have been published outlining appropriate screening, diagnosis, and treatment principles-many endorsing the use of glucose point-of-care testing (POCT). Unfortunately, the well-intended 'march' toward POCT, with bedside glucose meters as screening devices in the NICU, has resulted in unintended consequences with critical implications: a lack of international traceability to the 'gold' standard glucose method by POCT devices, under-recognition of POCT limitations, and a reliance upon a technology primarily driven to detect hyperglycemia in the adult population as opposed to neonatal hypoglycemia. As providers continue to advocate for improved POCT, there must be robust communication between providers and the clinical laboratory in the selection, standardization, and interpretation of glucose POCT to ensure optimal neonatal glucose detection.
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Affiliation(s)
- Kayla Parker
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Division of Clinical Biochemistry, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Barry D Kyle
- Department of Pathology and Laboratory Medicine, Division of Clinical Biochemistry, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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12
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Pullano SA, Greco M, Bianco MG, Foti D, Brunetti A, Fiorillo AS. Glucose biosensors in clinical practice: principles, limits and perspectives of currently used devices. Theranostics 2022; 12:493-511. [PMID: 34976197 PMCID: PMC8692922 DOI: 10.7150/thno.64035] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022] Open
Abstract
The demand of glucose monitoring devices and even of updated guidelines for the management of diabetic patients is dramatically increasing due to the progressive rise in the prevalence of diabetes mellitus and the need to prevent its complications. Even though the introduction of the first glucose sensor occurred decades ago, important advances both from the technological and clinical point of view have contributed to a substantial improvement in quality healthcare. This review aims to bring together purely technological and clinical aspects of interest in the field of glucose devices by proposing a roadmap in glucose monitoring and management of patients with diabetes. Also, it prospects other biological fluids to be examined as further options in diabetes care, and suggests, throughout the technology innovation process, future directions to improve the follow-up, treatment, and clinical outcomes of patients.
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Affiliation(s)
| | - Marta Greco
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100, Catanzaro, Italy
| | - Maria Giovanna Bianco
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100, Catanzaro, Italy
| | - Daniela Foti
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, 88100, Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100, Catanzaro, Italy
| | - Antonino S. Fiorillo
- Department of Health Sciences, Magna Græcia University of Catanzaro, 88100, Catanzaro, Italy
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13
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Karbalivand H, Iyare A, Aponte A, Xianhong X, Kim M, Havranek T. Hypoglycemia screening of asymptomatic newborns on the 2nd day of life. J Neonatal Perinatal Med 2021; 15:311-316. [PMID: 34974442 DOI: 10.3233/npm-210861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neonatal hypoglycemia management in the first 48 hours is guided by the American Academy of Pediatrics (AAP) and Pediatric Endocrine Society (PES) recommendations. Our aim was to determine the incidence of hypoglycemia via point of care test (POCT) on the 2nd day of life (DOL) among healthy, asymptomatic neonates regardless of risk factors. METHODS In this prospective observational study, preprandial point of care glucose concentration was measured on the 2nd DOL in 150 healthy, asymptomatic neonates in the newborn nursery. We used 50 mg/dl (2.8 mmol/L) as the hypoglycemia threshold based on PES recommendations. RESULTS The incidence of hypoglycemia on the second DOL was 10% among asymptomatic neonates (no risk factors = 8% ; late preterm birth (LPT) + small for gestational age (SGA) = 16% ; large for gestational age (LGA) + infant of diabetic mother (IDM) = 6%). SGA + LPT neonates accounted for the majority of the hypoglycemic cases (53.3%) and exhibited a trend towards the lowest glucose concentration (p = 0.09). CONCLUSION The incidence of hypoglycemia on DOL 2 among asymptomatic neonates is high and of unclear significance in the absence of dedicated neurodevelopmental follow-up.
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Affiliation(s)
- H Karbalivand
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - A Iyare
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - A Aponte
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - X Xianhong
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Kim
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - T Havranek
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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14
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Lin FY, Lee PY, Chu TF, Peng CI, Wang GJ. Neutral Nonenzymatic Glucose Biosensors Based on Electrochemically Deposited Pt/Au Nanoalloy Electrodes. Int J Nanomedicine 2021; 16:5551-5563. [PMID: 34429599 PMCID: PMC8379712 DOI: 10.2147/ijn.s321480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022] Open
Abstract
Background Type I diabetes occurs when the pancreas can only make limited or minimal insulin. Patients with type 1 diabetes need effective approaches to manage diabetes and maintain their blood-glucose concentration. Recently, continuous glucose monitoring (CGM) has been used to help control blood-glucose levels in patients with type 1 diabetes. Patients with type 2 diabetes may also benefit from CGM on multiple insulin injections, basal insulin, or sulfonylureas. Enzyme-free glucose detection in a neutral environment is the recent development trend of CGM. Materials and Methods Pt/Au alloy electrodes for enzyme-free glucose detection in a neutral environment were formed by electrochemically depositing Pt/Au alloy on a thin polycarbonate (PC) membrane surface with a uniformly distributed micro-hemisphere array. The PC membranes were fabricated using semiconductor microelectromechanical manufacturing processes, precision micro-molding, and hot embossing. Amperometry was used to measure the glucose concentration in PBS (pH 7.4) and artificial human serum. Results The Pt/Au nanoalloy electrode had excellent specificity for glucose detection, according to the experimental results. The device had a sensitivity of 2.82 μA mM−1 cm−2, a linear range of 1.39–13.9 mM, and a detection limit of 0.482 mM. Even though the complex interfering species in human blood can degrade the sensing signal, further experiments conducted in artificial serum confirmed the feasibility of the proposed Pt/Au nanoalloy electrode in clinical applications. Conclusion The proposed Pt/Au nanoalloy electrode can catalyze glucose reactions in neutral solutions with enhancing sensing performance by the synergistic effect of bimetallic materials and increasing detection surface area. This novel glucose biosensor has advantages, such as technology foresight, good detection performance, and high mass production feasibility. Thus, the proposed neutral nonenzymatic glucose sensor can be further used in CGMs.
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Affiliation(s)
- Fang-Yu Lin
- Graduate Institute of Biomedical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan
| | - Pei-Yuan Lee
- Graduate Institute of Biomedical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan.,Department of Orthopedics, Show Chwan Memorial Hospital, Changhua, 50008, Taiwan
| | - Tien-Fu Chu
- Department of Mechanical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan
| | - Chang-I Peng
- Department of Mechanical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan
| | - Gou-Jen Wang
- Graduate Institute of Biomedical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan.,Department of Mechanical Engineering, National Chung-Hsing University, Taichung, 40227, Taiwan.,Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
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15
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Kemas AM, Youhanna S, Zandi Shafagh R, Lauschke VM. Insulin-dependent glucose consumption dynamics in 3D primary human liver cultures measured by a sensitive and specific glucose sensor with nanoliter input volume. FASEB J 2021; 35:e21305. [PMID: 33566368 DOI: 10.1096/fj.202001989rr] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022]
Abstract
The liver plays a central role in glucose homeostasis and hepatic insulin resistance constitutes a key feature of type 2 diabetes. However, platforms that accurately mimic human hepatic glucose disposition and allow for rapid and scalable quantification of glucose consumption dynamics are lacking. Here, we developed and optimized a colorimetric glucose assay based on the glucose oxidase-peroxidase system and demonstrate that the system can monitor glucose consumption in 3D primary human liver cell cultures over multiple days. The system was highly sensitive (limit of detection of 3.5 µM) and exceptionally accurate (R2 = 0.999) while requiring only nanoliter input volumes (250 nL), enabling longitudinal profiling of individual liver microtissues. By utilizing a novel polymer, off-stoichiometric thiol-ene (OSTE), and click-chemistry based on thiol-Michael additions, we furthermore show that the assay can be covalently bound to custom-build chips, facilitating the integration of the sensor into microfluidic devices. Using this system, we find that glucose uptake of our 3D human liver cultures closely resembles human hepatic glucose uptake in vivo as measured by euglycemic-hyperinsulinemic clamp. By comparing isogenic insulin-resistant and insulin-sensitive liver cultures we furthermore show that insulin and extracellular glucose levels account for 55% and 45% of hepatic glucose consumption, respectively. In conclusion, the presented data show that the integration of accurate and scalable nanoliter glucose sensors with physiologically relevant organotypic human liver models enables longitudinal profiling of hepatic glucose consumption dynamics that will facilitate studies into the biology and pathobiology of glycemic control, as well as antidiabetic drug screening.
