The clinical utility of two human portable blood glucose meters in canine and feline practice

Diagnostic Limitations of Applying a Human Portable Blood Glucose Meter in the Detection of Hypoglycemia in Pregnant Ewes

Pregnant ewes are susceptible to hypoglycemia and ketosis; therefore, monitoring glycemic status is extremely important. Portable blood glucose meters (PBGMs) can assist in quickly and conveniently identifying glycemic disturbances in this species, provided that they meet the criteria of analytical accuracy. This study evaluated the performance of a human PBGM (Accu-Chek Performa®, Roche Diagnostics, Basel, Switzerland) in the glycemic evaluation of 34 pregnant ewes at days 90 and 120 of pregnancy in comparison with the results of glycemia determination by a reference method (RM). The device showed a high positive correlation (r = 0.71, 95%CI = 0.57-0.82, p < 0.0001) with the RM; however, 96.6% of the PBGM results (58.5 ± 9.82 mg/dL) were higher (p < 0.0001) than those obtained in the laboratory (48.6 ± 9.31 mg/dL). The PBGM tested was considered analytically inaccurate according to ISO 15197:2013, which states that when glucose levels are below 100 mg/dL, 95% of the measurements should deviate by no more than 15 mg/dL from the RM value, and 1/3 of the PBGM results were above this limit. Hypoglycemia (<50 mg/dL) was documented in 60.29% of samples tested on with the RM, but only 17.64% of results were below 50 mg/dL using the PBGM. Due to these limitations, Accu-Check Performa® results should be interpreted cautiously in pregnant sheep suspected of hypoglycemia.

High carbohydrate is preferable to high lipid parenteral nutrition in healthy dogs undergoing prolonged sedation

Parenteral nutrition (PN) is commonly used in intensive care units (ICUs) and is associated with earlier hospital outcome. However, there is scarcity of information about the metabolic effects of PN caloric distribution for dogs. Considering the high tolerance of dogs to lipids and, also, that hospitalized animals usually present insulin resistance, PN formulation with high fat instead high glucose can provide metabolic benefits in this specie. This study evaluated two PN protocols, based on high lipid or high carbohydrate in 12 healthy dogs under sedation/ventilation during 24 h. For baseline data, blood samples were collected 24 h before the study beginning. After fasting, the dogs were anesthetized and put under mechanical ventilation without energy support for 12 h to obtain: daily energy expenditure (DEE), respiratory quotient (RQ), oxygen consumption (VO2), carbon dioxide production (VCO2), lactate, glucose, cholesterol, and triglycerides concentrations. After, the dogs were allocated into two groups: lipid-based energy group (LEG) and carbohydrate-based energy group (CEG). Both groups received the PN infusions at a rate of 3 mL/kg/h for 12 h. Blood tests were performed 12, 24, and 48 h after infusion's completion. VO2 increased after PN in LEG, increasing energy expenditure compared to CEG. RQ remained close to 1 in CEG, indicating carbohydrate preferential consumption. Triglycerides increased in both groups after propofol infusion, remaining higher in LEG until the end of the evaluation. Glycaemia increased in CEG compared to baseline. In conclusion, both PN protocols can be used in healthy animals undergoing prolonged sedation protocols. However, high lipid PN had higher VO2 and DEE, and resulted in higher triglycerides concentrations and lower glycaemia indexes than carbohydrate, making high carbohydrate PN preferable to high lipid PN. Therefore, for use in critically ill patients, the data obtained in this study should be extrapolated, taking into consideration the specificity of each case.

