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McElfish PA, Riklon S, Andersen JA, Selig JP, Hudson J, Bing WI, Wase-Jacklick F, Niedenthal J, Lemari K, Otuafi H, Mendoza-Kabua P, Henske JA, Edem D, Rowland B, Schuh JB, O'Connor G, Ason M, Bauleni A, Ayers BL. Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol. Contemp Clin Trials 2024; 146:107705. [PMID: 39357739 DOI: 10.1016/j.cct.2024.107705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/12/2024] [Accepted: 09/28/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION The Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families. METHODS The purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study. SUMMARY This study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.
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Affiliation(s)
- Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA.
| | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Jennifer A Andersen
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - James P Selig
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Jonell Hudson
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Williamina Ioanna Bing
- University of Arkansas for Medical Sciences RMI, PO Box 50, G&L Building Uliga, Ste 4, Majuro, MH 96960, USA
| | | | - Jack Niedenthal
- RMI Ministry of Health & Human Services, PO Box 3131, Majuro, MH 96960, USA
| | - Kyle Lemari
- RMI Ministry of Health & Human Services, PO Box 3131, Majuro, MH 96960, USA
| | - Henry Otuafi
- Marshall Islands National Police Department, 90 Delap Main Rd, Majuro, MH 96960, USA
| | - Philmar Mendoza-Kabua
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Joseph A Henske
- University of Arkansas for Medical Sciences, 4301 W. Markham Ave, Little Rock, AR 72205, USA
| | - Dinesh Edem
- University of Arkansas for Medical Sciences, 4301 W. Markham Ave, Little Rock, AR 72205, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Janine Boyers Schuh
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Gail O'Connor
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Mohammed Ason
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Andy Bauleni
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
| | - Britni L Ayers
- University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St, Springdale, AR 72762, USA
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2
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Sacks DB, Kirkman MS, Little RR. Point-of-Care HbA1c in Clinical Practice: Caveats and Considerations for Optimal Use. Diabetes Care 2024; 47:1104-1110. [PMID: 38552140 PMCID: PMC11208753 DOI: 10.2337/dci23-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/04/2024] [Indexed: 06/22/2024]
Abstract
Hemoglobin A1c (A1C) is widely used for the diagnosis and management of diabetes. Accurate measurement of A1C is necessary for optimal clinical value. Assay standardization has markedly improved the accuracy and consistency of A1C testing. Devices to measure A1C at point of care (POC) are commercially available, allowing rapid results when the patient is seen. In this review, we describe how standardization of A1C testing was achieved, leading to high-quality results in clinical laboratories. We address the use of POC A1C testing in clinical situations and summarize the advantages and disadvantages of POC A1C testing. We emphasize the importance of considering the limitations of these devices and following correct testing procedures to ensure that accurate A1C results are obtained for optimal care of patients.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - M. Sue Kirkman
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randie R. Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO
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Shah VN, Kanapka LG, Karakus KE, Kollman C, Beck RW. The Association of High and Low Glycation With Incident Diabetic Retinopathy in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241254811. [PMID: 38805364 DOI: 10.1177/19322968241254811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND We investigated the risk of incident diabetic retinopathy (DR) among high glycator compared to low glycator patients based on the hemoglobin glycation index (HGI). Visit-to-visit variations in HGI also were assessed. METHODS Glycated hemoglobin (HbA1c) and continuous glucose monitoring data were collected up to 7 years prior to the date of eye examination defining incident DR or no retinopathy (control). Hemoglobin glycation index was calculated as difference in measured HbA1c and an estimated A1c from sensor glucose (eA1c) to define high (HbA1c - eA1c >0%) or low (HbA1c - eA1c <0%) glycator. Stable glycators were defined as ≥75% of visits with same HGI category. Logistic regression was used to assess the association between glycation category and incident DR. RESULTS Of 119 adults with type 1 diabetes (T1D), 49 (41%) were stable low glycator (HbA1c - eA1c <0%), 36 (30%) were stable high glycator (HbA1c - eA1c >0%), and 34 (29%) were unstable glycator. Using alternate criteria to define high vs low glycator (consistent difference in HbA1c - eA1c of > 0.4% or <0.4%, respectively), 53% of the adults were characterized as unstable glycator. Compared to low glycators, high glycators did not have a significantly higher risk for incident DR over time when adjusted for age, T1D duration and continuous glucose monitoring (CGM) sensor type (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 0.48-3.62, P = .15). CONCLUSIONS The risk of diabetic retinopathy was not found to differ significantly comparing high glycators to low glycators in adults with T1D. Moreover, HbA1c - eA1c relationship was not stable in nearly 30% to 50% adults with T1D, suggesting that discordance in HbA1c and eA1c are mostly related either HbA1c measurements or estimation of A1c from sensor glucose rather than physiological reasons.
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Affiliation(s)
- Viral N Shah
- Division of Endocrinology & Metabolism and Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Kagan Ege Karakus
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
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Short E, Selig JP, Felix HC, Painter J, McElfish PA, Rowland B, Ammerman AS, Bounds K, Henske J, Hudson JS, Li J, Young SG, Long CR. Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol. Contemp Clin Trials 2024; 140:107491. [PMID: 38458560 PMCID: PMC11065573 DOI: 10.1016/j.cct.2024.107491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION NCT04876053.
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Affiliation(s)
- Eliza Short
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jacob Painter
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK, Chapel Hill, NC 27599, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Christopher R Long
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
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5
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Selvin E, Stanton RC, Gabbay RA. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S20-S42. [PMID: 38078589 PMCID: PMC10725812 DOI: 10.2337/dc24-s002] [Citation(s) in RCA: 131] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Patel B, Judson T, Li P, Johnson K, Talley M. Diabetes Distress in Uninsured Patients with Diabetes During COVID-19 Pandemic: A Longitudinal Observational Study. J Community Health Nurs 2023; 40:233-241. [PMID: 36999671 DOI: 10.1080/07370016.2023.2186178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
This study assessed diabetes distress (DD) and glycemic control levels through three time periods during the COVID-19 pandemic in uninsured patients with diabetes. Diabetes Distress Screening Scales 2 and 17 were utilized to identify the prevalence of DD among uninsured patients during multiple stages of the COVID-19 pandemic at the Providing Access to Healthcare (PATH) diabetes clinic at the University of Alabama at Birmingham. For the 328 uninsured diabetic patients who were screened for DD at least once, the mean age was 46 years old with a majority being Black (55.5%), male (56.1%), and non-Hispanic (89.9%). Mean scores reflecting patients' level of DD initially increased in the first 6 months of the pandemic, from 2.86 to 3.44, and then decreased after 12 months of the COVID-19 pandemic to 3.09, while their mean hemoglobin A1c (HbA1c) followed a similar pattern of initial increase (from 11.31 to 12.13) followed by a decline (to 10.79). Addressing patient concerns quickly through early interventions to provide alternative means of care through telehealth and accommodating safe pick-up of diabetes supplies and medications, including insulin, can reduce DD and contribute to better management of glycemic control. Understanding the potential direct correlation of DD with HbA1c in uninsured patients with diabetes is an important factor for clinicians when providing care to this vulnerable population.
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Affiliation(s)
- Bela Patel
- Instructor, University of Alabama at Birmingham School of Nursing, Department of Acute, Chronic, and Continuing Care, Birmingham, Alabama, USA
| | - Tonya Judson
- Instructor, University of Alabama at Birmingham School of Nursing, Department of Family, Community & Health System, Birmingham, Alabama, USA
| | - Peng Li
- Associate Professor & Biostatistician, University of Alabama at Birmingham School of Nursing, Department of Acute, Chronic, and Continuing Care, Birmingham, Alabama, USA
| | - Karmie Johnson
- Assistant Professor, University of Alabama at Birmingham School of Nursing, Family, Community & Health System, Birmingham, Alabama, USA
| | - Michele Talley
- Interim Associate Dean for Clinical and Global Partnerships, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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8
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Short E, Gannon MA, Bounds K, Faitak B, Martin P, Moore S, Shannon D, Selig JP, English ES, Felix HC, Haggard-Duff L, Mejia-Otero J, McElfish PA, Long CR. An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol. Contemp Clin Trials Commun 2023; 33:101139. [PMID: 37215390 PMCID: PMC10195850 DOI: 10.1016/j.conctc.2023.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Diabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. Methods This is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. Results Recruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. Conclusion Findings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.
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Affiliation(s)
- Eliza Short
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Matthew A. Gannon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Pam Martin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Sarah Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - DeAnna Shannon
- Samaritan Community Center, 1211 W. Hudson Rd., Rogers, AR, 72756, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Emily S. English
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Juan Mejia-Otero
- Department of Pediatric Endocrinology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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10
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Pi L, Zheng Y, Shi X, Wang Z, Zhou Z. Using point-of-care HbA1c to facilitate the identification of diabetes and abnormal glucose regulation in primary healthcare settings. Front Public Health 2023; 11:1078361. [PMID: 37228727 PMCID: PMC10203162 DOI: 10.3389/fpubh.2023.1078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background Glycated hemoglobin A1c (HbA1c) is a critical index for the diagnosis and glycemic control evaluation of diabetes. However, a standardized method for HbA1c measurement is unaffordable and unavailable among the Chinese population in low-resource rural settings. Point-of-care (POC) HbA1c testing is convenient and inexpensive, but its performance remains to be elucidated. Objective To investigate the value of POC HbA1c for identifying diabetes and abnormal glucose regulation (AGR) in the resource-limited Chinese population. Methods Participants were recruited from 6 Township Health Centers in Hunan Province. Samples for POC HbA1c, venous HbA1c, fasting plasma glucose, and 2 h-plasma glucose were obtained after physical examination. The oral glucose tolerance test was performed as the gold standard for diagnosis. The diagnostic capacities of the POC HbA1c measurement in predicting undiagnosed diabetes and AGR were evaluated. Results Among 388 participants, 274 (70.6%) normoglycemic controls, 63 (16.2%) prediabetes patients, and 51 (13.1%) diabetes patients were identified with oral glucose tolerance test (OGTT). Meanwhile, among 97 participants who underwent two HbA1c detection methods simultaneously, a positive correlation was found between POC HbA1c and standardized HbA1c (r = 0.75, P < 0.001). No notable systematic difference was observed from the Bland-Altman Plots. The POC HbA1c cutoff values were 5.95 and 5.25%, which efficiently identified diabetes (AUC 0.92) and AGR (AUC 0.89), respectively. Conclusions The alternative POC HbA1c test efficiently discriminated AGR and diabetes from normoglycemia, especially among the Chinese population in primary healthcare settings.