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Affiliation(s)
- Aurino M Kemas
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Youhanna
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Reza Zandi Shafagh
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Micro and Nanosystem, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Volker M Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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16
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Nichols JH, Brandler ES, Fantz CR, Fisher K, Goodman MD, Headden G, Hoppensteadt D, Matika R, Peacock WF, Rodrigo J, Schützenmeister A, Swanson JR, Canada-Vilalta C, Miles G, Tran N. A Multicenter Evaluation of a Point-of-Care Blood Glucose Meter System in Critically Ill Patients. J Appl Lab Med 2021; 6:820-833. [PMID: 33837390 DOI: 10.1093/jalm/jfab005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Our purpose was to evaluate the performance of the ACCU-CHEK® Inform II blood glucose monitoring system (Roche Diagnostics GmbH) compared with the perchloric acid hexokinase (PCA-HK) comparator method on the cobas® 6000 analyzer (Roche Diagnostics International Ltd) in critically ill patients. METHODS Overall, 476 arterial (376 pediatric/adult, 100 neonate), 375 venous, and 100 neonatal heel-stick whole-blood samples were collected and evaluated from critical care settings at 10 US hospitals, including the emergency department, medical and surgical intensive care units (ICUs), and neonatal and pediatric ICUs. The ACCU-CHEK Inform II system was evaluated at 2 cutoff boundaries: boundary 1 was ≥95% of results within ±12 mg/dL of the reference (samples with blood glucose <75 mg/dL) or ±12% of the reference (glucose ≥75 mg/dL), and boundary 2 was ≥98% of results within ±15 mg/dL or ±15% of the reference. Clinical performance was assessed by evaluating sample data using Parkes error grid, Monte Carlo simulation, and sensitivity and specificity analyses to estimate clinical accuracy and implications for insulin dosing when using the ACCU-CHEK Inform II system. RESULTS Proportions of results within evaluation boundaries 1 and 2, respectively, were 96% and 98% for venous samples, 94% and 97% for pediatric and adult arterial samples, 84% and 98% for neonatal arterial samples, and 96% and 100% for neonatal heel-stick samples. Clinical evaluation demonstrated high specificity and sensitivity, with low risk of potential insulin-dosing errors. CONCLUSIONS The ACCU-CHEK Inform II system demonstrated clinically acceptable performance against the PCA-HK reference method for blood glucose monitoring in a diverse population of critically ill patients in US care settings.
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Affiliation(s)
- James H Nichols
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Corinne R Fantz
- Roche Diagnostics Corporation, US Medical and Scientific Affairs, Indianapolis, IN, USA
| | | | | | - Gary Headden
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Ryan Matika
- University of Arizona Medical Center, Tucson, AZ, USA
| | | | | | | | | | | | - Gabrielle Miles
- Roche Diagnostics Operations US, Biostatistics and Data Science, Indianapolis, IN, USA
| | - Nam Tran
- UC Davis Health, Sacramento, CA, USA
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17
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Suchowersky ND, Carlson EA, Lee HP, Behrend EN. Comparison of glucose concentrations in canine whole blood, plasma, and serum measured with a veterinary point-of-care glucometer. J Vet Diagn Invest 2021; 33:695-702. [PMID: 34075827 DOI: 10.1177/10406387211019755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have determined that, compared to whole blood, serum or plasma used in a portable blood glucometer (PBG) may provide more accurate results. We investigated the accuracy of a veterinary PBG (AlphaTRAK 2; Zoetis) for the measurement of glucose concentrations in serum, plasma, and whole blood compared to plasma glucose concentration measured by a biochemical analyzer. Blood samples from 53 client-owned dogs were collected. Lin concordance correlation coefficient (ρc) and Bland-Altman plots were used to determine correlation and agreement between the results obtained for the different sample types. Glucose concentration in whole blood measured by the veterinary PBG was more strongly correlated with the glucose concentration measured by the biochemical analyzer (ρc = 0.92) compared to plasma and serum glucose concentrations (ρc = 0.59 and 0.57, respectively). The mean differences between the glucose concentrations in whole blood, plasma, and serum measured by the veterinary PBG and the glucose concentration determined by the biochemical analyzer were 1.0, 6.3, and 6.7 mmol/L (18, 113, and 121 mg/dL), respectively. Our findings suggest that, when using this veterinary PBG, the accuracy of a glucose measurement obtained is higher when using whole blood compared to plasma or serum. Use of whole blood allows for more correct assessment and diagnosis, which are necessary for appropriate therapeutic intervention.
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Affiliation(s)
- Natalie D Suchowersky
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Elizabeth A Carlson
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Hollie P Lee
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Ellen N Behrend
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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18
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Olowoyeye A, Eisenberg R, Kim M, Havranek T. Factors related to passing the safety fast test among neonates with hypoglycaemia in the neonatal intensive care unit. J Paediatr Child Health 2021; 57:507-512. [PMID: 33145900 DOI: 10.1111/jpc.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate the success rates and predictors of safety fast test among neonates admitted to the neonatal intensive care unit for hypoglycaemia. METHODS A retrospective review of neonates transferred from the newborn nursery unit to the neonatal intensive care unit for intravenous dextrose therapy for hypoglycaemia from January 2016 to June 2019. Neonatal clinical and demographic variables were abstracted from the medical records. A successful safety fast test was defined by blood glucose >60 mg/dL (3.3 mmol/L) at 3, 4, 5 and 6 h after a feed. RESULTS Of the 76 neonates who had a safety fast test, 80% passed on their first attempt. Neonates who passed the safety fast test were less likely to be premature/small for gestational age (54.1% vs. 92.9%, P = 0.03), required less maximum glucose infusion rate (median 6 vs. 7 mg/kg/min; P = 0.04), and were younger at fasting challenge (median 5 vs. 9 days; P = 0.02), required lower overall intravenous glucose load (median 12 vs. 24 g/kg; P = 0.006). CONCLUSION Safety fast test may be a useful tool evaluating discharge readiness of neonates with persistent hypoglycaemia.
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Affiliation(s)
- Abiola Olowoyeye
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York, United States
| | - Ruth Eisenberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Tomas Havranek
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York, United States
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19
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Howell AP, Parrett JL, Malcom DR. Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings. J Diabetes Sci Technol 2021; 15:309-316. [PMID: 31766883 PMCID: PMC8256056 DOI: 10.1177/1932296819889638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Intravenous vitamin C therapy has been associated with reduced mortality in patients with sepsis. Of potential concern with this therapy are falsely elevated point-of-care (POC) blood glucose values vs laboratory analyzed (LA) readings. The purpose of this study was to compare POC and LA blood glucose measurements in patients receiving intravenous vitamin C therapy. METHODS All adults (≥18 years old) admitted from January 2017 to December 2018 who received at least two doses of intravenous vitamin C and had at least one paired blood glucose collection were eligible for inclusion. The primary endpoint was the accuracy in paired blood glucose values determined using the International Organization for Standardization (ISO) 15197:2013 criteria. Paired values were assessed for clinical impact using the Parkes consensus error grid analysis. A subgroup analysis was conducted to determine the impact of impaired renal function on outcomes. RESULTS Fourteen patients were included for analysis with 46 paired blood glucose levels. Compliance with ISO15197:2013 criteria was met in 34 (73.9%) paired values, which did not meet the minimum criteria for accuracy. Subgroup analysis showed that the paired values from patients with impaired renal function did not meet the minimum requirements for compliance, while those from patients without impaired renal function did. The Parkes error grid showed that the variation in POC measurements likely had minimal clinical impact. CONCLUSIONS Our study suggests that most patients receiving vitamin C for sepsis may still be monitored at POC with the glucose meter used in our study with minimal clinical impact.
