Comparison of Glucose Values of Blood Samples Taken in Three Different Ways

Measuring capillary blood glucose concentration: Is the first blood drop really the right blood drop?

BACKGROUND

Capillary blood glucose (CBG) is fundamental for diabetes mellitus management. However, it is still unclear whether the first or the subsequent blood drops most accurately reflect patients' blood glucose levels.

METHODS

128 healthy volunteers were included in this prospective cohort study from November 2021 to December 2021. Capillary blood glucose concentrations of the first four blood drops, measured using glucose meters were compared with venous blood concentrations of the respective donors, measured using an in-lab hexokinase method. ANOVA, the Spearman correlation coefficient and Bland-Altman plots were used to analyze the data.

RESULTS

The mean plasma glucose concentration was 90.46 mg/dl with an SD of ± 14.416 (5.02 ± 0.8 mmol/l). There were statistically strong correlations among the glucose concentrations of all capillary blood drops (correlation coefficients of r > 0.8). The first capillary blood drops showed the lowest mean difference to plasma blood glucose concentrations (+4.92 mg/dl; +0.27 mmol/l), followed by the third drop (+7.28 mg/dl; +0.4 mmol/l), second drop (+7.30 mg/dl; +0.4 mmol/l) and fourth drop (+8.87 mg/dl; +0.49 mmol/l).

CONCLUSION

There is a strong correlation and good agreement between the different capillary blood drops, making all blood drops equally suitable for blood glucose monitoring. In practice, the given setting (clinical or patient self-monitoring) should be considered upon choosing a specific blood drop.

Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study

INTRODUCTION

Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa.

AIM

We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD).

RESEARCH DESIGN AND METHODS

A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings.

RESULTS

In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour.

CONCLUSIONS

The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.

Effects of Different Methods Used to Take Blood Samples on Blood Glucose Measurements

The purpose of this study is to compare whether or not there is a difference between venous and capillary blood samples in blood glucose measurements and investigate the effects of different aseptic methods used in skin cleaning before collecting blood samples on measurement results. This quasi-experimental study was conducted with 109 patients. The capillary first and second blood drop values taken from the patients after fasting and at 2 hours following 75 g oral glucose tolerance test (OGTT) and capillary and venous blood glucose values were compared. There was no significant difference between the median venous blood glucose value and the capillary second blood drop value taken after wiping the finger with alcohol. There was no significant difference between the first and second blood drop values of capillary blood glucose 2 hours after OGTT.

Predictors of Time-to-Repeat Point-of-Care Glucose Following Hypoglycemic Events in Hospitalized Patients

BACKGROUND

Previous studies have shown low adherence to the recommendation to repeat point-of-care glucose (POCG) within 15 minutes following the treatment of inpatient hypoglycemia. We sought to evaluate whether patient and clinical factors may predict time-to-repeat (TTR) POCG following hypoglycemic events in hospitalized adult patients.

METHODS

This was a retrospective cross-sectional analysis of 22 226 index hypoglycemic (≤70 mg/dL) readings (of 993 395 total POCG samples) from 6226 hospital admissions within the Johns Hopkins Health System over three years. Time-to-repeat was defined as the difference in time (minutes) between the index POCG and the next POCG sample. Multivariable logistic regression was used to evaluate the association of TTR with clinical, patient, and hospital factors.

RESULTS

The median (IQR) TTR was 49 (25-119) minutes, and 14.1% of index POCGs had a TTR ≤15. Severity of hypoglycemia, intensive care unit (ICU), intermediate care (IMC) and pediatrics admissions, and dextrose or glucagon administration were associated with higher adjusted odds of TTR ≤15 minutes. Admission to community hospitals, procedural units, surgery, and labor and delivery was associated with lower adjusted odds of TTR ≤15 minutes. Age, sex, insulin on board, secretagogue use, diabetes type, nutritional status, previous POCG value, and glycemic variability were not significantly associated.

CONCLUSION

There is low adherence to the recommendation to repeat a POCG within 15 minutes following the treatment of inpatient hypoglycemia, which may be mediated by both patient and hospital factors. Further studies are needed to understand the mediators and implications of this practice variability.