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Affiliation(s)
- Linhua Pi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zheng
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Center for Medical Research, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiajie Shi
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen Wang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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11
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Petrovski G, Campbell J, Pasha M, Day E, Hussain K, Khalifa A, van den Heuvel T. Simplified Meal Announcement Versus Precise Carbohydrate Counting in Adolescents With Type 1 Diabetes Using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control. Diabetes Care 2023; 46:544-550. [PMID: 36598841 PMCID: PMC10148675 DOI: 10.2337/dc22-1692] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/03/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We aimed to compare glucose control in adolescents with type 1 diabetes (T1D) using the MiniMed 780G system who used simplified meal announcement with those who used precise carbohydrate counting. RESEARCH DESIGN AND METHODS This randomized controlled trial included 34 participants (age 12-18 years) with T1D who were on multiple daily injections or insulin pump and were scheduled to start using the MiniMed 780G system at Sidra Medicine in Qatar. After a 7-day run-in period, participants were randomly assigned to the fix group (simplified meal announcement by preset of three personalized fixed carbohydrate amounts) or the flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary end point. Secondary end points included HbA1c and other glycometrics. RESULTS During the 12-week study phase, TIR was 73.5 ± 6.7% in the fix and 80.3 ± 7.4% in the flex group, with a between-group difference of 6.8% in favor of flex (P = 0.043). Time >250 mg/dL was better in the flex group (P = 0.012), whereas HbA1c (P = 0.168), time below range (P = 0.283), and time between 180 and 250 mg/dL (P = 0.114) did not differ. CONCLUSIONS Adolescents using the MiniMed 780G system with a preset of three personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.
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Affiliation(s)
- Goran Petrovski
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Judith Campbell
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Maheen Pasha
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Emma Day
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
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Mandali PK, Prabakaran A, Annadurai K, Krishnan UM. Trends in Quantification of HbA1c Using Electrochemical and Point-of-Care Analyzers. SENSORS (BASEL, SWITZERLAND) 2023; 23:1901. [PMID: 36850502 PMCID: PMC9965793 DOI: 10.3390/s23041901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Glycated hemoglobin (HbA1c), one of the many variants of hemoglobin (Hb), serves as a standard biomarker of diabetes, as it assesses the long-term glycemic status of the individual for the previous 90-120 days. HbA1c levels in blood are stable and do not fluctuate when compared to the random blood glucose levels. The normal level of HbA1c is 4-6.0%, while concentrations > 6.5% denote diabetes. Conventionally, HbA1c is measured using techniques such as chromatography, spectroscopy, immunoassays, capillary electrophoresis, fluorometry, etc., that are time-consuming, expensive, and involve complex procedures and skilled personnel. These limitations have spurred development of sensors incorporating nanostructured materials that can aid in specific and accurate quantification of HbA1c. Various chemical and biological sensing elements with and without nanoparticle interfaces have been explored for HbA1c detection. Attempts are underway to improve the detection speed, increase accuracy, and reduce sample volumes and detection costs through different combinations of nanomaterials, interfaces, capture elements, and measurement techniques. This review elaborates on the recent advances in the realm of electrochemical detection for HbA1c detection. It also discusses the emerging trends and challenges in the fabrication of effective, accurate, and cost-effective point-of-care (PoC) devices for HbA1c and the potential way forward.
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Affiliation(s)
- Pavan Kumar Mandali
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
| | - Amrish Prabakaran
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
| | - Kasthuri Annadurai
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
- School of Arts, Sciences, Humanities & Education, SASTRA Deemed University, Thanjavur 613 401, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology& Advanced Biomaterials, SASTRA Deemed University, Thanjavur 613 401, India
- School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur 613 401, India
- School of Arts, Sciences, Humanities & Education, SASTRA Deemed University, Thanjavur 613 401, India
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13
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Turner-McGrievy GM, Wilson MJ, Carswell J, Okpara N, Aydin H, Bailey S, Davey M, Hutto B, Wilcox S, Friedman DB, Sarzynski MA, Liese AD. A 12-Week Randomized Intervention Comparing the Healthy US, Mediterranean, and Vegetarian Dietary Patterns of the US Dietary Guidelines for Changes in Body Weight, Hemoglobin A1c, Blood Pressure, and Dietary Quality among African American Adults. J Nutr 2023; 153:579-587. [PMID: 36894249 PMCID: PMC10196600 DOI: 10.1016/j.tjnut.2022.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The US Dietary Guidelines (USDG) form the basis of nutrition guidelines, but the research informing the 3 USDG dietary patterns (Healthy US-Style [H-US], Mediterranean [Med], and vegetarian [Veg]) has been drawn largely from observational studies among White populations. OBJECTIVES The Dietary Guidelines 3 Diets study was a 3-arm, 12-wk randomly assigned intervention among African American (AA) adults at risk of type 2 diabetes mellitus that tested the 3 USDG dietary patterns. METHODS The AAs (ages 18-65 y, BMI 25-49.9 kg/m2, and BMI was measured in kg/m2) with ≥3 type 2 diabetes mellitus risk factors were recruited. Weight, HbA1c, blood pressure, and dietary quality (healthy eating index [HEI]) were collected at baseline and 12 wk. In addition, participants attended weekly online classes that were designed using material from the USDG/MyPlate. Repeated measures, mixed models with maximum likelihood estimation, and robust computation of standard errors were tested. RESULTS Of the 227 participants screened, 63 were eligible (83% female; age 48.0 ± 10.6 y, BMI 35.9 ± 0.8 kg/m2) and randomly assigned to the Healthy US-Style Eating Pattern (H-US) (n = 21, 81% completion), healthy Mediterranean-style eating pattern (Med) (n = 22, 86% completion), or healthy vegetarian eating pattern (Veg) (n = 20, 70% completion) groups. Within-group, but not between groups, weight loss was significant (-2.4 ± 0.7 kg H-US, -2.6 ± 0.7 kg Med, -2.4 ± 0.8 kg Veg; P = 0.97 between group). There was also no significant difference between groups for changes in HbA1c (0.03 ± 0.05% H-US, -0.10 ± 0.05% Med, 0.07 ± 0.06% Veg; P = 0.10), systolic BP (-5.5 ± 2.7 mmHg H-US, -3.2 ± 2.5 mmHg Med, -2.4 ± 2.9 mmHg Veg; P = 0.70), diastolic blood pressure (-5.2 ± 1.8 mmHg H-US, -2.0 ± 1.7 mmHg Med, -3.4 ± 1.9 mmHg Veg; P = 0.41), or HEI (7.1 ± 3.2 H-US, 15.2 ± 3.1 Med, 4.6 ± 3.4 Veg; P = 0.06). Post hoc analyses showed that the Med group had significantly greater improvements in HEI compared to the Veg group (difference = -10.6 ± 4.6; 95% CI: -19.7, -1.4; P = 0.02). CONCLUSIONS The present study demonstrates that all 3 USDG dietary patterns lead to significant weight loss among AA adults. However, none of the outcomes were significantly different between groups. This trial was registered at clinicaltrials.gov as NCT04981847.
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Affiliation(s)
- Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Mary J Wilson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jessica Carswell
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nkechi Okpara
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Halide Aydin
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shiba Bailey
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Marty Davey
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S19-S40. [PMID: 36507649 PMCID: PMC9810477 DOI: 10.2337/dc23-s002] [Citation(s) in RCA: 816] [Impact Index Per Article: 816.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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15
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Amen MT, Pham TTT, Cheah E, Tran DP, Thierry B. Metal-Oxide FET Biosensor for Point-of-Care Testing: Overview and Perspective. Molecules 2022; 27:molecules27227952. [PMID: 36432052 PMCID: PMC9698540 DOI: 10.3390/molecules27227952] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Metal-oxide semiconducting materials are promising for building high-performance field-effect transistor (FET) based biochemical sensors. The existence of well-established top-down scalable manufacturing processes enables the reliable production of cost-effective yet high-performance sensors, two key considerations toward the translation of such devices in real-life applications. Metal-oxide semiconductor FET biochemical sensors are especially well-suited to the development of Point-of-Care testing (PoCT) devices, as illustrated by the rapidly growing body of reports in the field. Yet, metal-oxide semiconductor FET sensors remain confined to date, mainly in academia. Toward accelerating the real-life translation of this exciting technology, we review the current literature and discuss the critical features underpinning the successful development of metal-oxide semiconductor FET-based PoCT devices that meet the stringent performance, manufacturing, and regulatory requirements of PoCT.
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16
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Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations. Contemp Clin Trials Commun 2022; 30:101007. [PMID: 36186543 PMCID: PMC9515595 DOI: 10.1016/j.conctc.2022.101007] [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: 06/22/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023] Open
Abstract
Background Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches). Methods Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy. Conclusion The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.
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17
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Abildgaard A, Knudsen CS, Bjerg LN, Lund S, Støy J. Lot variation and inter-device differences contribute to poor analytical performance of the DCA Vantage™ HbA 1c POCT instrument in a true clinical setting. Clin Chem Lab Med 2022; 60:127-134. [PMID: 34480844 DOI: 10.1515/cclm-2021-0720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The glycated haemoglobin fraction A1c (HbA1c) is widely used in the management of diabetes mellitus, and the Siemens DCA Vantage™ point-of-care testing (POCT) instrument offers rapid HbA1c results even far from a clinical laboratory. However, the analytical performance has been questioned, and not much is known about effects of changing reagent lot, instrument and operator. We therefore compared the analytical performance of the DCA Vantage™ with established routine methods (Tosoh G8/G11 ion exchange HPLC) in a true clinical setting at two Danish hospitals. METHODS We extracted all routine clinical HbA1c results incidentally drawn from the same patient within 48 h (n=960 pairs) and evaluated the effect of reagent lot, operator and instrument. We also performed a prospective method comparison in our diabetes out-patient clinic (n=97). RESULTS The critical difference (CD) between two POCT results varied between 5.14 and 6.61 mmol/mol (0.47-0.55%), and the analytical imprecision of the DCA Vantage™ (CVA) was >3%. Significant effect of reagent lot and inter-instrument differences were found, whereas no effect of operator was seen. CONCLUSIONS The DCA Vantage™ HbA1c analysis does not fulfil the prevailing analytical performance specifications, but rigorous validation of new reagent lots and continuous recalibration of instruments may potentially improve the precision substantially. Our findings, therefore, clearly emphasise the necessity of a close collaboration between clinicians and laboratory professionals in the POCT field. Finally, POCT HbA1c results should always be interpreted together with other measures of glycaemic control to avoid inappropriate change of patient treatments due to measurement uncertainty.