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Affiliation(s)
| | - Jenna L. Parrett
- Department of Pharmacy, Baptist Health
Louisville, Louisville, KY, USA
| | - Daniel R. Malcom
- Department of Clinical and
Administrative Sciences, Sullivan University College of Pharmacy and Health
Sciences, Louisville, KY, USA
- Daniel R. Malcom, Sullivan University
College of Pharmacy and Health Sciences, Department of Clinical and
Administrative Sciences, 2100 Gardiner Ln, Louisville, KY 40205, USA.
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20
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Myers AK, Kim TS, Zhu X, Liu Y, Qiu M, Pekmezaris R. Predictors of mortality in a multiracial urban cohort of persons with type 2 diabetes and novel coronavirus 19. J Diabetes 2021; 13:430-438. [PMID: 33486896 PMCID: PMC8013168 DOI: 10.1111/1753-0407.13158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/09/2020] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Diabetes has been identified as a risk factor for intubation and mortality in patients with coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We seek to examine the impact of clinical variables such as glycosylated hemoglobin (HbA1c) on mortality and need for intubation, as well as demographic variables such as age, sex, and race on persons with type 2 diabetes and COVID-19. METHODS Analyses were conducted on 4413 patients with an International Classification of Diseases and Related Health Problems (ICD-10) diagnosis of type 2 diabetes and COVID-19. Survival analysis was conducted using Kaplan-Meier curves and the log-rank test to compare subgroup analyses. RESULTS In this multivariate analysis, male gender, older age, and hyperglycemia at admission were associated with increased mortality and intubation, but this was not seen for race, ethnicity, insurance type, or HbA1c. Based on Kaplan-Meier analysis, having comorbid conditions such as hypertension, chronic kidney disease, and coronary artery disease was associated with a statistically significant increased risk of mortality. CONCLUSIONS Glycemic levels at admission have a greater impact on health outcomes than HbA1c. Older men and those with comorbid disease are also at greater risk for mortality. Further longitudinal studies need to be done to evaluate the impact of COVID-19 on type 2 diabetes.
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Affiliation(s)
- Alyson K. Myers
- Department of Internal Medicine, Division of EndocrinologyNorth Shore University HospitalManhassetNew YorkUSA
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
| | - Tara S. Kim
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Internal Medicine, Division of EndocrinologyLenox Hill HospitalNew YorkNew YorkUSA
| | - Xu Zhu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
- Division of Health Services Research, Department of MedicineCenter for Health Innovations and Outcomes ResearchManhassetNew YorkUSA
| | - Yan Liu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
| | - Michael Qiu
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes ResearchNorthwell HealthManhassetNew YorkUSA
- David and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- The Feinstein Institute for Medical ResearchManhassetNew YorkUSA
- Division of Health Services Research, Department of MedicineCenter for Health Innovations and Outcomes ResearchManhassetNew YorkUSA
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21
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Eyam E, Inaku K, Emin E, Onuche O. Self-monitoring of blood glucose can be misleading without periodic re-calibration of glucose Meters: A pilot study. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_224_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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22
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Moheet A, Chan CL, Granados A, Ode KL, Moran A, Battezzati A. Hypoglycemia in cystic fibrosis: Prevalence, impact and treatment. J Cyst Fibros 2020; 18 Suppl 2:S19-S24. [PMID: 31679723 DOI: 10.1016/j.jcf.2019.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022]
Abstract
Hypoglycemia is a common and feared complication of insulin therapy. As in type 1 and type 2 diabetes, people with cystic fibrosis related diabetes are also at risk for hypoglycemia related to insulin therapy. Spontaneous hypoglycemia is also common in patients with CF without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF may also occur during or after an oral glucose tolerance test. In this review, we will discuss the definition, epidemiology, pathophysiology and impact of hypoglycemia, with a focus on people with cystic fibrosis. We will also review strategies to manage and prevent hypoglycemia.
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Affiliation(s)
- Amir Moheet
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Christine L Chan
- Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Andrea Granados
- Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, USA
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, Milan, Italy
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23
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Patel DM, Patel MV, Gurumukhani JK, Patel MM, Mahadevia HJ, Gajjar RA. Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885515666191227155624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy.
Clinical Case:
A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld.
In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.
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24
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Maidwell-Smith AA, Doel AM, Bernstein RM, Moore SE. Prevalence estimates of diabetes in pregnancy in a rural, sub-Saharan population. Diabetes Res Clin Pract 2020; 169:108455. [PMID: 32979418 PMCID: PMC7738751 DOI: 10.1016/j.diabres.2020.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
AIMS To determine the prevalence of Hyperglycaemia first Detected in Pregnancy (HDIP) in a cohort of women from rural Gambia and compare the diagnostic ability of capillary blood glucose (CBG) sampling to identify HIP versus laboratory-based analysis of venous plasma glucose (VPG). METHODS Pregnant women from rural Gambia (N = 251) underwent a 75 g Oral Glucose Tolerance Test (OGTT) at 28-weeks of gestation. Gestational Diabetes Mellitus was assessed as fasting glucose concentration ≥ 5.1-6.9 mmol/L; ≥10.0 mmol/L at 1-h post load; or ≥ 8.5 mmol/L at 2-h post load and Diabetes in Pregnancy as fasting glucose > 7.0 mmol/L. RESULTS A total of 199 and 244 women had VPG and CBG measurements respectively, and 198 women had both. 32 women (16.1%) were diagnosed with HDIP using VPG, mostly based on fasting concentrations. CONCLUSIONS The prevalence of HDIP in rural Gambia was higher than anticipated, emphasising a need for maternal diabetic policy. Based on the current findings, tailored recommendations could include measuring fasting VPG alone when conducting a full OGTT is not feasible. Similarly, CBG may be of value for excluding disease and thereby limiting costly laboratory-based investigations to a select few.
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Affiliation(s)
| | - Andrew M Doel
- Department of Women and Children's Health, King's College London, London, UK
| | - Robin M Bernstein
- Department of Anthropology, University of Colorado, Boulder, CO, USA; Health and Society Program, Institute of Behavioural Science, University of Colorado, Boulder, CO, USA
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK; MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Gambia.
