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Nevraumont A, Deltombe M, Bayart JL. How pre-analytical conditions impact glucose measurement and (gestational) diabetes diagnosis: A real-world stability study and a call for harmonization. Clin Chim Acta 2024; 562:119875. [PMID: 39013524 DOI: 10.1016/j.cca.2024.119875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/14/2024] [Accepted: 07/13/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND AIMS Since 2023, guidelines of the AACC/ADA recommend the use of citrate buffer-containing tubes as a first option for glucose measurement. This study aims to assess the pre-analytical stability of glucose under various conditions (room temperature (RT) or at 4 °C) and the potential real-world impact of introducing these tubes on (gestational) diabetes and IFG prevalence. MATERIALS AND METHODS 25 healthy volunteers were sampled to assess glucose stability across time, at 4 °C and at RT, before and following centrifugation. 701 patients undergoing fasting plasma glucose analysis and 109 women having OGTT were collected according to current procedures (NaFl K2C2O4 (NaFl) tubes) as well as with citrate-containing tubes (FC Mix). RESULTS The mean glucose concentration bias between FC Mix and NaFl tubes when centrifugation occurred within 5 min was 0.53 % and this difference raised slowly to reach 2.3 %, six-hours post-centrifugation. When centrifugation was delayed, a rapid decrease in glucose concentrations was observed for NaFl tubes (4.9 % at 30 min) and this trend was only partially reduced by placing samples at 4 °C (3.1 %). The decrease reached 10.8 % (RT) and 7.8 % (4 °C) at 2 h, before reaching a plateau. Samples collected on citrate remained stable during 24 h. In real-life conditions, the mean bias between FC Mix and NaFl tubes increased progressively over time and reached 8.59 % for samples centrifuged between two- and four-hours following sampling. Compared to widespread practices, the use of citrate-containing tubes increased IFG, DM and GDM prevalences by 84.0 %, 36.7 % and 150 %, respectively. CONCLUSIONS Glucose concentrations rapidly decrease in NaFl tubes following collection and placing samples at 4 °C reduces only marginally the decay. Citrate-containing tubes offer a valuable solution for direct and long-lasting glucose stabilization but, before wider adoption, large epidemiologic studies should confirm or redefine current diabetes diagnostic thresholds.
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Affiliation(s)
- Arnaud Nevraumont
- Department of Laboratory Medicine, Clinique St-Pierre, Ottignies, Belgium
| | - Matthieu Deltombe
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium; Institute of NeuroScience (IONS), Université Catholique de Louvain, Bruxelles, Belgium
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, Clinique St-Pierre, Ottignies, Belgium; Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
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2
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Kaufmann T, Slingerland RJ, Edens MA, Olthof CG. Glucose measurements with accu check inform II versus hexokinase plasma method during surgery under general anesthesia, an observational cohort study. J Clin Monit Comput 2024; 38:479-485. [PMID: 37688674 DOI: 10.1007/s10877-023-01072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Limited research exists on translation of in-vitro glucose measurement interfering compounds to the in-vivo situation. We investigated whether Point-of-Care glucose measurements by Accu Chek Inform II (ACI II) were accurate to monitor glucose concentrations during surgery with general anesthesia by comparing with the reference laboratory hexokinase plasma glucose test. METHOD Patients undergoing surgery with general anesthesia were included. Anesthesia was maintained with either Sevoflurane or Total intravenous anesthesia (TIVA). Prior to and after induction, blood glucose was measured with ACI II and the hexokinase test. Bland-Altman analysis was performed to assess method agreement. Subgroup analyses on glucose measurement differences per type of maintenance anesthesia were performed. RESULTS Thirty-nine patients were included, and 78 measurements were performed. All paired measurements had clinically acceptable agreement with a percentage error of 10.0% (95% CI 8.0 to 11.9). The mean difference (95% limits of agreement) between ACI II and hexokinase for all measurements was 0.0 mmol/L (-0.7 to 0.7 mmol/L). Before induction (n = 39), mean difference was -0.1 mmol/L (-0.6 to 0.4 mmol/L), and after induction (n = 39), mean difference was 0.1 mmol/L (-0.8 to 0.9 mmol/L). Further investigation showed the difference varied per test for patients receiving Sevoflurane compared to patients receiving TIVA (-0.2 ± 0.4 mmol/L vs. 0.4 ± 0.3 mmol/L, p < 0.001). Before and after induction, the difference between ACI II and hexokinase measurements increased for patients receiving Sevoflurane compared to patients receiving TIVA (0.4 ± 0.4 mmol/L vs. -0.4 ± 0.3 mmol/L, p < 0.001). CONCLUSION The agreement between glucose measurements using ACI II and the reference laboratory hexokinase test was clinically acceptable with a percentage error of 10.0% (95% CI 8.0 to 11.9). The use of TIVA may negatively affect the measurement performance of the ACI II.