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Affiliation(s)
- Anders Abildgaard
- Department of Clinical Biochemistry, Regional Hospital Horsens, Horsens, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Lise Nørkjær Bjerg
- Department of Clinical Biochemistry, Regional Hospital Central Jutland, Viborg, Denmark
| | - Sten Lund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
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Styles S, Wheeler B, Boucsein A, Crocket H, de Lange M, Signal D, Wiltshire E, Cunningham V, Lala A, Cutfield W, de Bock M, Serlachius A, Jefferies C. A comparison of FreeStyle Libre 2 to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control: a 12-week randomised controlled trial protocol. J Diabetes Metab Disord 2021; 20:2093-2101. [PMID: 34900845 PMCID: PMC8630241 DOI: 10.1007/s40200-021-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Purpose Frequent glucose monitoring is necessary for optimal glycaemic control. Second-generation intermittently scanned glucose monitoring (isCGM) systems inform users of out-of-target glucose levels and may reduce monitoring burden. We aim to compare FreeStyle Libre 2 (Abbott Diabetes Care, Witney, U.K.) to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control. Methods This open-label randomised controlled trial will enrol 100 children (4–13 years inclusive, diagnosis of type 1 diabetes ≥ 6 months, HbA1c 58–110 mmol/mol [7.5–12.2%]), from 5 New Zealand diabetes centres. Following 2 weeks of blinded sensor wear, children will be randomised 1:1 to control or intervention arms. The intervention (duration 12 weeks) includes second-generation isCGM (FreeStyle Libre 2) and education on using interstitial glucose data to manage diabetes. The control group will continue self-monitoring blood glucose. The primary outcome is the difference in glycaemic control (measured as HbA1c) between groups at 12 weeks. Pre-specified secondary outcomes include change in glucose monitoring frequency, glycaemic control metrics and psychosocial outcomes at 12 weeks as well as isCGM acceptability. Discussion This research will investigate the effectiveness of the second-generation isCGM to promote recommended glycaemic control. The results of this trial may have important implications for including this new technology in the management of children with type 1 diabetes. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 19 February 2020 (ACTRN12620000190909p) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1237-0090).
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Affiliation(s)
- Sara Styles
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Ben Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatrics, Southern District Health Board, Dunedin, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Hamish Crocket
- Health, Sport and Human Performance, School of Health, University of Waikato, Hamilton, New Zealand
| | - Michel de Lange
- Centre for Biostatistics, Te Pokapū Tatauranga Koiora, Division of Health Sciences, Dunedin, New Zealand
| | - Dana Signal
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand.,Capital & Coast District Health Board, Wellington, New Zealand.,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Anita Lala
- Paediatrics, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Wayne Cutfield
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Anna Serlachius
- Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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19
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Moreno-Oyervides A, Aguilera-Morillo MC, de la Cruz Fernández MJ, Pascual EL, Jiménez LL, Krozer V, Acedo P. Clinical assessment of W-band spectroscopy for non-invasive detection and monitoring of sustained hyperglycemia. BIOMEDICAL OPTICS EXPRESS 2021; 12:5008-5022. [PMID: 34513239 PMCID: PMC8407808 DOI: 10.1364/boe.428524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
HbA1c is the gold standard test for monitoring medium/long term glycemia conditions in diabetes care, which is a critical factor in reducing the risk of chronic diabetes complications. Current technologies for measuring HbA1c concentration are invasive and adequate assays are still limited to laboratory-based methods that are not widely available worldwide. The development of a non-invasive diagnostic tool for HbA1c concentration can lead to the decrease of the rate of undiagnosed cases and facilitate early detection in diabetes care. We present a preliminary validation diagnostic study of W-band spectroscopy for detection and monitoring of sustained hyperglycemia, using the HbA1c concentration as reference. A group of 20 patients with type 1 diabetes mellitus and 10 healthy subjects were non-invasively assessed at three different visits over a period of 7 months by a millimeter-wave spectrometer (transmission mode) operating across the full W-band. The relationship between the W-band spectral profile and the HbA1c concentration is studied using longitudinal and non-longitudinal functional data analysis methods. A potential blind discrimination between patients with or without diabetes is obtained, and more importantly, an excellent relation (R-squared = 0.97) between the non-invasive assessment and the HbA1c measure is achieved. Such results support that W-band spectroscopy has great potential for developing a non-invasive diagnostic tool for in-vivo HbA1c concentration monitoring in humans.
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Affiliation(s)
- Aldo Moreno-Oyervides
- Department of Electronic Technology, Universidad Carlos III de Madrid, Leganés, 28911 Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - M. Carmen Aguilera-Morillo
- Department of Applied Statistics and Operational Research, and Quality, Universitat Politècnica de València, 46022 Valencia, Spain
| | | | | | - Lucía Llanos Jiménez
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Viktor Krozer
- Physics Institute, Goethe University Frankfurt am Main, Frankfurt am Main 60438, Germany
| | - Pablo Acedo
- Department of Electronic Technology, Universidad Carlos III de Madrid, Leganés, 28911 Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
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20
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Graneri LT, Mamo JCL, D’Alonzo Z, Lam V, Takechi R. Chronic Intake of Energy Drinks and Their Sugar Free Substitution Similarly Promotes Metabolic Syndrome. Nutrients 2021; 13:nu13041202. [PMID: 33917297 PMCID: PMC8067378 DOI: 10.3390/nu13041202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022] Open
Abstract
Energy drinks containing significant quantities of caffeine, taurine and sugar are increasingly consumed, particularly by adolescents and young adults. The putative effects of chronic ingestion of either standard energy drink, MotherTM (ED), or its sugar-free formulation (sfED) on metabolic syndrome were determined in wild-type C57BL/6J mice, in comparison to a soft drink, Coca-Cola (SD), a Western-styled diet enriched in saturated fatty acids (SFA), and a combination of SFA + ED. Following 13 weeks of intervention, mice treated with ED were hyperglycaemic and hypertriglyceridaemic, indicating higher triglyceride glucose index, which was similar to the mice maintained on SD. Surprisingly, the mice maintained on sfED also showed signs of insulin resistance with hyperglycaemia, hypertriglyceridaemia, and greater triglyceride glucose index, comparable to the ED group mice. In addition, the ED mice had greater adiposity primarily due to the increase in white adipose tissue, although the body weight was comparable to the control mice receiving only water. The mice maintained on SFA diet exhibited significantly greater weight gain, body fat, cholesterol and insulin, whilst blood glucose and triglyceride concentrations remained comparable to the control mice. Collectively, these data suggest that the consumption of both standard and sugar-free forms of energy drinks induces metabolic syndrome, particularly insulin resistance.
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Affiliation(s)
- Liam T. Graneri
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6845, Australia; (L.T.G.); (J.C.L.M.); (Z.D.); (V.L.)
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - John C. L. Mamo
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6845, Australia; (L.T.G.); (J.C.L.M.); (Z.D.); (V.L.)
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Zachary D’Alonzo
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6845, Australia; (L.T.G.); (J.C.L.M.); (Z.D.); (V.L.)
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Virginie Lam
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6845, Australia; (L.T.G.); (J.C.L.M.); (Z.D.); (V.L.)
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Ryusuke Takechi
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6845, Australia; (L.T.G.); (J.C.L.M.); (Z.D.); (V.L.)
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
- Correspondence: ; Tel.: +61-8-92662607
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21
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Lenters-Westra E, English E. Are hemoglobin A 1c point-of-care analyzers fit for purpose? The story continues. Clin Chem Lab Med 2021; 59:765-774. [PMID: 33128524 DOI: 10.1515/cclm-2020-1308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/20/2020] [Indexed: 07/24/2024]
Abstract
OBJECTIVES Point-of-care (POC) analyzers are playing an increasingly important role in diabetes management but it is essential that we know the performance of these analyzers in order to make appropriate clinical decisions. Whilst there is a growing body of evidence around the more well-known analyzers, there are many 'new kids on the block' with new features, such as displaying the presence of potential Hb-variants, which do not yet have a proven track record. METHODS The study is a comprehensive analytical and usability study of six POC analyzers for HbA1c using Clinical and Laboratory Standards Institute (CLSI) protocols, international quality targets and certified International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Glycohemoglobin Standardization Program (NGSP) Secondary Reference Measurement Procedures (SRMP). The study includes precision (EP-5 and EP-15), trueness (EP-9), linearity (EP-6), sample commutability (fresh, frozen and lyophilized), interference of Hb-variants (fresh and frozen samples). RESULTS Only two of the six analyzers performed to acceptable levels over the range of performance criteria. Hb-variant interference, imprecision or variability between lot numbers are still poor in four of the analyzers. CONCLUSIONS This unique and comprehensive study shows that out of six POC analyzers studied only two (The Lab 001 and Cobas B101) met international quality criteria (IFCC and NGSP), two (A1Care and Innovastar) were borderline and two (QuikReadgo and Allegro) were unacceptable. It is essential that the scientific and clinical community are equipped with this knowledge in order to make sound decisions on the use of these analyzers.