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Shaw JL, McCudden CR, Colantonio DA, Booth RA, Lin DC, Blasutig IM, Moran T, Trofimczuk D, Carriere C, Gharra A, Portelance C, Tremblay C, Dupaul D, Breton N, Angelkovski M, Jariwala C, Embleton M, Campbell C, Groulx K, Larmour K. Effective interventions to improve the quality of critically high point-of-care glucose meter results. Pract Lab Med 2020; 22:e00184. [PMID: 33145388 PMCID: PMC7596339 DOI: 10.1016/j.plabm.2020.e00184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Point-of-care testing (POCT) is testing performed outside the traditional laboratory, often at the patient bedside. In hospital settings, blood glucose is the most common POCT. Staff performing POCT are not usually laboratory trained; they are clinical staff with a primary focus on treating patients. Clinical staff find POCT quality assurance (QA) practices burdensome and are often non-compliant. In hospitals within EORLA (Eastern Ontario Regional Laboratories Association), all critically high POCT glucose results must be repeated prior to acting, according to policy. Compliance with this policy is audited regularly. Design and methods: All POCT glucose tests performed in participating sites between January and June 2018 and June and December 2019 were audited for compliance with the critical repeat policy. The discordant repeat rate was also determined for each audit period. Between January and May 2019, there were interventions aimed at improving compliance with the repeat policy. Results Compliance with the critical repeat policy increased from 30 to 57% in 2019 compared to 2018, following nursing education and implementation of notifications on the glucose meters themselves. The rate of discordant repeat results (>20% different from initial) also improved at most sites in 2019 compared to 2018. Nurses cited insufficient cleaning of patient hands prior to initial testing as the primary reason for discordant repeats. Conclusions Operator compliance with POCT QA policies is an ongoing challenge requiring continual audit, feedback and education. A strong POCT multi-disciplinary committee with supports from senior and clinical leadership in an organization are key to improving compliance. Compliance with the policy requiring repeat of all critically high POCT glucose results is audited as a quality indicator. Audits demonstrated a high rate of non-compliance with the critical repeat policy by clinical staff performing POCT. Approximately 25% of critically high glucose results repeated were discordant (>20% different from the initial result) Implementation of meter notifications and nursing education led to significant improvements in compliance at most sites.
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Affiliation(s)
- Julie Lv Shaw
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Christopher R McCudden
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - David A Colantonio
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Ronald A Booth
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Danny C Lin
- Eastern Ontario Regional Laboratories Association, Canada.,Division of Biochemistry, The Ottawa Hospital, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada
| | - Ivan M Blasutig
- Eastern Ontario Regional Laboratories Association, Canada.,Department of Pathology and Laboratory Medicine, The University of Ottawa, Canada.,Division of Biochemistry, Children's Hospital of Eastern Ontario, Canada
| | - Thomas Moran
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | - Anas Gharra
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | - Dianne Dupaul
- Eastern Ontario Regional Laboratories Association, Canada
| | | | | | | | | | | | | | - Karen Larmour
- Eastern Ontario Regional Laboratories Association, Canada
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Matos ALS, Moreira JPDL, Luiz RR, da Silva EP, Rodacki M, Gómez JFB, Zajdenverg L. Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:454-461. [PMID: 32267357 PMCID: PMC10522073 DOI: 10.20945/2359-3997000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.
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Affiliation(s)
- Ana Lígia Soares Matos
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Jessica Pronestino de Lima Moreira
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Evelise Pochmann da Silva
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Guzman NA, Guzman DE. A Two-Dimensional Affinity Capture and Separation Mini-Platform for the Isolation, Enrichment, and Quantification of Biomarkers and Its Potential Use for Liquid Biopsy. Biomedicines 2020; 8:biomedicines8080255. [PMID: 32751506 PMCID: PMC7459796 DOI: 10.3390/biomedicines8080255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 02/07/2023] Open
Abstract
Biomarker detection for disease diagnosis, prognosis, and therapeutic response is becoming increasingly reliable and accessible. Particularly, the identification of circulating cell-free chemical and biochemical substances, cellular and subcellular entities, and extracellular vesicles has demonstrated promising applications in understanding the physiologic and pathologic conditions of an individual. Traditionally, tissue biopsy has been the gold standard for the diagnosis of many diseases, especially cancer. More recently, liquid biopsy for biomarker detection has emerged as a non-invasive or minimally invasive and less costly method for diagnosis of both cancerous and non-cancerous diseases, while also offering information on the progression or improvement of disease. Unfortunately, the standardization of analytical methods to isolate and quantify circulating cells and extracellular vesicles, as well as their extracted biochemical constituents, is still cumbersome, time-consuming, and expensive. To address these limitations, we have developed a prototype of a portable, miniaturized instrument that uses immunoaffinity capillary electrophoresis (IACE) to isolate, concentrate, and analyze cell-free biomarkers and/or tissue or cell extracts present in biological fluids. Isolation and concentration of analytes is accomplished through binding to one or more biorecognition affinity ligands immobilized to a solid support, while separation and analysis are achieved by high-resolution capillary electrophoresis (CE) coupled to one or more detectors. When compared to other existing methods, the process of this affinity capture, enrichment, release, and separation of one or a panel of biomarkers can be carried out on-line with the advantages of being rapid, automated, and cost-effective. Additionally, it has the potential to demonstrate high analytical sensitivity, specificity, and selectivity. As the potential of liquid biopsy grows, so too does the demand for technical advances. In this review, we therefore discuss applications and limitations of liquid biopsy and hope to introduce the idea that our affinity capture-separation device could be used as a form of point-of-care (POC) diagnostic technology to isolate, concentrate, and analyze circulating cells, extracellular vesicles, and viruses.
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Affiliation(s)
- Norberto A. Guzman
- Princeton Biochemicals, Inc., Princeton, NJ 08816, USA
- Correspondence: ; Tel.: +1-908-510-5258
| | - Daniel E. Guzman
- Princeton Biochemicals, Inc., Princeton, NJ 08816, USA
- Department of Internal Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; or
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Lane SL, Koenig A. Development and evaluation of a formula to correct blood glucose concentration measurements in hemodiluted and hemoconcentrated feline blood samples tested by use of a veterinary point-of-care glucometer. J Am Vet Med Assoc 2020; 254:1180-1185. [PMID: 31039098 DOI: 10.2460/javma.254.10.1180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of PCV on blood glucose concentration measurements in feline blood samples tested with a point-of-care (POC) glucometer and to develop and evaluate a correction formula that adjusts POC glucometer-measured blood glucose concentration (POCgluc) for a given PCV. DESIGN Experimental and prospective study. SAMPLE Blood samples from 4 healthy and 16 hospitalized cats. PROCEDURES Heparinized blood samples from healthy cats were processed into packed RBCs and plasma. Packed RBCs were resuspended with plasma to achieve PCVs ranging from 0% to 87%. Duplicate PCV and POCgluc measurements were obtained for each suspension. Plasma glucose concentration as measured by a clinical laboratory biochemical analyzer (LABgluc) was assessed; results were compared with the POCgluc. A formula to correct POCgluc measurements for PCV was developed. Blood samples from hospitalized cats were used to evaluate the formula. RESULTS For each healthy cat, LABgluc values were similar for all PCVs; the mean difference between POCgluc and LABgluc at PCVs outside a range of 35% to 55% was significant. Mean differences between POCgluc and LABgluc were 24.3 and 41.5 mg/dL, whereas mean differences between corrected POCgluc and LABgluc were 3 and 25.9 mg/dL for samples from healthy and hospitalized cats, respectively. Correlation between corrected POCgluc and LABgluc was stronger than that between POCgluc and LABgluc for samples from healthy and hospitalized cats. CONCLUSIONS AND CLINICAL RELEVANCE The POCgluc did not reflect LABgluc in hemodiluted or hemoconcentrated feline blood samples. Use of a correction formula appeared to reduce this error. Additional studies are needed to evaluate the frequency with which this correction formula might prevent clinical errors. (J Am Vet Med Assoc 2019;254:1180-1185).