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Affiliation(s)
- Thomas Kaufmann
- Department of Anesthesiology, Isala, Zwolle, The Netherlands
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Mireille A Edens
- Department of Innovation and Science, Isala, Zwolle, the Netherlands
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3
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Islam MN, Lyons C, Griffin TP, Hamon S, Dunne FP, O'Shea PM. Maintaining glucose integrity ex-vivo: Impact of preanalytical specimen handling. Ann Clin Biochem 2024; 61:133-142. [PMID: 37626439 DOI: 10.1177/00045632231199374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Adopting the WHO protocol for glucose analysis is arguably impractical in the routine clinical setting. Deviations may develop due to a lack of understanding regarding the impact of glycolysis on the accuracy of results. AIM We sought to assess the stability of glucose in two different blood collection tubes (BCT), BD Vacutainer® FX 'Fl-Ox' and Greiner Vacuette® FC-Mix 'FC-Mix' stored at room temperature (RT:18-22°C) and 4°C over 8.5 days. METHOD Each participant provided venous whole blood collected into 51 BCTs; 'Fl-Ox' (n = 26) and 'FC-Mix' (n = 25). One Fl-Ox sample from each participant was handled according to the WHO recommended method. The remaining BCTs were stored at 4°C/RT prior to analyses at designated study timepoints. Glucose was measured using the hexokinase assay on the Cobas® 8000 platform. RESULTS Participants (n = 8, Male = 2) were aged 24-56 years. Plasma glucose measured in FI-Ox BCTs according to the WHO sample-handling method had a median concentration of 5.73 mmol/L (Range: 5.39-10.37 mmol/L). Glucose decreased by greater than minimal difference (>0.26 mmol/L) in blood collected into Fl-Ox and stored @4°C/RT within 24 h of phlebotomy. FC-Mix BCT maintained glucose <0.26 mmol/L @4°C over a period of 8.5 days and up to 4 days @RT when compared to the WHO recommended method. CONCLUSION Glucose in FC-Mix BCT stored @4°C demonstrated the best agreement with results determined using the WHO specifications. When FC-Mix tubes were stored @RT, glucose was stable for 4 days. These findings suggest that the FC-Mix BCT effectively inhibits glycolysis and should be introduced into routine clinical practice.
