Point-of-care blood glucose testing for diabetes care in hospitalized patients: an evidence-based review

Using technology to support diabetes care in hospital: Guidelines from the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) group and Diabetes Technology Network (DTN) UK

This article summarises the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Group guidelines on the use of technology to support diabetes care in hospital. The guideline incorporates two main areas: (i) use of wearable technology devices to improve diabetes management in hospital (including continuous glucose monitoring and insulin pump therapy) and (ii) information technology. Although it is reasonable to extrapolate from the evidence available, that devices developed to enhance diabetes care outside hospital will show similar benefits, there are challenges posed within the inpatient setting in hospital. This guidance provides a pragmatic approach to supporting self-management in individuals using wearable technology admitted to hospital. Furthermore, it also aims to provide a best practice guide for using information technology to monitor diabetes care and communicate between health professionals.

Hydrogel-Forming Microneedles and Applications in Interstitial Fluid Diagnostic Devices

Hydrogel-forming microneedles are constructed from or coated with polymeric, hydrophilic materials that swell upon insertion into the skin. Designed to dissolve or disintegrate postinsertion, these microneedles can deliver drugs, vaccines, or other therapeutics. Recent advancements have broadened their application scope to include the collection, transport, and extraction of dermal interstitial fluid (ISF) for medical diagnostics. This review presents a brief introduction to the characteristics of dermal ISF, methods for extraction and sampling, and critical assessment of the state-of-the-art in hydrogel-forming microneedles for ISF diagnostics. Key factors are evaluated including material composition, swelling behavior, biocompatibility, and mechanical strength necessary for effective microneedle performance and ISF collection. The review also discusses successful examples of dermal ISF assays and microneedle sensor integrations, highlighting notable achievements, identifying research opportunities, and addressing challenges with potential solutions. Despite the predominance of synthetic hydrogels in reported hydrogel-forming microneedle technologies due to their favorable swelling and gelation properties, there is a significant variety of biopolymers and composites reported in the literature. The field lacks consensus on the optimal material, composition, or fabrication methods, though emerging evidence suggests that processing and fabrication techniques are critical to the performance and utility of hydrogel-forming microneedles for ISF diagnostics.

Expanding the horizon of continuous glucose monitoring into the future of pediatric medicine

Glucose monitoring has rapidly evolved with the development of minimally invasive continuous glucose monitoring (CGM) using interstitial fluid. It is recommended as standard of care in the ambulatory setting, nearly replacing capillary glucose testing in those with access to CGM. The newest CGM devices continue to be smaller and more accurate, and integration with automated insulin delivery systems has further revolutionized the management of diabetes, leading to successful improvements in care and quality of life. Many studies confirm accuracy and application of CGM in various adult inpatient settings. Studies in adult patients increased during the COVID 19 Pandemic, but despite reassuring results, inpatient CGM use is not yet approved by the FDA. There is a lack of studies in inpatient pediatric settings, although data from the NICU and PICU have started to emerge. Given the exponential increase in the use of CGM, it is imperative that hospitals develop protocols for CGM use, with a need for ongoing implementation research. In this review we describe how CGM systems work, discuss benefits and barriers, summarize research in inpatient pediatric CGM use, explore gaps in research design along with emerging recommendations for inpatient use, and discuss overall CGM utility beyond outpatient diabetes management. IMPACT: Current CGM systems allow for uninterrupted monitoring of interstitial glucose excursions, and have triggered multiple innovations including automated insulin delivery. CGM technology has become part of standard of care for outpatient diabetes management, endorsed by many international medical societies, now with significant uptake, replacing capillary glucose testing for daily management in patients with access to CGM technology. Although CGM is not approved by the FDA for inpatient hospital use, studies in adult settings support its use in hospitals. More studies are needed for pediatrics. Implementation research is paramount to expand the role of CGM in the inpatient setting and beyond.