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Moorman JM. Part I: Continuous glucose monitoring systems. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Inman M, Parker K, Strueby L, Lyon AW, Lyon ME. A Simulation Study to Assess the Effect of Analytic Error on Neonatal Glucose Measurements Using the Canadian Pediatric Society Position Statement Action Thresholds. J Diabetes Sci Technol 2020; 14:519-525. [PMID: 31694397 PMCID: PMC7576938 DOI: 10.1177/1932296819884923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Canadian Pediatric Society (CPS) has endorsed an algorithm for the screening and immediate management of babies at risk of neonatal hypoglycemia that provides time-dependent glucose concentration action thresholds. The objective of this study was to evaluate the impact of glucose analytic error (bias and imprecision) on the misclassification of glucose meter results from a neonatal intensive care unit (NICU) using the CPS guidelines. METHODS A simulation dataset of true glucose values (N = 100 000) was derived by finite mixture model analysis of NICU glucose data (N = 23 749). Bias and imprecision were added to create measured glucose values. The percentages of measured glucose values that were misclassified at CPS action thresholds were determined by Monte Carlo simulation. RESULTS Measurement biases ranging from -20 to +20 mg/dL combined with coefficients of variation 0% to 20% were evaluated to predict misclassification rates at 32, 36, and 47 mg/dL. The models demonstrated low risk of false normoglycemia-at 5% CV and +10 mg/dL bias: 0.8% to 5% misclassification at the 32 and 47 mg/dL thresholds due to bias. The models demonstrated risk of false hypoglycemia-at 5% CV and -10 mg/dL bias: 3% to 12.5% misclassification at 32 and 47 mg/dL thresholds due to both bias and imprecision. CONCLUSION Using CPS action thresholds, the simulation model predicted the proportion of neonates at risk of inappropriate clinical action-both of omission or "failure to treat" and commission or "overtreatment" in response to NICU glucose meter results at specific bias and imprecision values.
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Affiliation(s)
- Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kayla Parker
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrew W. Lyon
- Division of Clinical Biochemistry, Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Royal University Hospital, Saskatoon, SK, Canada
| | - Martha E. Lyon
- Division of Clinical Biochemistry, Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Royal University Hospital, Saskatoon, SK, Canada
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von Meyer A, Luppa PB, Cadamuro J. The extended internal QC (eIQC): a new practical approach for quality assurance in point-of-care glucose testing using the POCTopus Software – a pilot study. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Quality assurance (QA) in point-of-care testing (POCT) is an important issue for organizing POCT structures within the healthcare sector. In Germany, only one device needs to participate in an external QA program, if the responsible core laboratory is supervising internal quality controls of all other identical POCT devices. This flexible definition of quality control (QC) testing is in line with the fundamentals of ISO 22870 and the ISO 15189, but can only be regarded as a minimum requirement.
Methods
We present a pilot study for an inexpensive new approach for additional POCT QC measurement similar to the external QA program within the medical laboratory using capillary glucose measurement as an example. This new system, referred to as “extended internal QC (eIQC)”, uses in-house generated QC material from leftover full blood from routine diagnostics. We provide information on calculation of target values and acceptance ranges and preliminary data on stability and comparison between POCT and core laboratory testing (COBAS 8000). Additionally, we simulated the approach using three devices within the laboratory as surrogate for three POCT sites. In this pilot study, measurements of QC material beyond the mandatory QA plan are structured and optimized through the use of the POCTopus Software solution.
Results
QC material was easily generated including specification of target values. The software aided in automatized processing of the samples. The software showed limitations in evaluation and monitoring without relevant use of resources. We found a significant bias between measurements on POCT and COBAS 8000 instruments.
Conclusions
The presented new approach for additional QAs for POCT enables POCT coordinators to establish an additional safety and QC level. Further software improvements are required. Further studies are needed for validation and comparison measurements between methods. Overall, this approach offers great potential for POCT structures seeking higher quality standards.
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Affiliation(s)
- Alexander von Meyer
- Institute for Laboratory Medicine and Microbiology, Kliniken Nordoberpfalz AG , Söllnerstraße 16, 92637 Weiden and Amberg , Germany , Phone: +49-179-2940459
| | - Peter B. Luppa
- Institute for Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar , Technische Universität München , Munich , Germany
| | - Janne Cadamuro
- Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria
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Pilackas K, El-Oshar S, Carter C. Clinical Reliability of Point-of-Care Glucose Testing in Critically Ill Patients. J Diabetes Sci Technol 2020; 14:65-69. [PMID: 31282177 PMCID: PMC7189150 DOI: 10.1177/1932296819858633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Point-of-care (POC) glucometers are commonly used in intensive care units (ICUs). The Centers for Medicare & Medicaid Services have called into question the accuracy of POC glucometers in critically ill patients. This study sought to identify specific characteristics within our facility's ICU patients that were associated with inaccuracies in POC glucose measurements. METHODS We conducted a prospective cohort study that compared POC capillary blood glucose samples with venous samples collected in our ICU. All nonpregnant patients >18 years old admitted to the ICU with orders for daily laboratory testing that included blood glucose were eligible for inclusion. RESULTS A total of 46 patients were enrolled and 85 samples were collected. The mean difference between venous and POC samples was 5.23 mg/dL (95% CI, 3.16-7.3 mg/dL). Measurement inaccuracies would have altered treatment in 7/85 instances (8.2%). The only clinically significant inaccuracy found was the omission of 2 units of insulin in 1 hyperglycemic patient. Measurement inconsistencies generally underestimated low blood glucose values (2/2 instances) and overestimated high blood glucose values (4/5 instances). CONCLUSIONS In our study, the mean difference between venous and POC glucose samples was small. Similarly, measurement inaccuracies that would have altered treatment were rare and only one instance was deemed clinically significant. We conclude that POC capillary glucose testing within our cohort and in similar critically ill patients is likely safe and effective.
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Affiliation(s)
| | - Seraj El-Oshar
- Gwinnett Medical Center - Lawrenceville,
Lawrenceville, GA, USA
| | - Chris Carter
- SSM Health St. Clare Hospital – Fenton,
MO, USA
- Chris Carter, SSM Health St. Clare Hospital
– Fenton, 1015 Bowles Ave., Fenton, MO 63026, USA.
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Principe SC, Augusto A, Costa TM. Point-of-care testing for measuring haemolymph glucose in invertebrates is not a valid method. CONSERVATION PHYSIOLOGY 2019; 7:coz079. [PMID: 31798882 PMCID: PMC6882269 DOI: 10.1093/conphys/coz079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
Blood glucose is widely used as a physiological parameter for vertebrates and invertebrates. However, its measurement in the field is often difficult due to the need for expensive and non-portable equipment. Point-of-care (POC) devices, originally intended for human use, are increasingly being used for measuring blood parameters of animals in the field. In this regard, POC glucose meters are becoming valuable tools for conservation physiologists, as glucose can be a useful indicator of stress response. In invertebrates, the use of POC glucose meters is still scarce, and no study yet has evaluated their usability in crustaceans and molluscs. We tested if a POC device can be used to measure haemolymph glucose in two widely used models, Leptuca thayeri and Perna perna, compared with a standard laboratory method. The device was unable to measure glucose in P. perna haemolymph due to equipment inaccuracy and low glucose concentration in this species (10.13 ± 6.25 mg/dL). Additionally, despite the device being capable of measuring glucose in L. thayeri haemolymph, Bland-Altman plots showed a strong bias and wide limits of agreement, and Lin's concordance correlation coefficient showed a weak concordance between methods. When simulating experimental conditions, POC results differed from those found using the standard method. We conclude that POC glucose meters are unsuitable for assessing glucose in mussels and should not be used in crabs as results are inaccurate.