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Affiliation(s)
- Md Nahidul Islam
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
- School of Biological and Chemical Sciences, University of Galway, Galway, Ireland
| | - Claire Lyons
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Tomas P Griffin
- School of Medicine, University of Limerick, Limerick, Ireland
- Department of Diabetes, University Hospital Limerick, Limerick, Ireland
| | - Siobhan Hamon
- Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Ireland
| | - Paula M O'Shea
- Department of Clinical Chemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
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4
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Pierre CC, Wiencek JR. The impact of environmental factors on external and internal specimen transport. Clin Biochem 2022; 115:13-21. [PMID: 36379239 DOI: 10.1016/j.clinbiochem.2022.11.005] [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: 08/12/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
The environment that a clinical specimen is exposed to is an important preanalytical factor in laboratory testing. There are numerous environmental conditions that a specimen may experience before it arrives at the clinical laboratory for analysis. Specimens collected at offsite locations are typically stored at the site and transported to the clinical laboratory via courier. Depending on the geographic location, season, method of storage and method of transport, the specimen can experience varying climate conditions that can lead to inaccurate test results. Specimens collected within the healthcare institution are not exempt from suboptimal storage and transport environments. For example, specimens transported via pneumatic tube systems can experience extreme agitation and rapid accelerations and decelerations. Suboptimal storage and transport temperatures occur less frequently within health systems due to multiple regulatory requirements for temperature monitoring; however, temperature monitoring may not occur at every stage of the preanalytical phase. This review will highlight both internal and external environmental conditions that can cause preanalytical errors in clinical laboratory testing. Strategies to mitigate environmentally-induced preanalytical errors and regulatory gaps for environmental monitoring in the preanalytical phase will also be discussed.
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Affiliation(s)
- Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA 17604-3555, United States
| | - Joesph R Wiencek
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN 37232-5310, United States.
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Jamieson EL, Dimeski G, Flatman R, Hickman PE, Ross Dallas Jones G, V Marley J, David McIntyre H, McNeil AR, Nolan CJ, Potter JM, Sweeting A, Ward P, Williams P, Rita Horvath A. Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling. Clin Biochem 2022; 115:33-48. [PMID: 36244469 DOI: 10.1016/j.clinbiochem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.
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Rasmussen RW, Straarup D, Thorlacius-Ussing O, Handberg A, Christensen PA. Fully automatic d-lactate assay using a modified commercially available method. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:312-317. [PMID: 33879006 DOI: 10.1080/00365513.2021.1907859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intestinal infarction is the fast-evolving endpoint of impaired blood perfusion to an intestinal segment which may have fatal outcome. Early diagnosis and treatment within 6 h reduce mortality. Currently, d-lactate is a promising biomarker, however, not available in the acute clinical setting. The aim of this study is implementation of d-lactate analysis in a routine clinical setting. We used a spectrophotometric method, based on enzymatic oxidation of d-lactate by d-lactate dehydrogenase (D-LDH) coupled to the reduction of nicotinamide-adenine dinucleotide (NAD+). The amount of NADH formed in this reaction is equivalent to d-lactate. The primary concern in this method is interfering NADH formed by oxidation of l-lactate by l-lactate dehydrogenase (L-LDH). A commercially available kit for d-lactate measurement was implemented on our existing automated routine laboratory equipment including pH-inactivation of L-LDH. Our setup fulfilled clinical quality goals. We were able to measure d-lactate with an acceptable performance of the analysis and a short turn-around time. The method can be used to distinguish between the expected cut-off for intestinal ischemia around 0.3 mM and the upper reference limit of 0.05 mM. With a turnaround time of just 9 min, the analysis has potential as a readily available detection of circulating d-lactate for early diagnosis of intestinal ischemia.