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Affiliation(s)
- Erna Lenters-Westra
- Isala, Department of Clinical Chemistry, Zwolle, The Netherlands
- European Reference Laboratory for Glycohemoglobin, Location Zwolle, Isala, The Netherlands
| | - Emma English
- University of East Anglia, Faculty of Medicine and Health, Norwich Research Park, Norwich, UK
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22
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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23
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McElfish PA, Boyers J, Purvis RS, O'Connor B, Carleton A, Bing W, Rowland B, Molgaard C, George A, Tibon LR, Hoose D, Riklon S. Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol. Contemp Clin Trials Commun 2021; 21:100710. [PMID: 33506140 PMCID: PMC7815654 DOI: 10.1016/j.conctc.2021.100710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources. OBJECTIVES This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research. METHODS This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI. CONCLUSIONS This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Betsy O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Williamina Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Craig Molgaard
- College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Ainrik George
- Marshall Islands Postal Service Authority, Majuro, 96960, Marshall Islands
| | - Lydia R. Tibon
- Kora in Jiban Lorojake Ejmour, PO Box 372, G & L Building Ground Floor, Majuro, 96960, Marshall Islands
| | - Dalton Hoose
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
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24
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Barron E, Misra S, English E, John WG, Sampson M, Bachmann MO, Barth J, Oliver N, Alberti KGMM, Bakhai C, O'Neill S, Young B, Wareham NJ, Khunti K, Jebb S, Smith J, Valabhji J. Experience of point-of-care HbA1c testing in the English National Health Service Diabetes Prevention Programme: an observational study. BMJ Open Diabetes Res Care 2020; 8:e001703. [PMID: 33318069 PMCID: PMC7737024 DOI: 10.1136/bmjdrc-2020-001703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION To report the observations of point-of-care (POC) glycated hemoglobin (HbA1c) testing in people with non-diabetic hyperglycemia (NDH; HbA1c 42-47 mmol/mol (6.0%-6.4%)), applied in community settings, within the English National Health Service Diabetes Prevention Programme (NHS DPP). RESEARCH DESIGN AND METHODS A service evaluation assessing prospectively collected national service-level data from the NHS DPP, using data from the first referral received in June 2016-October 2018. Individuals were referred to the NHS DPP with a laboratory-measured HbA1c in the NDH range and had a repeat HbA1c measured at first attendance of the program using one of three POC devices: DCA Vantage, Afinion or A1C Now+. Differences between the referral and POC HbA1c and the SD of the POC HbA1c were calculated. The factors associated with the difference in HbA1c and the association between POC HbA1c result and subsequent attendance of the NHS DPP were also evaluated. RESULTS Data from 73 703 participants demonstrated a significant mean difference between the referral and POC HbA1c of -2.48 mmol/mol (-0.23%) (t=157, p<0.001) with significant differences in the mean difference between devices (F(2, 73 700)=738, p<0.001). The SD of POC HbA1c was 4.46 mmol/mol (0.41%) with significant differences in SDs between devices (F(2, 73 700)=1542, p<0.001). Participants who were older, from more deprived areas and from Asian, black and mixed ethnic groups were associated with smaller HbA1c differences. Normoglycemic POC HbA1c versus NDH POC HbA1c values were associated with lower subsequent attendance at behavioral interventions (58% vs 67%, p<0.001). CONCLUSION POC HbA1c testing in community settings was associated with significantly lower HbA1c values when compared with laboratory-measured referrals. Acknowledging effects of regression to the mean, we found that these differences were also associated with POC method, location, individual patient factors and time between measurements. Compared with POC HbA1c values in the NDH range, normoglycemic POC HbA1c values were associated with lower subsequent intervention attendance.
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Affiliation(s)
| | - Shivani Misra
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
- Clinical Biochemistry, Blood Sciences, North West London Pathology, London, UK
| | - Emma English
- School of Health Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich, Norfolk, UK
| | - W Garry John
- Department of Clinical Biochemistry, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Michael Sampson
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, UK
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Max O Bachmann
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Julian Barth
- Department of Blood Science, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Oliver
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K G M M Alberti
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, Leicestershire, UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Jonathan Valabhji
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Diabetes and Endocrinology, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
- NHS England and NHS Improvement, London, UK
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25
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Khoury ZH, Illesca P, Sultan AS. Salivary Fructosamine as a Noninvasive Glycemic Biomarker: A Systematic Review. JDR Clin Trans Res 2020; 6:382-389. [PMID: 32881595 DOI: 10.1177/2380084420954354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Standard diagnostic and monitoring methods for glycemic status involve invasive sample collection through venous puncture or fingerstick. Recent attention has been focused on exploring noninvasive methods through oral biofluids. Specifically, serum fructosamine has been established as a short-term (2- to 3-wk) marker of disease status in patients with diabetes. Fructosamine measured through noninvasive means such as saliva has shown promise, but its clinical applicability is unknown. OBJECTIVE Evaluate the available evidence on using salivary fructosamine as a reliable noninvasive marker to screen and diagnose patients with diabetes mellitus in the clinical setting. A comparative analysis of the correlative accuracy of salivary fructosamine measurements with established blood glycemic biomarkers such as serum fructosamine, blood glucose, and HbA1c will be conducted. METHODS Six electronic databases (PubMed, PubMed Central, MEDLINE, EMBASE, Scopus, Cochrane Library) were searched for original research papers (clinical and animal studies) that were relevant to the objective of this systematic review. The search was initiated on May 28, 2020. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Bias risk assessment, overall quality, and level of evidence were based on the Oxford Centre for Evidence-Based Medicine, Appraisal Tool for Cross-Sectional Studies, and Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies tool. Heterogeneity was assessed using the National Institutes of Health quality assessment tool for cross-sectional studies. RESULTS A total of 174 records were identified. Full-text articles screened for eligibility (n = 21) identified only 6 original research articles relevant to the research question and were thus included in the systematic review. The types of studies identified were cross-sectional and in vivo studies. Three studies (3/6) showed positive correlation of salivary fructosamine with blood glucose levels, while 1 study (1/6) demonstrated a positive correlation with glycated hemoglobin (HbA1c). Limitations related to sample size and selection were identified along with a fair level of interstudy heterogeneity. CONCLUSION Based on the evidence evaluated, the utility of salivary fructosamine as a noninvasive marker to screen and diagnose patients with diabetes is doubtful. The overall level of evidence was low (IIIB) and the risk of bias was determined to be high. KNOWLEDGE TRANSFER STATEMENT Further evidence in the form of large-scale well-controlled studies is needed prior to recommending salivary fructosamine as a noninvasive diagnostic tool for glycemic status in patients with diabetes mellitus.
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Affiliation(s)
- Z H Khoury
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - P Illesca
- Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - A S Sultan
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
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26
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Jakoby MG, Schleder M, Luff V, Yergler C, Botchway A, Burns C. A 2-Hour Diabetes Self-Management Education Program for Patients With Low Socioeconomic Status Improves Short-Term Glycemic Control. J Patient Cent Res Rev 2020; 7:275-281. [PMID: 32760759 DOI: 10.17294/2330-0698.1745] [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: 11/04/2022] Open
Abstract
Diabetes self-management education (DSME) improves glycemic control, but patients with low socioeconomic status face institutional and personal barriers to receiving DSME. A retrospective single cohort study of a 2-hour group DSME program prioritizing accessibility and completion of a tightly focused curriculum was performed to determine if glycemic control improved and whether a longer, more comprehensive, prospective evaluation of the program is indicated. All patients who participated in the program from September 2017 to December 2018 were included in the analysis. The primary study endpoint was change in hemoglobin A1c (HbA1c) from baseline. A total of 58 out of 94 patients (61.7%) had paired measurements of HbA1c. Mean HbA1c improved from 9.8% ± 2.2% (83.5 ± 24.2 mmol/mol) to 8.3% ± 2.0% (67.7 ± 22.0 mmol/mol) at a median of 4 months after participation in the program (P<0.001). The proportion of patients with any improvement in HbA1c was 75.9% (44 of 58; P=0.003), and 65.5% of patients (38 of 58; P=0.066) had an improvement in HbA1c of ≥0.5%. These results demonstrate the benefit of highly targeted DSME for low-income patients and justify a longer-term and prospective evaluation of the program.
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Affiliation(s)
- Michael G Jakoby
- Division of Endocrinology, SIU School of Medicine, Springfield, IL
| | | | - Vickie Luff
- Central Counties Health Center, Springfield, IL
| | | | | | - Cheryl Burns
- Diabetes Education, SIU School of Medicine, Springfield, IL
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27
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A Resilience Intervention for Adults with Type 2 Diabetes: Proof-of-Concept in Community Health Centers. Int J Behav Med 2020; 27:565-575. [DOI: 10.1007/s12529-020-09894-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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28
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Burnside M, Lewis D, Crocket H, Wilson R, Williman J, Jefferies C, Paul R, Wheeler BJ, de Bock M. CREATE (Community deRivEd AutomaTEd insulin delivery) trial. Randomised parallel arm open label clinical trial comparing automated insulin delivery using a mobile controller (AnyDANA-loop) with an open-source algorithm with sensor augmented pump therapy in type 1 diabetes. J Diabetes Metab Disord 2020; 19:1615-1629. [PMID: 32837953 PMCID: PMC7261211 DOI: 10.1007/s40200-020-00547-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 01/22/2023]
Abstract
Background Commercialised automated insulin delivery (AID) systems have demonstrated improved outcomes in type 1 diabetes (T1D), however, they have limited capacity for algorithm individualisation, and can be prohibitively expensive if an individual is without access to health insurance or health funding subsidy. Freely available open-source algorithms, which have the ability to individualise algorithm parameters paired with commercial insulin pumps, and continuous glucose monitoring make up the so-called "do it yourself" (DIY) approach to AID. Limited data on the open-source approach have shown promising results, but data from a large randomised control trial are lacking. Methods The CREATE (Community deRivEd AutomaTEd insulin delivery) trial is an open-labelled, randomised, parallel 24-week, multi-site trial comparing sensor augmented pump therapy (SAPT) to our AnyDANA-loop. The three components of AnyDANA-loop are: 1) OpenAPS algorithm implemented in a smartphone (a version of AndroidAPS), 2) DANA-i™ insulin pump and, 3) Dexcom G6R continuous glucose monitor (CGM). The primary outcome measure is the percentage of time in target sensor glucose range (3.9 -10mmol/L). Secondary outcomes include psycho-social factors and platform performance. Analysis of online collective learning, characteristic of the open-source approach, is planned. 100 participants with T1D aged 7 - 70 years (age stratified into children/adolescents 7-15 years and adults 16-70 years), will be recruited from four sites in New Zealand. A 24-week continuation phase follows, to assess long-term safety.