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Affiliation(s)
- Silas C Principe
- São Paulo State University (UNESP), Biosciences Institute, Botucatu Campus, R. Prof. Dr. Antônio Celso, 250, 18618-000, Botucatu, São Paulo, Brazil
- São Paulo State University (UNESP), Biosciences Institute, Coastal Campus, Praça Infante Dom Henrique, s/n, P.O. Box: 73601, 11380-972, São Vicente, São Paulo, Brazil
| | - Alessandra Augusto
- São Paulo State University (UNESP), Biosciences Institute, Coastal Campus, Praça Infante Dom Henrique, s/n, P.O. Box: 73601, 11380-972, São Vicente, São Paulo, Brazil
- São Paulo State University (UNESP), CAUNESP, Prof. Paulo Donato Castellane, s/n, 14884-900, Jaboticabal, São Paulo, Brazil
| | - Tânia M Costa
- São Paulo State University (UNESP), Biosciences Institute, Botucatu Campus, R. Prof. Dr. Antônio Celso, 250, 18618-000, Botucatu, São Paulo, Brazil
- São Paulo State University (UNESP), Biosciences Institute, Coastal Campus, Praça Infante Dom Henrique, s/n, P.O. Box: 73601, 11380-972, São Vicente, São Paulo, Brazil
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Affiliation(s)
- Mahdi Alsaleem
- The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Lina Saadeh
- The State University of New York, University at Buffalo, Buffalo, NY, USA
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Maciel EDS, Quaresma FRP, Figueiredo FWDS, Sarraf JS, Luis TP, Sesti LFC, Fonseca FLA, Adami F. The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy. CIENCIA & SAUDE COLETIVA 2019; 24:4297-4305. [PMID: 31664401 DOI: 10.1590/1413-812320182411.01012018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 03/29/2018] [Indexed: 11/22/2022] Open
Abstract
The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.
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Affiliation(s)
- Erika da Silva Maciel
- Universidade Federal do Tocantins. Av. Lourdes Solino s/n, Setor Universitário. 77650-000 Miracema do Tocantins, TO, Brasil.
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Point-of-care testing in diabetes management. REV ROMANA MED LAB 2019. [DOI: 10.2478/rrlm-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The prevalence of diabetes mellitus (DM) has rapidly increased over the last decades, reaching epidemic magnitudes, particularly in lowand middle-income countries. Point-of-care (POC) technology enables decision making near or at the site of patient care. Portable blood glucose meters and HbA1c testing are used by the healthcare provider and millions of patients with diabetes to monitor the safety and effectiveness of the diabetes treatment. However, POC capillary blood glucose and POC HbA1c testing are not recommended for diabetes diagnosis. Rather, they have been used for screening diabetes in lowand middle-income countries to decrease the disease burden.
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Andriankaja OM, Muñoz-Torres FJ, Vergara JL, Pérez CM, Joshipura K. Utility of point-of-care vs reference laboratory testing for the evaluation of glucose levels. Diabet Med 2019; 36:626-632. [PMID: 30710457 PMCID: PMC6599708 DOI: 10.1111/dme.13922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
AIMS To assess the level of agreement between point-of-care and laboratory reference glucose values in defining glycaemic status. METHODS We analysed 1292 overweight/obese, non-institutionalized participants, aged 40-65 years, in the San Juan Overweight Adults Longitudinal Study. Fasting venous blood glucose was determined using a point-of-care Bayer Contour Blood Glucose Meter and by Vitros System 250 instrument (laboratory). American Diabetes Association thresholds were used to classify participants into normoglycaemia (< 5.6 mmol/l), prediabetes (5.6 to 6.9 mmol/l), or diabetes groups (≥ 7 mmol/l). RESULTS Bland-Altman plot analysis showed a slope of 0.04 (P=0.002) for the regression between the mean difference and the average of the two methods. The slopes were significantly different from zero among people with normoglycaemia (β=-0.57, P<0.001), and prediabetes (β=-0.75, P<0.001) but not among people with diabetes (β=-0.02, P=0.68). When the prediabetes and diabetes groups were merged into one group, the slope was 0.01, and the glucose values remained similar using the two methods (P=0.76). CONCLUSION Point-of-care blood glucose measurement may be useful to screen people with diabetes, and to assess glucose among individuals with diabetes where blood can be drawn, but laboratory tests are unavailable or untimely.
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Affiliation(s)
- O M Andriankaja
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - F J Muñoz-Torres
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - J L Vergara
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - C M Pérez
- Department of Biostatistics and Epidemiology, School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - K Joshipura
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Güntner AT, Abegg S, Königstein K, Gerber PA, Schmidt-Trucksäss A, Pratsinis SE. Breath Sensors for Health Monitoring. ACS Sens 2019; 4:268-280. [PMID: 30623644 DOI: 10.1021/acssensors.8b00937] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Breath sensors can revolutionize medical diagnostics by on-demand detection and monitoring of health parameters in a noninvasive and personalized fashion. Despite extensive research for more than two decades, however, only a few breath sensors have been translated into clinical practice. Actually, most never even left the scientific laboratories. Here, we describe key challenges that currently impede realization of breath sensors and highlight strategies to overcome them. Specifically, we start with breath marker selection (with emphasis on metabolic and inflammatory markers) and breath sampling. Next, the sensitivity, stability, and selectivity requirements for breath sensors are described. Concepts are elaborated to systematically address these requirements by material design (focusing on chemoresistive metal oxides), orthogonal arrays, and filters. Finally, aspects of portable device integration, user communication, and clinical applicability are discussed.
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Affiliation(s)
- Andreas T. Güntner
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Sebastian Abegg
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
| | - Karsten Königstein
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, CH-4052 Basel, Switzerland
| | - Philipp A. Gerber
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Arno Schmidt-Trucksäss
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, CH-4052 Basel, Switzerland
| | - Sotiris E. Pratsinis
- Particle Technology Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, CH-8092 Zurich, Switzerland
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Villena Gonzales W, Mobashsher AT, Abbosh A. The Progress of Glucose Monitoring-A Review of Invasive to Minimally and Non-Invasive Techniques, Devices and Sensors. SENSORS (BASEL, SWITZERLAND) 2019; 19:E800. [PMID: 30781431 PMCID: PMC6412701 DOI: 10.3390/s19040800] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023]
Abstract
Current glucose monitoring methods for the ever-increasing number of diabetic people around the world are invasive, painful, time-consuming, and a constant burden for the household budget. The non-invasive glucose monitoring technology overcomes these limitations, for which this topic is significantly being researched and represents an exciting and highly sought after market for many companies. This review aims to offer an up-to-date report on the leading technologies for non-invasive (NI) and minimally-invasive (MI) glucose monitoring sensors, devices currently available in the market, regulatory framework for accuracy assessment, new approaches currently under study by representative groups and developers, and algorithm types for signal enhancement and value prediction. The review also discusses the future trend of glucose detection by analyzing the usage of the different bands in the electromagnetic spectrum. The review concludes that the adoption and use of new technologies for glucose detection is unavoidable and closer to become a reality.
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Affiliation(s)
- Wilbert Villena Gonzales
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
| | - Ahmed Toaha Mobashsher
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
| | - Amin Abbosh
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Brisbane 4072, Australia.
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Are point-of-care measurements of glycated haemoglobin accurate in the critically ill? Aust Crit Care 2018; 32:465-470. [PMID: 30591312 DOI: 10.1016/j.aucc.2018.11.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Critically ill patients with type 2 diabetes mellitus (T2DM) and chronic hyperglycaemia may benefit from a more liberal approach to glucose control than patients with previously normal glucose tolerance. It may therefore be useful to rapidly determine HbA1c concentrations. Point-of-care (POC) analysers offer rapid results but may be less accurate than laboratory analysis. AIM(S) The aim of this study was to determine agreement between POC and laboratory HbA1c testing in critically ill patients with T2DM. METHODS Critically ill patients with T2DM had concurrent laboratory, capillary-, and arterial-POC HbA1c measurements performed. Data are presented as mean (standard deviation) or median [interquartile range]. Measurement agreement was assessed by Lin's concordance correlation coefficient, Bland-Altman 95% limits of agreement, and classification by Cohen's kappa statistic. RESULTS HbA1c analysis was performed for 26 patients. The time to obtain a result from POC analysis took a median of 9 [7, 10] minutes. Laboratory analysis took a median of 328 [257, 522] minutes from the time of test request to the time of report. Lin's correlation coefficient showed almost perfect agreement (0.99%) for arterial- vs capillary-POC and both POC methods vs arterial laboratory analysis. Bland-Altman plots showed a mean difference of 2.0 (3.7) with 95% limits of agreement of -5.4 to 9.3 for capillary vs laboratory, 1.6 (3.4) and -5.1 to 8.4 for arterial vs laboratory, and -0.137 (2.6) and -5.2 to 4.9 for capillary vs arterial. Patient classification as having inadequately controlled diabetes (>53 mmol/mol) showed 100% agreement across all tests. CONCLUSIONS HbA1c values can be accurately and rapidly obtained using POC testing in the critically ill.