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Affiliation(s)
| | - David Straarup
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Astrup Christensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Comparison of Accu Chek Inform II point-of-care test blood glucose meter with Hexokinase Plasma method for a diabetes mellitus population during surgery under general anesthesia. J Clin Monit Comput 2021; 36:355-361. [PMID: 33496941 PMCID: PMC9123023 DOI: 10.1007/s10877-021-00656-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/08/2021] [Indexed: 11/04/2022]
Abstract
Purpose Blood glucose (BG) concentrations of patients with diabetes mellitus (DM) are monitored during surgery to prevent hypo- and hyperglycemia. Access to point-of-care test (POCT) glucose meters at an operating room will usually provide monitoring at shorter intervals and may improve glycemic control. However, these meters are not validated for patients under general anesthesia. Methods This cross-sectional study included 75 arterial BG measurements from 75 patients (71 with DM, mostly insulin dependent) who underwent elective non-cardiac surgery under general anesthesia. Arterial blood samples were taken at least 60 minutes after induction. One drop of blood was used for Accu Chek Inform II (ACI II) POCT BG meter and the residual blood was sent to the clinical laboratory for a Hexokinase Plasma reference method. A Bland–Altman plot was used to visualize the differences between both methods, and correlation was assessed using the intra-class correlation coefficient (ICC). Results The results showed an estimated mean difference of 0.8 mmol/L between ACI II and the reference method, with limits of agreement equal to -0.6 and 2.2 mmol/L. In general, the reference method produced higher values than ACI II. ICC was 0.955 (95% CI 0.634–0.986), P < 0.001, and concordance correlation coefficient (CCC) was 0.955 (95% CI 0.933–0.970). Conclusion Arterial BG measurements during surgery in patients with DM under general anesthesia using POCT BG meter are in general lower than laboratory measurements, but the ICC and CCC show a clinically acceptable correlation. We conclude that POCT measurements conducted on arterial specimens using the ACI II provide sufficiently accurate results for glucose measurement during surgery under general anesthesia.
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8
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Kristensen K, Wangel AM, Katsarou A, Shaat N, Simmons D, Fadl H, Berntorp K. Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference. J Diabetes Res 2020; 2020:7937403. [PMID: 32280717 PMCID: PMC7115054 DOI: 10.1155/2020/7937403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. METHODS A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n = 135), 1 h (n = 135), 1 h (n = 135), 1 h (. RESULTS Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P < 0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. CONCLUSIONS A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.
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Affiliation(s)
- Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anne-Marie Wangel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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9
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Coward SM, O'Neill FC, McAdam L, Reilly L, McKeeman GC. Stabilization of Plasma Glucose: The Use of Newer Technology and Pragmatic Laboratory Practice. J Appl Lab Med 2019; 3:1028-1034. [PMID: 31639694 DOI: 10.1373/jalm.2018.027227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The target values for plasma glucose concentrations for the investigation and diagnosis of diabetes and impaired fasting glucose, and the realization that small incremental changes in glucose concentration increase the risk of adverse events, has led to greater focus on laboratory glucose results. Although analytical methods show acceptable precision, the control of preanalytical error due to the stability of glucose remains problematic. The aim of this study was to compare glucose concentrations in 3 different and commercially available blood tubes, with analysis and storage under current practices and conditions. METHODS Blood samples for glucose were obtained from consenting patients attending the Diabetic Clinic at the Royal Victoria Hospital, Belfast. Blood was collected into BD Vacutainer® Barricor™ Lithium Heparin tubes, BD Vacutainer Fluoride EDTA tubes, and Greiner Vacuette® FC-Mix (sodium fluoride/citrate/Na2EDTA) tubes in that order. The Barricor tubes were immediately centrifuged at 4000g for 3 min. All samples were then sent to the Biochemistry Laboratory for analysis on the same day, and again the following day after storage at 4 °C. RESULTS There was no significant difference in mean glucose concentrations between immediately centrifuged Barricor and FC-Mix tubes when analyzed on day 0. Both tube types demonstrated higher mean glucose concentrations than traditional fluoride EDTA (F/EDTA) samples. CONCLUSIONS Both immediately separated Barricor and citrated FC-Mix plasma preserve glucose concentrations to the same extent, and better than F/EDTA preservative. These newer technologies involved offer pragmatic solutions to improved glucose analysis, allowing laboratories to choose the best option given the source of their samples.