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Affiliation(s)
- M Burnside
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
| | | | - H Crocket
- Te Huataki Waiora School of Health, Sport & Human Performance, University of Waikato, Hamilton, New Zealand
| | - R Wilson
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - J Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - C Jefferies
- Department of Paediatric Endocrinology, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - R Paul
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand.,Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Paediatric Department, Southern District Health Board, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
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29
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McElfish PA, Ayers B, Riklon S, Selig JP, Yeary KHC, Carleton A, Wilmoth R, Laukon F, Gittelsohn J, Netwon M, Long CR. Study protocol for a multilevel diabetes prevention program for Marshallese Pacific Islanders in faith-based organizations. Contemp Clin Trials Commun 2020; 17:100528. [PMID: 32025587 PMCID: PMC6997497 DOI: 10.1016/j.conctc.2020.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 10/29/2022] Open
Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Britni Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - James P. Selig
- College of Public Health University of Arkansas for Medical Sciences, 4301 West Markham, #820, Little Rock, AR, 72205, USA
| | - Karen Hye-cheon Yeary
- Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carton Streets, Buffalo, NY, 14263, USA
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Ralph Wilmoth
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Faith Laukon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125, N. College Ave., Fayetteville, AR, 72703, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 North Wolfe St, Baltimore, MD, 21205-2179, USA
| | - Morda Netwon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
| | - Christopher R. Long
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR, 72703, USA
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30
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Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Performance of Point-of-Care Testing Compared with the Standard Laboratory Diagnostic Test in the Measurement of HbA1c in Indonesian Diabetic and Nondiabetic Subjects. J Diabetes Res 2020; 2020:2037565. [PMID: 32733964 PMCID: PMC7369652 DOI: 10.1155/2020/2037565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 06/19/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study is aimed at investigating if point-of-care testing for HbA1c (POCT-HbA1c) using the HemoCue® HbA1c 501 system could be an alternative method for diabetes screening and monitoring to replace the HbA1c measurement in a standard diagnostic laboratory. DESIGN This was a cross-sectional study to assess the agreement between POCT and a standard laboratory measurement method for determining the level of HbA1c. Setting and Participants. In total, 108 participants were recruited to participate in this study, consisting of 61 diabetics and 47 nondiabetics. The diabetic group comprised 37 females and 24 males, diagnosed with type 2 diabetes mellitus (DM) and undergoing diabetes treatment at several community health care centres in Bandung, West Java. The nondiabetic group consisted of 15 female and 32 male patients of several community health care centres and healthy volunteers. Sample Collection and Analysis. A venous blood sample was taken for routine HbA1c analysis by the diagnostic laboratory method. For the POCT-HbA1c, a blood sample was taken from the fingertip at the same time and analysed with the HemoCue® HbA1c 501 system. Outcome Measures. The HbA1c results of both methods were compared and analysed with a Bland-Altman agreement plot. The sensitivity and specificity of the POCT-HbA1c data were also compared with those of the standard diagnostic results. RESULTS Based on the Bland-Altman plot, the HbA1c level for 100 out of 108 (92.59%) subjects analysed by the POCT-HbA1c was within the range of the 95% limit of agreement. Compared with the standard diagnostic assay, the sensitivity of the POCT-HbA1c was 97.83% and its specificity was 77.42%. CONCLUSIONS The high sensitivity and accuracy of POCT-HbA1c indicate that it is a potential method for diabetes screening and monitoring to replace the routine diagnostic laboratory HbA1c measurement, especially when a rapid result is required.
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Affiliation(s)
- Afiat Berbudi
- Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nofri Rahmadika
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Adi Imam Tjahjadi
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Microbiology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Pharmacology and Therapy Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Mach JC, Barone H, Boni C, Jimenez H, Tinglin M. Evaluating the impact of an international short-term medical mission through diabetic glycemic control. J Public Health (Oxf) 2019; 41:815-820. [PMID: 30388245 DOI: 10.1093/pubmed/fdy182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/02/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This prospective observational study evaluated the impact of a primary care-based, international, short-term medical mission's (STMM) impact on diabetes disease burden as represented through reductions in hemoglobin A1C (HbA1c). METHODS From November 2016 to May 2017, we tracked the HbA1c's of diabetic individuals in Dajabon, Dominican Republic through care provided by Waves of Health (WOH). Participants were provided counseling, glucose monitoring equipment, a 6-month supply of anti-diabetic medications, and received a 'check-in' phone call at 3 months. HbA1c's were re-measured at 6-month follow up. We hypothesized WOH diabetic care would have a modest impact of reducing mean HbA1c by 0.5%. RESULTS In total, 75% (n = 76) of 101 participants presented for follow-up care. Mean and median HbA1c decreased from 8.71 (SD 2.0) and 8.5% to 8.36 (SD 2.1) and 7.7%, respectively (P = 0.07). The percentage of individuals with HbA1c ≤7.5 increased by 10.4% at follow-up. The mean HbA1c decrease was 1.1%. CONCLUSIONS Though limited by sample size, our results suggest that medical STMM's may have a clinically meaningful impact in chronic disease management when utilizing a systematic combination of education, medical therapy, clearly documented medication instructions and regular trip intervals.
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Affiliation(s)
- John C Mach
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd., Biddeford, ME, USA
| | - Hope Barone
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd., Biddeford, ME, USA
| | - Christopher Boni
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd., Biddeford, ME, USA.,The Waves of Health, 113 Wilson Ave., Rutherford, NJ, USA
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van Raalten F, Hiemstra YL, Keulen N, van Duivenvoorde Y, Stoecklein K, Verhagen EA, Boer C. Level of agreement of point-of-care and laboratory HbA1c measurements in the preoperative outpatient clinic in non-diabetic patients who are overweight or obese. J Clin Monit Comput 2019; 33:1139-1144. [PMID: 30659411 PMCID: PMC6823319 DOI: 10.1007/s10877-019-00255-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022]
Abstract
Implementation of point-of-care HbA1c devices in the preoperative outpatient clinic might facilitate the early diagnosis of glycemic disturbances in overweight or obese patients undergoing surgery, but validation studies in this setting do not exist. We determined the level of agreement between a point-of-care and laboratory HbA1c test in non-diabetic patients visiting the outpatient clinic for preoperative risk profiling. Point-of-care HbA1c levels were measured in whole blood obtained by a finger prick (Siemens DCA Vantage HbA1c analyzer) and in hemolysed EDTA blood in the central laboratory (LAB). Bland Altman and Clarke's error grid analysis were used to analyze the agreement between the point-of-care and laboratory measurements. Patients (n = 49) were 55 ± 11 years old, 47% were male with a body mass index (BMI) of 30.6 ± 3.4 kg/m2. The mean HbA1c was 38.1 ± 3.7 mmol/mol or 5.6 ± 0.3%. One patient was diagnosed with a HbA1c indicative for diabetes mellitus (6.7%). Bland Altman analysis revealed a bias of - 0.53 ± 1.81 mmol/mol with limits of agreement of - 4.09 to 3.03 mmol/mol and a bias of - 0.05 ± 0.17% with limits of agreement - 0.39 to 0.28%. The percentage error was 9.2% and 5.9% for HbA1c expressed in mmol/mol and %, respectively. Clarke's error grid analysis showed that 48 out of 49 measurements were located in area A (98%). Point-of-care HbA1c measurements showed a high level of agreement with the laboratory test in the outpatient setting, and may be used for preoperative risk profiling in patients prone to cardiometabolic complications.Trial registration: Netherlands Trial Register NTR3057.
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Affiliation(s)
- Floris van Raalten
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Yasmine L Hiemstra
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Noor Keulen
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Yoni van Duivenvoorde
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Katrin Stoecklein
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Evert A Verhagen
- Department of Public & Occupational Health, Amsterdam UMC, VU University, Amsterdam Public Health, De Boelelaan 1117, 1081, Amsterdam, The Netherlands
| | - Christa Boer
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081, Amsterdam, The Netherlands.
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Dubach IL, Christ ER, Diem P. HbA 1c-testing: Evaluation of two point-of-care analysers. Prim Care Diabetes 2019; 13:583-587. [PMID: 31175054 DOI: 10.1016/j.pcd.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/02/2019] [Accepted: 05/12/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND HbA1c is a critical parameter for the medical management of patients with diabetes mellitus. Interventions that reduce HbA1c levels lead to a diminution of microvascular complications. For two decades, point of care testing (POCT) methods have been regularly used to measure HbA1c. The results significantly impact on the management of patients with diabetes mellitus and the accuracy of the results is critical. It is important to know the performance of common methods of HbA1c measurements in daily life. We, therefore, aimed at evaluating the accuracy of two different analysers especially developed for POCT and compared them to a reference method. METHODS We prospectively tested two widely used POCT methods to measure HbA1c, namely Afinion™ AS100 Analyzer (Axis-Shield, Oslo Norway) and DCA Vantage™ Analyzer (Siemens Healthcare Diagnostics, Tarrytown NY, US) in venous samples of 100 patients. As a reference method, we used the high-performance liquid chromatography method G8 HPLC used in the Biochemistry Laboratory of the Inselspital Bern. The National Glycohaemoglobin Standardization Program (NGSP) has certificated all methods used in this study. The comparability and degree of agreement was assessed using Bland-Altman plot. RESULTS The HbA1c levels ranged from 33 to 116 mmol/mol (5.2-12.8%), 31-122 mmol/mol (5.0-13.3%) and 30-119 mmol/mol (4.9-13%) for Afinion™, DCA Vantage™ and G8 HPLC Analyzer, respectively. The 95% limits of agreement were between -0.84 and +0.30 for the Afinion™ and -0.71 and +0.29 for DCA Vantage™. The results of both POCT were significantly lower with a bias of -0.27% and -0.21% (p < 0.0001) for Afinion™ and DCA Vantage™ Analyzer, respectively. CONCLUSIONS The POCT methods tested in this study showed a good correlation with the laboratory reference method, however, with an overall negative bias.
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Affiliation(s)
- Irina L Dubach
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland; Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Emanuel R Christ
- Division of Endocrinology, Diabetes and Metabolism, University of Basel, Basel, Switzerland
| | - Peter Diem
- Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
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Lenters-Westra E, English E. Analysis: Investigating the quality of POCT devices for HbA1c, what are our next steps? J Diabetes Sci Technol 2019; 13:1154-1157. [PMID: 31113240 PMCID: PMC6835179 DOI: 10.1177/1932296819850838] [Citation(s) in RCA: 5] [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: 01/03/2023]
Abstract
There are a growing number of publications evaluating the performance of HbA1c point-of-care testing (POCT) devices when compared to routine laboratory instruments, but is this what we need from future studies? Here we describe the current understanding of the performance of POCT for HbA1c, which areas need further studies, and the key requirements for future publications based on performance evaluations of these devices. These include studies in clinical settings, performance measured against internationally standardized reference methods, and the need to evaluate new to the market devices that do not currently have a detailed performance history. In addition we highlight the need for external quality assessment schemes that are designed to support POCT in a wide range of clinical settings.