Impact on result interpretation of correct and incorrect selection of veterinary glucometer canine and feline settings

Veterinary glucometers should be correctly coded for the patient species; however, coding errors occur in clinical settings and the impact of such errors has not been characterized. We compared glucose concentrations in 127 canine and 37 feline samples using both canine and feline settings on a veterinary glucometer (AlphaTrak; Zoetis). All samples were measured first on the canine setting and then measured using the feline setting. Glucose concentration was also measured using a central laboratory biochemical analyzer (Cobas c311; Roche). Three data comparisons for each species were investigated: incorrectly coded glucometer vs. correctly coded glucometer, correctly coded glucometer vs. Cobas c311, and incorrectly coded glucometer vs. Cobas c311. For each comparison, the following analyses were conducted: Spearman rank correlation coefficient, Bland-Altman difference plot analysis, mountain plot analysis, and Deming regression. For clinical context, Clarke error grids were constructed. There was high positive correlation for all comparisons with both species. For all comparisons, mean difference was low (-0.7 to 0.5 mmol/L for canine samples, 1.0-2.0 mmol/L for feline samples). Incorrect glucometer coding resulted in proportional bias for canine samples and positive constant bias for feline samples, and individual differences could be large (-4.44 mmol/L for one dog, 6.16 mmol/L for one cat). Although the glucometer should be used per the manufacturer's recommendation, coding errors are unlikely to have severe adverse clinical consequences for most patients based on error grid analysis.

Evaluation of Three Human-Use Glucometers for Blood Glucose Measurement in Dogs

BACKGROUND

Glucometers or portable sensors are used to quickly measure blood glucose at low cost. They are used in veterinary practice and by guardians to monitor diseases that require, as in diabetes mellitus. However, not all commercially available glucometers (human and veterinary) are suitable for this purpose. Hypotheses/Objectives. The objective was to evaluate the analytical and clinical precision of three human-use portable glucometers. Animals. This study evaluated 115 samples in three glycemic ranges (hypoglycemia, normoglycemia, and hyperglycemia) from 82 dogs recruited from veterinary services.

METHODS

The portable glucometers are the FreeStyle Freedom Lite®, FreeStyle Optium Neo®, and On Call Plus® models. Glucometer results were compared with the enzymatic colorimetric glucose oxidase laboratory reference method. Using descriptive and comparative statistical analysis, there were correlations between these devices and the standard method, ISO 15197 : 2003 and ISO 15197 : 2013 standards, and error grid analysis.

RESULTS

Only the Freedom Lite® device observed a statistical difference when compared with the reference method. Despite the underestimated glucose concentrations assessed with humane devices, all three tested herein showed a positive coefficient. However, none of these achieved all ISO guidelines. Conclusion and Clinical Importance. Although there was wide use of portable humane devices for dog glucose measurements on routine, the results are generally inferior when compared to the reference method. The FreeStyle Optium Neo® glucometer obtained the best result and is therefore the best option among the glucometers evaluated; however, for the first attendance on veterinary routine, all three glucometers had a satisfactory glucose measurement until the reference method availability.

Comparison of glucose concentrations in canine whole blood, plasma, and serum measured with a veterinary point-of-care glucometer

Previous studies have determined that, compared to whole blood, serum or plasma used in a portable blood glucometer (PBG) may provide more accurate results. We investigated the accuracy of a veterinary PBG (AlphaTRAK 2; Zoetis) for the measurement of glucose concentrations in serum, plasma, and whole blood compared to plasma glucose concentration measured by a biochemical analyzer. Blood samples from 53 client-owned dogs were collected. Lin concordance correlation coefficient (ρ_c) and Bland-Altman plots were used to determine correlation and agreement between the results obtained for the different sample types. Glucose concentration in whole blood measured by the veterinary PBG was more strongly correlated with the glucose concentration measured by the biochemical analyzer (ρ_c = 0.92) compared to plasma and serum glucose concentrations (ρ_c = 0.59 and 0.57, respectively). The mean differences between the glucose concentrations in whole blood, plasma, and serum measured by the veterinary PBG and the glucose concentration determined by the biochemical analyzer were 1.0, 6.3, and 6.7 mmol/L (18, 113, and 121 mg/dL), respectively. Our findings suggest that, when using this veterinary PBG, the accuracy of a glucose measurement obtained is higher when using whole blood compared to plasma or serum. Use of whole blood allows for more correct assessment and diagnosis, which are necessary for appropriate therapeutic intervention.