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Affiliation(s)
- Stephen M Coward
- Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland.
| | - Fiona C O'Neill
- Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Leanne McAdam
- Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Lynsey Reilly
- Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Gareth C McKeeman
- Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland
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10
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Hermanides RS, Kennedy MW, Kedhi E, van Dijk PR, Timmer JR, Ottervanger JP, Dambrink JH, Gosselink AM, Roolvink V, Miedema K, Slingerland RJ, Koopmans P, Bilo HJ, van 't Hof AW. Impact of elevated HbA1c on long-term mortality in patients presenting with acute myocardial infarction in daily clinical practice: insights from a 'real world' prospective registry of the Zwolle Myocardial Infarction Study Group. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:616-625. [PMID: 31124695 DOI: 10.1177/2048872619849921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction. METHODS A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up. RESULTS Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, p<0.001) and long-term mortality (19% vs. 26% vs. 35%, p<0.001) for both pre-diabetes patients as well as newly diagnosed diabetes patients was poor and comparable to known diabetes patients. After multivariate analysis, newly diagnosed diabetes was independently associated with long-term mortality (hazard ratio 1.72, 95% confidence interval 1.27-2.34, P=0.001). CONCLUSIONS In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c ⩾48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.
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Affiliation(s)
| | | | - Elvin Kedhi
- Department of Cardiology, Isala, The Netherlands
| | - Peter R van Dijk
- Department of Internal Medicine, Isala, The Netherlands.,Department of Internal Medicine, University Medical Center, Groningen, The Netherlands
| | | | | | | | | | | | - Kor Miedema
- Department of Clinical Chemistry, Isala, The Netherlands
| | | | | | - Henk Jg Bilo
- Department of Internal Medicine, Isala, The Netherlands.,Department of Internal Medicine, University Medical Center, Groningen, The Netherlands
| | - Arnoud Wj van 't Hof
- Department of Cardiology, Isala, The Netherlands.,Department of Cardiology, Maastricht University Medical Center, The Netherlands.,Department of Cardiology, Zuyderland, The Netherlands
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11
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Bonetti G, Giavarina D, Carta M. Clinical impact of citrate-containing tubes on the detection of glucose abnormalities by the oral glucose tolerance test. Diagnosis (Berl) 2019; 6:377-383. [DOI: 10.1515/dx-2018-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/15/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Plasma glucose levels provide the cornerstone of diabetes evaluation, and so it is crucial that clinical laboratories provide accurate and reliable plasma glucose results. To prevent in vitro glycolysis, citrate is used. Here, we present the first study on the 75-g oral glucose tolerance test (OGTT) using the currently available new citrate-containing tubes in liquid and granular forms and the previous sodium fluoride (NaF) for the diagnosis of carbohydrate metabolism disorders and gestational diabetes mellitus (GDM) according to the American Diabetes Association (ADA) guidelines.
Methods
The 75-g OGTT was performed in 147 volunteers, 83 of whom were pregnant women. Blood was collected in NaF/K3 ethylenediaminetetraacetic acid (EDTA) and NaF/Na2EDTA/citrate in liquid form in tubes in Brescia and in NaF/K2Ox and NaF/Na2EDTA/citrate in granular form in Vicenza. Glucose was measured within 3–4 h from the OGTT. The mean biases were calculated and compared with the desirable bias (<± 2.1%).
Results
OGTT glucose concentrations were higher in citrate tubes when compared to NaF-containing tubes. When citrate tubes were used, GDM increased to 12.5 and 11.7% in Brescia and Vicenza, respectively. Impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM) increased to 36.7, 6.7 and 3.4%, respectively, in Brescia. In Vicenza, an increase of 47 and 1.9% in IFG and IGT, respectively, was found.
Conclusions
OGTT glucose measurement in citrate-containing tubes was shown to be more effective than those containing only NaF in diagnosing carbohydrate disorders. This new glycolysis inhibitor seems to be a necessary preanalytical tool for accurate and reliable plasma glucose results.