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Affiliation(s)
- Erna Lenters-Westra
- Department of Clinical Chemistry, Isala, Zwolle, The Netherlands
- European Reference Laboratory for Glycohemoglobin, location Isala, Zwolle, The Netherlands
- Erna Lenters-Westra, PhD, Isala, Dr. Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Emma English
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
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Helgeson VS, Vaughn AK, Seltman H, Orchard T, Libman I, Becker D. Featured Article: Trajectories of Glycemic Control Over Adolescence and Emerging Adulthood: An 11-Year Longitudinal Study of Youth With Type 1 Diabetes. J Pediatr Psychol 2019; 43:8-18. [PMID: 28510719 DOI: 10.1093/jpepsy/jsx083] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective To identify trajectories of glycemic control over adolescence and emerging adulthood and to test whether demographic and psychosocial variables distinguished these trajectories. Methods We enrolled 132 youth with type 1 diabetes when they were average age 12 and followed them for 11 years. We used group-based trajectory modeling to identify distinct patterns of glycemic control, and examined whether age 12 demographic and psychosocial variables distinguished the subsequent trajectories. Results We identified 5 trajectories of glycemic control: stable on target, stable above target, volatile late peak, stable high, and inverted U. Parent social status and household structure distinguished the more problematic trajectories from the stable on target group. Friend conflict, psychological distress, unmitigated communion, and self-care behavior at age 12 distinguished problematic glycemic control trajectories from the stable on target group. Conclusions These results can be used to identify youth who are at risk for deteriorating glycemic control over adolescence.
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Affiliation(s)
| | | | | | | | - Ingrid Libman
- Children's Hospital of UPMC and University of Pittsburgh
| | - Dorothy Becker
- Children's Hospital of UPMC and University of Pittsburgh
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36
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Mobile Health for Diagnosis-PixoTest HbA1c POCT System. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Anderson P, Grills N, Singh R, Singh R, Evans RG, Sengupta P, Thrift AG. Prevalence of diabetes and pre-diabetes in rural Tehri Garhwal, India: influence of diagnostic method. BMC Public Health 2019; 19:817. [PMID: 31234815 PMCID: PMC6591826 DOI: 10.1186/s12889-019-7184-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background There are few available data regarding the prevalence of diabetes in the sub-Himalayan region of India. The aim of this study was to determine the prevalence of pre-diabetes and diabetes in rural Garhwal based on glycosylated hemoglobin. Methods In a cross-sectional survey of 500 adults from five randomly selected villages in Chamba, a mountainous Tehri Garhwal district in Uttarakhand in north-west India, we determined the prevalence of diabetes (hemoglobin (Hb) A1c ≥ 6.5%) and pre-diabetes (5.7% ≤ HbA1c ≤ 6.4%). In a sub-sample of those diagnosed with diabetes or pre-diabetes (n = 140), fasting blood glucose (FBG, n = 117) or postprandial blood glucose (PBG, n = 23), and blood hemoglobin concentration, was measured at follow-up. Results Based on HbA1c, 10.0% had diabetes and 56.4% pre-diabetes. Of those diagnosed as diabetic by HbA1c, 10 of 16 (62.5%) were diagnosed as diabetic by FBG (> 125 mg/dL) or PBG (≥200 mg/dL). In those diagnosed as pre-diabetic by HbA1c, only 55 of 124 (44.4%) were diagnosed as pre-diabetic by FBG (100–125 mg/dL) or PBG (140–199 mg/dL). A large proportion of these 140 individuals (67.1%) were moderately to severely anemic (Hb < 11.4 mg/dL). The diagnostic gap for pre-diabetes between HbA1c and FBG/PBG was similar for the groups with and without moderate to severe anemia. Conclusions HbA1c and FBG/PBG have similar diagnostic performance for diabetes in this population. However, many individuals were diagnosed with pre-diabetes by HbA1c but not FBG/PBG. The relative excess diagnosis of pre-diabetes with HbA1c does not appear to be explained by anemia, an endemic condition in India. The prognostic significance of diagnosis of pre-diabetes by HbA1c but not FBG/PBG remains unknown, but merits investigation. Electronic supplementary material The online version of this article (10.1186/s12889-019-7184-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pam Anderson
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Rajesh Singh
- Garhwal Community Development and Welfare Society, Mussoorie Road, Chamba, India
| | - Rajkumari Singh
- Garhwal Community Development and Welfare Society, Mussoorie Road, Chamba, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | | | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3800, Australia.
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Boucher SE, Gray AR, de Bock M, Wiltshire EJ, Galland BC, Tomlinson PA, Rayns J, MacKenzie KE, Wheeler BJ. Effect of 6 months' flash glucose monitoring in adolescents and young adults with type 1 diabetes and suboptimal glycaemic control: managing diabetes in a 'flash' randomised controlled trial protocol. BMC Endocr Disord 2019; 19:50. [PMID: 31109342 PMCID: PMC6528266 DOI: 10.1186/s12902-019-0378-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Teenagers and young adults with type 1 diabetes (T1D) experience significant burden managing this serious chronic condition and glycaemic control is at its unhealthiest during this life stage. Flash glucose monitoring (FGM) is a new technology that reduces the burden of glucose monitoring by easily and discreetly displaying glucose information when an interstitial glucose sensor worn on the upper arm is scanned with a handheld reader, as opposed to traditional capillary glucose sampling by finger prick (otherwise known as self-monitored blood glucose, SMBG). The effectiveness of this technology and impacts of its long-term use in youth with pre-existing suboptimal glycaemic control are unknown. This study therefore aims to investigate the effectiveness of FGM in addition to standard care in young people with T1D. METHODS This is a two phase study programme including a multi-centre randomised, parallel-group study consisting of a 6-month comparison between SMBG and FGM, with an additional 6-month continuation phase. We will enrol adolescents with T1D aged 13-20 years (inclusive), with suboptimal glycaemic control (mean glycated haemoglobin (HbA1c) in past 6 months ≥75 mmol/mol [≥9%]). Participants will be randomly allocated (1:1) to FGM (FreeStyle Libre; intervention group) or to continue SMBG with capillary blood glucose testing (usual care group). All participants will continue other aspects of standard care with the study only providing the FreeStyle Libre. At 6 months, the control group will cross over to the intervention. The primary outcome is the between group difference in changes in HbA1c at 6 months. Additional outcomes include a range of psychosocial and health economic measures as well as FGM acceptability. DISCUSSION >If improvements are found, this will further encourage steps towards integrating FGM into regular diabetes care for youth with unhealthy glycaemic control, with the expectation it will reduce daily diabetes management burden and improve short- and long-term health outcomes in this high-risk group. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry on 5 March 2018 ( ACTRN12618000320257p ) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1205-5784).
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Affiliation(s)
- Sara E. Boucher
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Esko J. Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Paediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul A. Tomlinson
- Paediatric Department, Southern District Health Board, Invercargill, New Zealand
| | - Jenny Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E. MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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Kenealy T, Herd G, Musaad S, Wells S. HbA 1c screening in the community: Lessons for safety and quality management of a point of care programme. Prim Care Diabetes 2019; 13:170-175. [PMID: 30545795 DOI: 10.1016/j.pcd.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 01/15/2023]
Abstract
AIM To describe quality management processes and appropriate interpretation with respect to HbA1c point-of-care (POC) testing in a national diabetes and cardiovascular risk screening programme. METHODS We compared HbA1c results from capillary blood, measured by the cobas b 101 (Roche Diagnostics) POC testing system, with results from venous blood measured by accredited laboratory analysers to inform national screening practice and a (separately-reported) randomised controlled trial. Difference plots and regressions were used to aid interpretation around 40 and 50mmol/mol, the cut-offs used to identify "pre-diabetes" and diabetes in New Zealand. RESULTS After initial acceptable tests, subsequent batches delivered POC results that varied from laboratory HbA1c by +6 to -14mmol/mol around the clinical cut-offs. Ten faulty batches of discs were recalled worldwide. POC testing was suspended in one region, as was the planned trial. The manufacturing defect was rectified, accuracy of the new batches was confirmed, and testing resumed. CONCLUSION POC testing must be conducted within stringent quality assurance processes prior to and while in use. Within such a system, POC testing for HbA1c can be sufficiently accurate for screening and diagnosis of diabetes.
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Affiliation(s)
- Timothy Kenealy
- South Auckland Clinical School, University of Auckland, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
| | - Geoffrey Herd
- Northland District Health Board, Private Bag 9742, Whangarei 0148, New Zealand.
| | - Samarina Musaad
- Labtests, P.O. Box 12049 Penrose, Auckland 1642, New Zealand.
| | - Susan Wells
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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Kip MMA, Hummel JM, Eppink EB, Koffijberg H, Hopstaken RM, IJzerman MJ, Kusters R. Understanding the adoption and use of point-of-care tests in Dutch general practices using multi-criteria decision analysis. BMC FAMILY PRACTICE 2019; 20:8. [PMID: 30630430 PMCID: PMC6327588 DOI: 10.1186/s12875-018-0893-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The increasing number of available point-of-care (POC) tests challenges clinicians regarding decisions on which tests to use, how to efficiently use them, and how to interpret the results. Although POC tests may offer benefits in terms of low turn-around-time, improved patient's satisfaction, and health outcomes, only few are actually used in clinical practice. Therefore, this study aims to identify which criteria are, in general, important in the decision to implement a POC test, and to determine their weight. Two POC tests available for use in Dutch general practices (i.e. the C-reactive protein (CRP) test and the glycated haemoglobin (HbA1c) test) serve as case studies. The information obtained from this study can be used to guide POC test development and their introduction in clinical practice. METHODS Relevant criteria were identified based on a literature review and semi-structured interviews with twelve experts in the field. Subsequently, the criteria were clustered in four groups (i.e. user, organization, clinical value, and socio-political context) and the relative importance of each criterion was determined by calculating geometric means as implemented in the Analytic Hierarchy Process. Of these twelve experts, ten participated in a facilitated group session, in which their priorities regarding both POC tests (compared to central laboratory testing) were elicited. RESULTS Of 20 criteria in four clusters, the test's clinical utility, its technical performance, and risks (associated with the treatment decision based on the test result) were considered most important for using a POC test, with relative weights of 22.2, 12.6 and 8.5%, respectively. Overall, the experts preferred the POC CRP test over its laboratory equivalent, whereas they did not prefer the POC HbA1c test. This difference was mainly explained by their strong preference for the POC CRP test with regard to the subcriterion 'clinical utility'. CONCLUSIONS The list of identified criteria, and the insights in their relative impact on successful implementation of POC tests, may facilitate implementation and use of existing POC tests in clinical practice. In addition, having experts score new POC tests on these criteria, provides developers with specific recommendations on how to increase the probability of successful implementation and use.