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Giani E, Macedoni M, Barilli A, Petitti A, Mameli C, Bosetti A, Cristiano A, Radovanovic D, Santus P, Zuccotti GV. Performance of the Flash Glucose Monitoring System during exercise in youth with Type 1 diabetes. Diabetes Res Clin Pract 2018; 146:321-329. [PMID: 30312715 DOI: 10.1016/j.diabres.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022]
Abstract
AIM Metabolic changes during exercise may affect the accuracy of glucose sensors impacting on Type 1 diabetes (T1D) management. The present study aimed at assessing the performance of the Flash Glucose Monitoring system (isCGM) during exercise and in free-living condition in youth with T1D. METHODS Seventeen youth (53% male), aged 13.7 ± 3.8 years, with T1D for 5.4 ± 3.8 years, HbA1c 7.4 ± 1.0% (57 ± 11 mmol/mol), were enrolled. Paired isCGM, plasma (PG) and capillary (CG) glucose values (total of 136) were collected during an interval exercise (45 min at 55% VO2max load with 20 s sprints at 80% VO2max every 10 min). Paired isCGM and CG (total of 832) were collected during free-living condition. RESULTS During exercise, isCGM absolute relative difference (ARDs) means/medians were 12.5/9.4% versus PG and 15.4/10.8% versus CG. During rest, ARDs means/medians were 16.6/12.0%. The Consensus Error Grid analysis showed 98.4% of readings during exercise and 97.24% during rest in zones A + B. Percentage of readings meeting the ISO criteria for CG levels <5.55 mmol/L was 62.5% during exercise, 53.4% during rest; for CG levels ≥5.55 mmol/L was 64.0% during exercise, 60.4% during rest. CONCLUSIONS isCGM demonstrated similar clinical safety and performance during exercise and in everyday life; further studies are needed to confirm its accuracy during exercise.
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Affiliation(s)
- Elisa Giani
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy.
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Anna Barilli
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Agnese Petitti
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Alessandra Bosetti
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
| | - Andrea Cristiano
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, via G.B. Grassi 20157 Milan, Italy
| | - Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, via G.B. Grassi 20157 Milan, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, via G.B. Grassi 20157 Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
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Buse JD, Donovan LE, Naugler CT, Sadrzadeh SMH, de Koning L. Intervention to Reduce Unnecessary Glucose Tolerance Testing in Pregnant Women. J Appl Lab Med 2018; 3:418-428. [PMID: 33636922 DOI: 10.1373/jalm.2018.026047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/04/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) can be diagnosed in pregnant women by increased fasting plasma glucose alone, which eliminates the need for performing a 75 g oral glucose tolerance test (OGTT). If whole blood glucose meters are used to triage fasting samples in order to decide whether to give the glucose drink, a cutpoint with appropriate sensitivity and specificity for elevated fasting plasma glucose is needed. METHODS The number of GDM diagnoses by increased fasting plasma glucose alone was determined from specimens collected and tested at core laboratories in urban hospitals, rural health centers, and from specimens collected at patient phlebotomy service centers (PSCs) for plasma testing at a central laboratory. The number of glucose drinks avoided was counted after implementing the diagnostic cutoff of ≥95 mg/dL (5.3 mmol/L) at urban hospitals and rural health centers, which have on-site plasma testing, and after selecting a PSC meter fasting venous whole blood glucose cutpoint after calculating sensitivity and specificity for plasma glucose ≥95 mg/dL (5.3 mmol/L) using logistic regression. RESULTS Among 4850 OGTTs, there were 1315 GDM diagnoses annually, of which 409 were from increased fasting plasma glucose. Ninety-one percent of OGTTs were performed at PSCs. If a fasting plasma glucose cutpoint of ≥95 mg/dL (5.3 mmol/L) was implemented at urban hospitals and rural health centers and a meter fasting venous whole blood glucose cutpoint of ≥108 mg/dL (6.0 mmol/L) (25% sensitivity, 99.9% specificity) was implemented at PSCs, the drink would be appropriately avoided by 145 patients/year, and inappropriately avoided by 3 patients/year. After implementing these cutpoints, the drink was appropriately avoided in 91 patients during a 36-week period, with none inappropriately avoiding it. CONCLUSION Modifying fasting glucose cutpoints reduced unnecessary diagnostic OGTTs in pregnant women.
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Affiliation(s)
- Joshua D Buse
- Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lois E Donovan
- Diabetes in Pregnancy Clinic, Calgary Zone, Alberta Health Services Division of Endocrinology and Metabolism, and the Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher T Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S M Hossein Sadrzadeh
- Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence de Koning
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Smith KE, Brown CS, Manning BM, May T, Riker RR, Lerwick PA, Hayes TL, Fraser GL. Accuracy of Point-of-Care Blood Glucose Level Measurements in Critically Ill Patients with Sepsis Receiving High-Dose Intravenous Vitamin C. Pharmacotherapy 2018; 38:1155-1161. [PMID: 30230568 DOI: 10.1002/phar.2182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE High-dose intravenous vitamin C is a potential treatment option for patients with sepsis and may interfere with point-of-care (POC) blood glucose (BG) testing. This study aimed to determine if vitamin C dosing used for sepsis affected POC BG level results. DESIGN Prospective observational pilot study. SETTING Intensive care unit in a large academic tertiary care medical center. PATIENTS Five consecutive critically ill adults hospitalized between April 1 and June 1, 2017, who received two or more doses of intravenous vitamin C 1500 mg for the treatment of sepsis and had at least two paired POC BG levels and laboratory venous BG levels measured within 1 hour of each other during vitamin C therapy. MEASUREMENTS AND MAIN RESULTS The performance of POC BG level measurement was compared with the reference method of laboratory BG level measurement. The concordance to minimum accuracy criteria for BG meters set forth by the International Organization for Standardization (ISO) 15197:2013, the measurement of agreement between POC BG level and laboratory BG level using the Bland-Altman method, and the clinical accuracy through Parkes error grid analysis were assessed. A total of 16 paired POC and laboratory BG level measurements from the five patients were included. The accuracy of POC BG with laboratory BG level measurements during vitamin C administration according to ISO 15197:2013 criteria was 81.3%, which did not meet the minimum accuracy criteria of 95%. The Bland-Altman analysis showed a mean difference between POC and laboratory BG levels of 8.9 mg/dl, and the Parkes error grid analysis showed that the differences between POC and laboratory BG level measurements would not have resulted in a change in clinical action. CONCLUSION The accuracy and agreement of POC and laboratory BG level measurements in critically ill patients receiving vitamin C were consistent with previously published reports in critically ill patients not receiving vitamin C and did not demonstrate clinically significant interference due to vitamin C dosing for sepsis.