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Affiliation(s)
- Graziella Bonetti
- Central Clinical Chemistry Laboratory , A.S.S.T Spedali Civili of Brescia, Piazzale Spedali Civili 1 , 25123 Brescia , Italy , Phone: +39 030 3995508, Fax: +39 030 3995646
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12
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Bonetti G, Carta M, Lapolla A, Miccoli R, Testa R, Mosca A. Correct determination of glycemia in the diagnosis and management of diabetes: Recommendations for the optimization of the pre-analytical phase. Nutr Metab Cardiovasc Dis 2019; 29:1-3. [PMID: 30482424 DOI: 10.1016/j.numecd.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 01/30/2023]
Affiliation(s)
- G Bonetti
- U.O.C. Laboratorio Centrale Analisi Chimico-Cliniche, ASST- Spedali Civili, Brescia, Italy
| | - M Carta
- Laboratorio di Chimica Clinica ed Ematologia, Ospedale San Bortolo, Vicenza, Italy
| | - A Lapolla
- Dip. di Medicina, Università degli Studi, Padova, Italy
| | - R Miccoli
- Dip. di Medicina Clinica e Sperimentale, Sez. Diabetologia e Malattie Metaboliche, Università degli Studi, Pisa, Italy
| | - R Testa
- Lab. Analisi Chimico-Cliniche e Molecolari, Istituto Nazionale di Ricovero e Cura per gli Anziani IRCCS INRCA, Ancona, Italy
| | - A Mosca
- Dip. di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi, Milano, Italy.
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Lippi G, Nybo M, Cadamuro J, Guimaraes JT, van Dongen-Lases E, Simundic AM. Blood Glucose Determination: Effect of Tube Additives. Adv Clin Chem 2018; 84:101-123. [PMID: 29478513 DOI: 10.1016/bs.acc.2017.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The measurement of fasting plasma glucose may be biased by a time-dependent decrease of glucose in blood tubes, mainly attributable to blood cell metabolism when glycolysis is not rapidly inhibited or blood cells cannot be rapidly separated from plasma. Although glycolysis inhibitors such as sodium fluoride (NaF) in combination with potassium oxalate (KOx) are currently used for overcoming this drawback, their efficacy for stabilizing blood glucose is seemingly limited, and probably lower than that of newer additives such as the citrate buffer. Therefore, we performed a critical analysis of the current scientific literature aimed to generate evidence-based information about the advantages of using citrate buffer in blood tubes compared to the more conventional NaF additive. The results of our systematic overview of the literature show that citrate blood tubes represent a considerable step forward in achieving more accurate and reliable plasma glucose measurements, thereby limiting the risk of underdiagnosing diabetes due to spurious decrease of glucose concentration in uncentrifuged blood specimens, ensuring higher stability of glucose levels over time, while simultaneously producing less hemolysis compared to NaF blood tubes. Therefore, we suggest that the use of this new mixture should be encouraged for achieving a higher degree of accuracy and standardization of plasma glucose measurements.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy.
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Joao T Guimaraes
- São João Hospital Center, University of Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
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14
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Bonetti G, Carta M. The new Greiner FC-Mix tubes equal the old Terumo ones and are useful as glucose stabilizer after prolonged storage of samples. Biochem Med (Zagreb) 2017; 27:030901. [PMID: 29018304 PMCID: PMC5628000 DOI: 10.11613/bm.2017.030901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/22/2017] [Indexed: 02/03/2023] Open
Abstract
Introduction The aim of our study is to compare new Greiner tubes containing granulated citrate buffer with the Terumo ones and to verify if they are suitable for glucose stabilization after prolonged storage. Materials and methods In Study 1, blood was collected in two Terumo and two Greiner tubes from 40 healthy volunteers. Samples were stored at room temperature (RT) for 1 and 2 hours, respectively. Comparison was made by Deming regression. In Study 2, glucose was measured in a reference tube (N = 50), according to the ADA-NACB guidelines and in aliquots of Greiner samples maintained un-centrifuged at RT for 1, 2, 4 (N = 50) and 24, 48, 72 hours (N = 35). Results There were insignificant mixed biases between the Terumo and Greiner tubes. Compared to reference (5.3 mmol/L), glucose concentration in the new tubes was 5.4 (P < 0.05), 5.4 (P < 0.05), 5.3 (P = 0.265), 5.2 (P = 0.156), 5.3 (P < 0.05) and 5.2 (P < 0.05) mmol/L after 1, 2, 4, 24, 48 and 72 hours at RT, respectively. There was no biological difference between any of the time points up to 48 h (bias < ± 1.95%). Conclusions The study shows that the new tubes perform equally well as the Terumo ones and ensure glucose stabilization up to 48 h as well as permit to create a link between the previous studies demonstrating the clinical utility of granulated citrate buffer and the future ones.