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Affiliation(s)
- Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands.
| | - J Marjan Hummel
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Elra B Eppink
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | | | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands
| | - Ron Kusters
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, 7500, AE, Enschede, The Netherlands.,Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
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Rambaran K, Bhagan B, Ali A, Ali F, Toolsie S, Lobin R, Beharry S, Ghany S, Mohammed S, Davis G, Sakhamuri S, Teelucksingh S, Seemungal T. High Prevalence of Diabetes Mellitus in a Cohort of Patients with Chronic Obstructive Pulmonary Disease in Trinidad, West Indies. Turk Thorac J 2019; 20:12-17. [PMID: 30664421 DOI: 10.5152/turkthoracj.2018.18036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Both chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are highly prevalent in Trinidad, West Indies. Our objective was to evaluate the prevalence of DM in a cohort of Trinidadian patients with COPD and investigate the possible impact of diabetes on COPD using standard outcome measures, that is, lung function, exacerbations, quality of life and depression questionnaires, as well as mortality. MATERIALS AND METHODS This was a cross-sectional follow-up study utilizing a cohort of 105 patients from chest clinics in the three major general hospitals in Trinidad. RESULTS Diabetes was diagnosed based on a glycated hemoglobin (HbA1c) level of ≥6.5% (or a prior self-reported history), and for pre-diabetes, of 5.7%-6.4%. Of 105 patients, 40% fulfilled the criteria for diabetes and 40% for pre-diabetes. Of those diagnosed with diabetes, 38% obtained this diagnosis de novo. A history of intravenous corticosteroid use was associated with higher HbA1c levels (p=0.043) upon diagnosis. The percentage of predicted forced vital capacity was negatively related to HbA1c (p=0.033), but those with diabetes also had a greater body mass index (p=0.001). After a 1-year follow-up, mortality was significantly greater among patients with diabetes (p=0.026). Patients with at least one exacerbation in the past year or poorer lung function parameters had worse quality of life (p≤0.040) and depression (p≤0.018) scores. Notably, 31.4% of the total cohort exhibited clinically significant depression scores. CONCLUSION This study revealed that a high proportion of COPD patients in tertiary care had diabetes or pre-diabetes.
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Affiliation(s)
- Kirin Rambaran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Bryan Bhagan
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Amanda Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Firas Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivan Toolsie
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Rekha Lobin
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivani Beharry
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sabrina Ghany
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Saeeda Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Gershwin Davis
- Department of Para-clinical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sateesh Sakhamuri
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Terence Seemungal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
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Saxton AT, Miranda JJ, Ortiz EJ, Pan W. Assessment of Two Diabetes Point-of-care Analyzers Measuring Hemoglobin A1c in the Peruvian Amazon. Ann Glob Health 2018. [PMID: 30779508 PMCID: PMC6748252 DOI: 10.29024/aogh.2368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: With an estimated 174 million undiagnosed cases of diabetes mellitus worldwide and 80% of them occurring in low- and middle-income countries an effective point-of-care diagnostic tool is key to fighting this global epidemic. Glycated hemoglobin has become a reliable biomarker for the diagnosis and prognosis of diabetes. Objective: We assessed two point-of-care (POC) analyzers in multi-ethnic communities of the Amazon Rainforest in Peru where laboratory-based glycated hemoglobin (HbA1c) testing is not available. Methods: 203 venous blood samples were tested for HbA1c by Afinion and DCA Vantage analyzers as well as a Premier Hb9210 high-performance liquid chromatography (HPLC) method as the reference standard. The coefficient of variation (CV) of each device was calculated to assess assay imprecision. Bland-Altman plots were used to assess bias. Ambient temperature, humidity, and barometric pressure were also evaluated for their effect on HbA1c results using multivariate regression. Findings: There was a wide range of HbA1c for participants based on the HPLC test: 4.4–9.0% (25–75 mmol/mol). The CV for the Afinion was 1.75%, and 4.01% for Vantage. The Afinion generated higher HbA1c results than the HPLC (mean difference = +0.56% [+6 mmol/mol]; p < 0.001), as did the DCA Vantage (mean difference = +0.32% [4 mmol/mol] p < 0.001). Temperature and humidity were not related to HbA1c; however, barometric pressure was associated with HPLC HbA1c results for the Afinion. Conclusions: Imprecision and bias were not low enough to recommend either POC analyzer for HbA1c determinations in this setting.
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Affiliation(s)
- Anthony T Saxton
- Duke Global Health Institute, Duke University.,Miller School of Medicine, Miami University, US
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia.,School of Medicine, Universidad Peruana Cayetano Heredia, PE
| | | | - William Pan
- Duke Global Health Institute, Duke University.,Nicholas School of the Environment, Duke University, US
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Saxton AT, Miranda JJ, Ortiz EJ, Pan W. Assessment of Two Diabetes Point-of-care Analyzers Measuring Hemoglobin A1c in the Peruvian Amazon. Ann Glob Health 2018; 84:618-624. [PMID: 30779508 PMCID: PMC6748252 DOI: 10.9204/aogh.2368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With an estimated 174 million undiagnosed cases of diabetes mellitus worldwide and 80% of them occurring in low- and middle-income countries an effective point-of-care diagnostic tool is key to fighting this global epidemic. Glycated hemoglobin has become a reliable biomarker for the diagnosis and prognosis of diabetes. OBJECTIVE We assessed two point-of-care (POC) analyzers in multi-ethnic communities of the Amazon Rainforest in Peru where laboratory-based glycated hemoglobin (HbA1c) testing is not available. METHODS 203 venous blood samples were tested for HbA1c by Afinion and DCA Vantage analyzers as well as a Premier Hb9210 high-performance liquid chromatography (HPLC) method as the reference standard. The coefficient of variation (CV) of each device was calculated to assess assay imprecision. Bland-Altman plots were used to assess bias. Ambient temperature, humidity, and barometric pressure were also evaluated for their effect on HbA1c results using multivariate regression. FINDINGS There was a wide range of HbA1c for participants based on the HPLC test: 4.4-9.0% (25-75 mmol/mol). The CV for the Afinion was 1.75%, and 4.01% for Vantage. The Afinion generated higher HbA1c results than the HPLC (mean difference = +0.56% [+6 mmol/mol]; p < 0.001), as did the DCA Vantage (mean difference = +0.32% [4 mmol/mol] p < 0.001). Temperature and humidity were not related to HbA1c; however, barometric pressure was associated with HPLC HbA1c results for the Afinion. CONCLUSIONS Imprecision and bias were not low enough to recommend either POC analyzer for HbA1c determinations in this setting.
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Affiliation(s)
- Anthony T. Saxton
- Duke Global Health Institute, Duke University, Durham, NC, US
- Miller School of Medicine, Miami University, Miami, FL, US
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, PE
| | | | - William Pan
- Duke Global Health Institute, Duke University, Durham, NC, US
- Nicholas School of the Environment, Duke University, Durham, NC, US
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Galindo-Méndez M, Sánchez-López A, Cruz-Fuentes L. The estimation of uncertainty of measurement of glycated hemoglobin as an analytical performance specification and in the interpretation of its results. Clin Biochem 2018; 63:92-96. [PMID: 30595159 DOI: 10.1016/j.clinbiochem.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Glycated hemoglobin (HbA1c) plays a key role in monitoring the glycemic state of an individual. Uncertainty of measurement (U) indicates the magnitude of the doubt about a measurement result. To properly classify an individual as under either good or poor glycemic control, it has been suggested that U of an HbA1c result should not exceed ±0.5%. METHODS The statistical method used to calculate uncertainty of measurement was the "top down" approach suggested by EURACHEM/CITAC. This approach allows the inclusion of imprecision, bias, uncertainty of bias and uncertainty of the calibration of the HbA1c method. The value of bias was obtained using data generated from the external quality assessment of the Randox International Quality Assessment Scheme and that of the Unity data management software system. Imprecision was calculated after the daily analysis of two levels of control sera. RESULTS Calculation of uncertainty of measurement of HbA1c was a straightforward procedure used to calculate U. Due to the different bias results obtained using two different external quality programs, the results of U were significantly different (±0.19% vs ± 0.43%) from each other; however, in both cases, the U results were below the maximal suggested uncertainty of ±0.5%. CONCLUSIONS The calculation of U of HbA1c by the EURACHEM/CITAC method is a practical approach that can be used as an additional analytical goal in the measurement of HbA1c. In addition, this information can aid clinicians to determine the level of confidence that can be placed in the test results.
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Affiliation(s)
| | | | - Ludi Cruz-Fuentes
- Laboratorios Galindo SC, Av. Juárez 501, Oaxaca, Oaxaca, CP 68000, Mexico
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45
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O'Brien J, Hamilton K, Williams A, Fell J, Mulford J, Cheney M, Wu S, Bird ML. Improving physical activity, pain and function in patients waiting for hip and knee arthroplasty by combining targeted exercise training with behaviour change counselling: study protocol for a randomised controlled trial. Trials 2018; 19:425. [PMID: 30086780 PMCID: PMC6081939 DOI: 10.1186/s13063-018-2808-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/16/2018] [Indexed: 01/25/2023] Open
Abstract
Background Osteoarthritis often results in prolonged periods of reduced physical activity and is associated with adverse health outcomes, including increased risk of cardiovascular and metabolic diseases. Exercise interventions for patients on the waiting list for arthroplasty can reduce the risk of long-term adverse outcomes by increasing activity levels. However, uptake and ongoing positive rates of physical activity in this population are low and the impact of pre-operative behaviour counselling on exercise is not known. Method/design The exercise and behaviour change counselling (ENHANCE) trial is a two-arm assessor-blind randomised controlled trial to assess the effectiveness of a 12-week exercise intervention designed to improve long-term physical activity and functional abilities for people awaiting arthroplasty. Participants on the waiting list for hip and knee arthroplasty are recruited from one clinical site in Australia. After collection of baseline data, participants are randomised to either an intervention or control group. The control group receive usual care, as recommended by evidence-based guidelines. The intervention group receive an individualised programme of exercises and counselling sessions. The 12-week exercise programme integrates multiple elements, including up to five in-person counselling sessions, supported by written materials. Participants are encouraged to seek social support among their friends and self-monitor their physical activity. The primary outcome is physical activity (daily step count and percentage of day spent in sedentary activities). Secondary outcomes include pain ratings, physical function, psychosocial factors and changes in clinical markers linked with potential common chronic diseases (diabetes and cardiovascular disease). All outcomes are assessed at baseline and 26 weeks later and again at 26 weeks post-surgery. Discussion This study seeks to address a significant gap in current osteoarthritis management practice by providing evidence for the effectiveness of an exercise programme combined with behaviour counselling for adults waiting for hip and knee arthroplasty. Theory-driven evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact on the development of secondary chronic disease in this population. Information gained from this study will contribute to the evidence base on the management of adults waiting for hip and knee arthroplasty. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617000357358. Registered on 8 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2808-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jane O'Brien
- School of Health Sciences, University of Tasmania, Launceston, Australia.