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Affiliation(s)
- Kathryn E Smith
- Department of Pharmacy, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | | | | | - Teresa May
- Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland Maine
| | - Richard R Riker
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland Maine
| | - Patricia A Lerwick
- Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland Maine
| | - Timothy L Hayes
- Department of Pathology, Maine Medical Center, Portland, Maine
| | - Gilles L Fraser
- Department of Pharmacy, Maine Medical Center, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts.,Department of Critical Care Medicine, Neuroscience Institute, Maine Medical Center, Portland Maine
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Omengue AM, Sobngwi E, Dehayem M, Balt EV, Boli AM, Choukem SP, Gautier JF, Mbanya JC. Effect of Body Lotions on Capillary Blood Glucose Measurement - Interference of Hydroquinone-Containing Body Lotion with Capillary Glucose Measurement. EUROPEAN ENDOCRINOLOGY 2018; 14:44-46. [PMID: 29922351 PMCID: PMC5954594 DOI: 10.17925/ee.2018.14.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
Abstract
The reliability of capillary blood glucose measurements is tremendously important for patients’ care and follow-up. Some factors independent of glucose control could however affect readings during ambulatory monitoring of capillary glucose levels in patients with diabetes mellitus. We sought to evaluate the impact of three body lotions commonly used in Cameroon on different strata of glycaemia. We explored their influence over time on measured capillary glucose values. We enrolled 16 participants. Eligible individuals were adult patients with diabetes (n=12) stratified into three levels of capillary glucose values (100 ± 40 mg/dL [5.55 ± 2.22 mmol/L], 200 ± 40 mg/dL [11.1 ± 2.22 mmol/L] and 300 ± 40 mg/dL [16.65 ± 2.22 mmol/L]) and normoglycaemic individuals (n=4). We measured capillary blood glucose before application, immediately after, then 5, 30 and 60 minutes after application of sweet almond oil, corticosteroid cream and hydroquinone lotion. The measurements made on impregnated body lotion-permeated fingers were compared to that of a clean finger. We observed a significant increase (delta [95% confidence interval, CI]: 119.5% [77.4–222.1]) of capillary glucose level immediately after administration of hydroquinone-containing body lotion (p<0.001). Capillary glucose values after the use of corticoid cream and sweet almond oil was stable 5, 30 and 60 minutes after application (p=0.875 and p=0.883 respectively). In the case of the hydroquinone-containing body lotion, there was a significant difference between capillary glucose level at 5 minutes (delta [95%CI]: 81.6% [55.3–214.2]; p<0.001), 30 minutes (delta [95%CI]: 71.6% [21.8–134.6]; p<0.001) and 60 minutes (delta [95%CI]: 58.3% [2.8–133.3]; p=0.013) after application compared to the value obtained from the clean finger. We observed from our study that there were significant variations in capillary blood glucose measurements induced by the use of hydroquinone lotion.
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Affiliation(s)
- Andrea Ma Omengue
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Eugène Sobngwi
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon
| | - Mesmin Dehayem
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Eric V Balt
- Diabetes Research Centre, Vrije Universiteit Brussel, Brussels, Belgium.,Diabetes Clinic, Department of Internal Medicine, Universitair Ziekenhuis Brussel - UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anne Mo Boli
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Simeon P Choukem
- Faculty of Health Sciences, University of Buea, Cameroon.,Department of Internal Medicine, Douala General Hospital, Cameroon
| | - Jean F Gautier
- Department of Endocrinology and Diabetes, Lariboisière Hospital, University Paris-Diderot, Paris, France.,Inserm UMRS 1138, Cordeliers Research Centre, Paris, France
| | - Jean-Claude Mbanya
- National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.,Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Laboratory of Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon
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Lundsgaard-Nielsen SM, Pors A, Banke SO, Henriksen JE, Hepp DK, Weber A. Critical-depth Raman spectroscopy enables home-use non-invasive glucose monitoring. PLoS One 2018; 13:e0197134. [PMID: 29750797 PMCID: PMC5947912 DOI: 10.1371/journal.pone.0197134] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/26/2018] [Indexed: 11/24/2022] Open
Abstract
One of the most ambitious endeavors in the field of diabetes technology is non-invasive glucose sensing. In the past decades, a number of different technologies have been assessed, but none of these have found its entry into general clinical use. We report on the development of a table-top confocal Raman spectrometer that was used in the home of patients with diabetes and operated for extended periods of time unsupervised and without recalibration. The system is based on measurement of glucose levels at a ‘critical depth’ in the skin, specifically in the interstitial fluid located below the stratum corneum but above the underlying adipose tissue layer. The region chosen for routine glucose measurements was the base of the thumb (the thenar). In a small clinical study, 35 patients with diabetes analyzed their interstitial fluid glucose for a period of 60 days using the new critical-depth Raman (CD-Raman) method and levels were correlated to reference capillary blood glucose values using a standard finger-stick and test strip product. The calibration of the CD-Raman system was stable for > 10 days. Measurement performance for glucose levels present at, or below, a depth of ~250μm below the skin surface was comparable to that reported for currently available invasive continuous glucose monitors. In summary, using the CD-Raman technology we have demonstrated the first successful use of a non-invasive glucose monitor in the home.
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Affiliation(s)
| | | | | | - Jan E. Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Bhide A, Muthukumar S, Saini A, Prasad S. Simultaneous lancet-free monitoring of alcohol and glucose from low-volumes of perspired human sweat. Sci Rep 2018; 8:6507. [PMID: 29695724 PMCID: PMC5916883 DOI: 10.1038/s41598-018-24543-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/26/2018] [Indexed: 01/03/2023] Open
Abstract
A lancet-free, label-free biosensor for simultaneous detection of sweat glucose and alcohol was demonstrated using zinc oxide thin films integrated into a nanoporous flexible electrode system. Sensing was achieved from perspired human sweat at low volumes (1-3 μL), comparable to ambient conditions without external stimulation. Zinc oxide thin film electrodes were surface functionalized with alcohol oxidase enzyme and with glucose oxidase enzyme towards developing an affinity biosensor specific to the physiological relevant range of alcohol comprising of 0-2 drinks (0-50 mg/dl) and physiologically relevant range of glucose ranging from hypo- to hyper-glycaemia (50-130 mg/dl) in perspired human sweat. Sensing was achieved by measuring impedance changes associated with alcohol and glucose binding onto the sensor interface using electrochemical impedance spectroscopy with a dynamic range from 0.01-200 mg/dl and a limit of detection of 0.01 mg/dl for alcohol in human sweat. Sensor calibration in synthetic sweat containing interferents (25-200 mg/dl) and comparison using regression and Bland-Altman analysis of sweat sensor performance was done with BACtrack®. Combinatorial detection of glucose and ethanol in perspired human sweat and comparison of sweat sensor performance with Accu-Chek® blood glucose monitoring system that we expect would be relevant for pre-diabetics and diabetics for monitoring their glucose levels and alcohol consumption.
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Affiliation(s)
- Ashlesha Bhide
- Department of Bioengineering, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080, USA
| | | | - Amreek Saini
- Department of Bioengineering, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080, USA
| | - Shalini Prasad
- Department of Bioengineering, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX, 75080, USA.
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Bikker R, Grote-Koska D, Domberg P, Brand K. Validity of two POCT glucose measurement devices in hypoglycaemia - how reliable is my result? Scandinavian Journal of Clinical and Laboratory Investigation 2017; 78:157-158. [PMID: 29199450 DOI: 10.1080/00365513.2017.1411971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rolf Bikker
- a Institute of Clinical Chemistry, Hannover Medical School , Hannover , Germany
| | - Denis Grote-Koska
- a Institute of Clinical Chemistry, Hannover Medical School , Hannover , Germany
| | - Petra Domberg
- a Institute of Clinical Chemistry, Hannover Medical School , Hannover , Germany
| | - Korbinian Brand
- a Institute of Clinical Chemistry, Hannover Medical School , Hannover , Germany
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