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Affiliation(s)
- Graziella Bonetti
- Clinical Chemistry Laboratory, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Mariarosa Carta
- Clinical Chemistry and Haematology Laboratory, St. Bortolo Hospital, Vicenza, Italy
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15
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Saracevic A, Dukic L, Juricic G, Milevoj Kopcinovic L, Mirosevic G, Simundic AM. Various glycolysis inhibitor-containing tubes for glucose measurement cannot be used interchangeably due to clinically unacceptable biases between them. ACTA ACUST UNITED AC 2017; 56:236-241. [DOI: 10.1515/cclm-2017-0279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/29/2017] [Indexed: 01/16/2023]
Abstract
Abstract
Background:
The aim of our study was to determine the difference between glucose concentration measured 30 min after venipuncture in ice-chilled heparin plasma sample and all currently available citrate buffer-containing tubes (Greiner Glucomedics, Greiner FC Mix and Sarstedt GlucoEXACT) and still widely used sodium fluoride/potassium oxalate (NaF/Kox) tubes from Greiner.
Methods:
Blood was collected from 20 healthy volunteers and 20 patients with diabetes into LiH, NaF/KOx, Glucomedics, FC mix and GlucoEXACT tubes. Glucose was measured within 30 min from blood sampling in duplicate on the Architect c8000 analyzer. Mean biases between all tube types were calculated and compared to the recommended criteria (1.95%). Additionally, glucose concentrations measured in all five tube types were compared using the Friedman test.
Results:
In the entire studied population, glucose concentrations measured in Glucomedics, FC mix and GlucoEXACT were higher (7.3%, 3.2% and 2.0%, respectively) than in the ice-chilled LiH tubes. When all glycolysis inhibitor-containing tubes were compared, Glucomedics tubes significantly differed from GlucoEXACT and FC mix tubes (biases −4.9% and 4.0%, respectively). In addition, there was a significant difference between the NaF/KOx tube and Glucomedics, as well as FC mix tubes (biases 7.1% and 3.0%, respectively).
Conclusions:
Glucose concentrations measured in recommended ice-chilled lithium heparin- and citrate buffer-containing tubes are not comparable. Significant biases exist between various glycolysis inhibitor-containing tubes; therefore, they cannot be used interchangeably.
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Affiliation(s)
- Andrea Saracevic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Sveti Duh 64 , Zagreb , Croatia , Phone: +385 1 3712 117
| | - Lora Dukic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
| | - Gordana Juricic
- Department of Laboratory Diagnostics , General Hospital Pula , Pula , Croatia
| | - Lara Milevoj Kopcinovic
- University Department of Chemistry, University Hospital Center “Sestre Milosrdnice” , Zagreb , Croatia
| | - Gorana Mirosevic
- Department of Endocrinology, Diabetology and Metabolic diseases “Mladen Sekso” , University Hospital Center “Sestre Milosrdnice” , Zagreb , Croatia
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics , University Hospital “Sveti Duh” , Zagreb , Croatia
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Montagnana M, Lippi G. Overcoming preanalytical issues for diagnosing diabetes with fasting plasma glucose. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:257. [PMID: 28706925 DOI: 10.21037/atm.2017.05.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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