| | - Kyra Hamilton
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrew Williams
- Sports & Exercise Science, School of Health Sciences, University of Tasmania, Launceston, Australia
| | - James Fell
- Sports & Exercise Science, School of Health Sciences, University of Tasmania, Launceston, Australia
| | | | - Michael Cheney
- Sports & Exercise Science, School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Sam Wu
- Department of Health and Medical Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Elliott TG, Dooley KC, Zhang M, Campbell HS, Thompson DJ. Comparison of Glycated Hemoglobin Results Based on At-Home and In-Lab Dried Blood Spot Sampling to Routine Venous Blood Sampling In-Lab in Adult Patients With Type 1 or Type 2 Diabetes. Can J Diabetes 2018; 42:426-432.e1. [DOI: 10.1016/j.jcjd.2017.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/30/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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English E, Lenters-Westra E. HbA1c method performance: The great success story of global standardization. Crit Rev Clin Lab Sci 2018; 55:408-419. [PMID: 30001673 DOI: 10.1080/10408363.2018.1480591] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diagnosing and monitoring the treatment of people with diabetes is a global issue and uses considerable resources in laboratories and clinics worldwide. Hemoglobin A1c (HbA1c) has been the mainstay of monitoring glycemic control in people with diabetes for many years and more recently it has been advocated as a diagnostic tool for type 2 diabetes mellitus (T2DM). Good analytical performance is key to the successful use of any laboratory test, but is critical when using the test to diagnose disease, especially when the potential number of diagnoses could exceed 500 million people. Very small variations in bias or increased imprecision could lead to either a missed diagnosis or overdiagnosis of the disease and given the scale of the global disease burden, this could mean erroneous categorization of potentially millions of people. Fundamental to good performance of diagnostic testing is standardization, with defined reference materials and measurement procedures. In this review, we discuss the historical steps to first harmonize HbA1c testing, followed by the global standardization efforts and provide an update on the current situation and future goals for HbA1c testing.
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Affiliation(s)
- Emma English
- a Faculty of Medicine and Health , University of East Anglia, Norwich Research Park , Norwich , England
| | - Erna Lenters-Westra
- b Department of Clinical Chemistry , Isala, Zwolle , the Netherlands.,c European Reference Laboratory for Glycohemoglobin , Zwolle , the Netherlands
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Lenters-Westra E, English E. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose? J Diabetes Sci Technol 2018; 12:762-770. [PMID: 29921132 PMCID: PMC6134306 DOI: 10.1177/1932296818785612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Point-of-care (POC) testing is becoming increasingly valuable in health care delivery, and it is important that the devices used meet the same quality criteria as main laboratory analyzers. While external quality assessment (EQA) provides a great tool for assessing quality, many POC devices are not enrolled in these schemes and standard laboratory evaluations are needed to assess performance. METHODS The Clinical and Laboratory Standards Institute (CLSI) protocols EP-5 and EP-9 were applied to investigate imprecision, accuracy and bias. We assessed bias using the mean of 4 certified secondary reference measurement procedures (SRMPs). RESULTS The Afinion2™ and the Quo-Lab had CVs of ≤1.7 and ≤2.4% respectively in IFCC SI units (≤1.2 and ≤1.7% NGSP) and a bias ≤2 mmol/mol (≤0.2% NGSP) at 48 and 75 mmol/mol (6.5 and 9.0% NGSP). Sigma for the Afinion2 was 5.8 and for the Quo-Lab 4.0. Both methods passed the NGSP criteria with 2 instruments when compared with 4 individual SRMPs. The HbA1c 501 had a CV of 3.4% and 2.7% in IFCC SI units (2.1% and 1.7% NGSP) and a bias ≤2.4 mmol/mol (≤0.2% NGSP) and passed the NGSP criteria with 2 instruments compared with 4 individual SRMPs except for instrument 2 compared with the Tosoh G8. Sigma was 2.1. The A1Care had a sigma of 1.4 and failed all criteria mainly due to a high CV (6.2% and 4.1% in IFCC SI units [4.1% and 2.9% NGSP] at 48 and 75 mmol/mol [6.5 and 9.0% NGSP]). CONCLUSIONS The analytical performance was excellent for the Afinion2 and the Quo-Lab, acceptable for the HbA1c 501 and unacceptable for the A1Care according to different used criteria, demonstrating that whilst performance is improving there are still areas for considerable improvement.
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Affiliation(s)
- Erna Lenters-Westra
- Department of Clinical Chemistry, Isala,
Zwolle, The Netherlands
- European Reference Laboratory for
Glycohemoglobin, Location Isala, Zwolle, The Netherlands
- Erna Lenters-Westra, PhD, Isala, Dr Van
Heesweg 2, 8025 AB Zwolle, The Netherlands.
| | - Emma English
- Faculty of Medicine and Health,
University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Kaur J, Jiang C, Liu G. Different strategies for detection of HbA1c emphasizing on biosensors and point-of-care analyzers. Biosens Bioelectron 2018; 123:85-100. [PMID: 29903690 DOI: 10.1016/j.bios.2018.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/23/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022]
Abstract
Measurement of glycosylated hemoglobin (HbA1c) is a gold standard procedure for assessing long term glycemic control in individuals with diabetes mellitus as it gives the stable and reliable value of blood glucose levels for a period of 90-120 days. HbA1c is formed by the non-enzymatic glycation of terminal valine of hemoglobin. The analysis of HbA1c tends to be complicated because there are more than 300 different assay methods for measuring HbA1c which leads to variations in reported values from same samples. Therefore, standardization of detection methods is recommended. The review outlines the current research activities on developing assays including biosensors for the detection of HbA1c. The pros and cons of different techniques for measuring HbA1c are outlined. The performance of current point-of-care HbA1c analyzers available on the market are also compared and discussed. The future perspectives for HbA1c detection and diabetes management are proposed.
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Affiliation(s)
- Jagjit Kaur
- Graduate School of Biomedical Engineering, ARC Centre of Excellence in Nanoscale Biophotonics (CNBP), Faculty of Engineering, The University of New South Wales, Sydney 2052, Australia; Australian Centre for NanoMedicine, The University of New South Wales, Sydney 2052, Australia
| | - Cheng Jiang
- Nuffield Department of Clinical Neurosciences, Department of Chemistry, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Guozhen Liu
- Graduate School of Biomedical Engineering, ARC Centre of Excellence in Nanoscale Biophotonics (CNBP), Faculty of Engineering, The University of New South Wales, Sydney 2052, Australia; Australian Centre for NanoMedicine, The University of New South Wales, Sydney 2052, Australia; International Joint Research Center for Intelligent Biosensor Technology and Health, Central China Normal University, Wuhan 430079, PR China.
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50
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Kumar V, Hebbar S, Bhat A, Panwar S, Vaishnav M, Muniraj K, Nath V, Vijay RB, Manjunath S, Thyagaraj B, Siddalingappa C, Chikkamoga Siddaiah M, Dasgupta I, Anandh U, Kamala T, Srikanta SS, Krishnaswamy PR, Bhat N. Application of a Nanotechnology-Based, Point-of-Care Diagnostic Device in Diabetic Kidney Disease. Kidney Int Rep 2018; 3:1110-1118. [PMID: 30197977 PMCID: PMC6127407 DOI: 10.1016/j.ekir.2018.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/10/2018] [Accepted: 05/21/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Early detection of diabetes mellitus (DM) and diabetic kidney disease (DKD) is important for preventing end-stage renal failure and reducing cardiovascular complications. Availability of a validated point-of-care (PoC) device that can measure various DKD markers would be useful in this respect, especially in resource-poor parts of the world. Methods We validated a novel nanotechnology-based multianalyte PoC device (minimally invasive and does not require trained medical personnel) against laboratory gold standard tests for the detection of 5 biomarkers related to management of DM and DKD. The prospective study was funded by an International Society of Nephrology American Nephrologists of Indian Origin grant in 2 phases: (i) proof of concept: random samples were tested for the analytes with the PoC device and correlated with the laboratory gold standard; and (ii) clinical validation in a well-characterized cohort of patients. A nonenzymatic- and nonantibody-based electrochemical PoC device for quantitative measurement of markers—glycosylated hemoglobin (HbA1c), hemoglobin, serum albumin, microalbuminuria, urine creatinine, and albumin-to-creatinine ratio−was developed and used in this study. The disposable strips were interfaced with a multipotentiostat hand-held PoC device (3.7-V rechargeable lithium battery, 5-inch touch screen, Bluetooth enabled) working in amperometry mode, which provided the results in <1 minute. Data were analyzed using linearity plots and Bland-Altman difference plot analysis. Results A total of 4717 individuals were screened during the study (phase 1: 2576 and phase 2: 2141.) In phase 2, samples were tested in 529 subjects (346 females)—120 subjects with type 1 DM, 255 subjects with type 2 DM, 54 subjects without DM, 400 subjects with stage 2 chronic kidney disease, and 30 subjects with stage 3 chronic kidney disease. Conclusion A nanotechnology-based PoC device for quantitative measurement of HbA1c, hemoglobin, serum albumin, microalbuminuria, and the urine albumin-to-creatinine ratio was developed for detection of early DKD and showed excellent correlation between the device and laboratory results. This device has the potential for early detection of DM and/or DKD, especially in remote communities in underserved areas of the world where prevalence of diabetes is rapidly increasing.
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Affiliation(s)
- Vinay Kumar
- PathShodh Healthcare Pvt. Ltd., Bangalore, India
| | - Suraj Hebbar
- PathShodh Healthcare Pvt. Ltd., Bangalore, India
| | | | | | - Madhumati Vaishnav
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Kavitha Muniraj
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Vasanthi Nath
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Reshma Banaki Vijay
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Sapna Manjunath
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Babithadevi Thyagaraj
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - Chandraprabha Siddalingappa
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | | | | | | | - Thummala Kamala
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - S S Srikanta
- Samatvam Diabetes Endocrinology Centre, Jnana Sanjeevini Medical Center and Diabetes Hospital Diabetes Collaborative Study Group, Bangalore, India
| | - P R Krishnaswamy
- Centre for Nano Science and Engineering, Indian Institute of Science, Bangalore, India
| | - Navakanta Bhat
- PathShodh Healthcare Pvt. Ltd., Bangalore, India.,Centre for Nano Science and Engineering, Indian Institute of Science, Bangalore, India
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