Mitochondrion-Directed Nanoparticles Loaded with a Natural Compound and a microRNA for Promoting Cancer Cell Death via the Modulation of Tumor Metabolism and Mitochondrial Dynamics

Mitochondrial dysfunction may cause cancer and metabolic syndrome. Ellagic acid (abbreviated as E), a phytochemical, possesses anticancer activity. MicroRNA 125 (miR-125) may regulate metabolism. However, E has low aqueous solubility, and miR-125 is unstable in a biological fluid. Hence, this study aimed to develop nanoparticle formulations for the co-treatment of miR-125 and E. These nanoparticles were modified with one mitochondrion-directed peptide and a tumor-targeted ligand, and their modulating effects on mitochondrial dysfunction, antitumor efficacy, and safety in head and neck cancer (HNC) were evaluated. Results revealed that miR-125- and E-loaded nanoparticles effectively targeted cancer cells and intracellular mitochondria. The co-treatment significantly altered cellular bioenergetics, lipid, and glucose metabolism in human tongue squamous carcinoma SAS cells. This combination therapy also regulated protein expression associated with bioenergenesis and mitochondrial dynamics. These formulations also modulated multiple pathways of tumor metabolism, apoptosis, resistance, and metastasis in SAS cells. In vivo mouse experiments showed that the combined treatment of miR-125 and E nanoparticles exhibited significant hypoglycemic and hypolipidemic effects. The combinatorial therapy of E and miR-125 nanoparticles effectively reduced SAS tumor growth. To our best knowledge, this prospective study provided a basis for combining miRNA with a natural compound in nanoformulations to regulate mitochondrial dysfunction and energy metabolism associated with cancer.

Precision and accuracy of a point-of-care glucometer in horses and the effects of sample type

Point-of-care glucometry is used commonly in clinical and research settings; however, accuracy and precision of this method are concerns. The objectives of this study were to determine the accuracy of glucometry in adult horses and the precision of duplicate measurements. Blood samples were collected from 62 horses into one plain syringe, one EDTA tube and three fluoride oxalate (FO) tubes. Immediately after collection, glucose concentrations in whole blood were determined, in duplicate, by glucometry from the syringe (plain whole blood [WB] group), EDTA tube (EDTA group) and one FO tube (FO group). One FO sample was used to measure plasma glucose concentration by a laboratory chemistry analyser (LAB group) ≤1 h after collection. The third FO tube was used to measure plasma glucose concentration by glucometry after 3 h storage (FO3hr group). Adequate precision was present for all groups (coefficient of variation: 0.7-3.5%) except WB (5.5-9.4%). Between groups, correlations were significant (P < 0.05; except for WB-EDTA), varied with group comparison, and tended to be lowest for comparisons involving WB. Mean bias was lowest for WB-LAB and greatest for FO-LAB and FO3hr-LAB; however, the limits of agreement were ≥4.65 mmol/L for WB-LAB and ≤2.75 mmol/L for most other comparisons. For the glucometer used, performance was influenced by sample type: WB was unsuitable, while FO or EDTA samples resulted in adequate precision and accuracy, provided under-estimation of glucose concentrations is accounted for by using method-specific reference ranges. Glucometer performance and optimal sample type(s) should be determined prior to use in horses.

Evaluation of newly developed veterinary portable blood glucose meter with hematocrit correction in dogs and cats

This study evaluated the accuracy of a newly developed veterinary portable blood glucose meter (PBGM) with hematocrit correction in dogs and cats. Sixty-one dogs and 31 cats were used for the current study. Blood samples were obtained from each dog and cat one to six times. Acceptable results were obtained in error grid analysis between PBGM and reference method values (glucose oxidation methods) in both dogs and cats. Bland–Altman plot analysis revealed a mean difference between the PBGM value and reference method value of −1.975 mg/dl (bias) in dogs and 1.339 mg/dl (bias) in cats. Hematocrit values did not affect the results of the veterinary PBGM. Therefore, this veterinary PBGM is clinically useful in dogs and cats.

ISFM consensus guidelines on the practical management of diabetes mellitus in cats

PRACTICAL RELEVANCE

Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats.

CLINICAL CHALLENGES

Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently--unless hypoglycaemia is encountered.

EVIDENCE BASE

The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.