Predicting hypoglycemia in ICU patients: a machine learning approach

BACKGROUND

The current study sets out to develop and validate a robust machine-learning model utilizing electronic health records (EHR) to forecast the risk of hypoglycemia among ICU patients in Jordan.

RESEARCH DESIGN AND METHODS

The present study drew upon a substantial cohort of 13,567 patients admitted 26,248 times to the intensive care unit (ICU) over 10 years from July 2012 to July 2022. The primary outcome of interest was the occurrence of any hypoglycemic episode during the patient's ICU stay. Developing and testing predictor models was conducted using Python machine-learning libraries.

RESULTS

A total of 1,896 were eligible to participate in the study, 206 experienced at least one hypoglycemic episode. Eight machine-learning models were trained to predict hypoglycemia. All models showed predicting power with a range of 74.53-99.69 for AUROC. Except for Naive Bayes, the six remaining models performed distinctly better than the basic logistic regression usually used for prediction in epidemiological studies. CatBoost model was consistently the best performer with the highest AUROC (0.99), accuracy and precision, sensitivity and specificity, and recall.

CONCLUSIONS

We used machine learning to anticipate the likelihood of hypoglycemia, which can significantly decrease hypoglycemia incidents and enhance patient outcomes.

Point of care devices for detection of Covid-19, malaria and dengue infections: A review

Need for affordable, rapid and user-friendly point of care (POC) devices are increasing exponentially for strengthening the health care system in primary care as well as for self- monitoring in routine analysis. In addition to routine analysis of glucose, Covid-19 type fast spreading, infectious diseases have created further push for exploring rapid, cost-effective and self-monitoring diagnostic devices. Successful implementation of self-monitoring devices for Covid -19 has been realized. However, not much success has been realized for malaria and dengue which are two fatal diseases that affect the population in underdeveloped and developing countries. To monitor the presence of parasites for these diseases, rapid, onsite monitoring devices are still being explored. In this review, we present a review of the research carried out on electrochemical POC devices for monitoring infectious diseases such as Covid-19, malaria and dengue.

Evaluating the Bias of Two Point-of-Care Glucometers for Calves and Ewes: Awareness for Ruminant Practitioners

(1) Background: Multiple point-of-care (POC) glucometers are in use in veterinary medicine, but few are compared to each other. This leaves the potential for clinicians to be unaware of the effect of bias when comparing results from different POC glucometers. (2) Methods: Samples from healthy calves and ewes were simultaneously compared with two POC veterinary glucometers, the Precision Xtra and the AlphaTrak2, under both the “canine” and “feline” settings. The results of each sample were statistically analyzed with linear regression and Bland–Altman analysis. (3) Results: 170 samples from healthy calves and 108 samples from healthy ewes were available for comparison. Calves: The AT2 consistently overestimated blood glucose concentrations when compared to the PX device with the calves. Correlationt with the PX was r = 0.8496 (canine setting) and r = 0.8861 (feline setting). Both the canine and feline settings demonstrated a consistent bias (41.11 and 33.64 mg/dL, respectively). Ewes: The AT2 consistently overestimated blood glucose concentrations when compared to the PX device with the ewes. Correlation with the PX was R = 0.4710 (canine setting) and R = 0.7269 (feline setting). Both the canine and feline settings demonstrated a consistent bias (21.23 and 14.54 mg/dL, respectively). (4) Clinicians should be aware of the potential for consistent bias when evaluating calf and sheep blood glucose concentrations as the AT2 device, at both settings, overestimated blood glucose compared to the previously validated PX. This reliability appears to change when the values are farther from the normal ranges, which should be considered when making clinical decisions based on data from these devices.

Commutable Blood Materials from the Fixed-Cell Method for Performance Evaluation of Blood Glucose by a Glucose Meter

Glucose meters provide a rapid blood glucose status for evidence-based diagnosis, monitoring, and treatment of diabetes mellitus. We aimed to evaluate the commutability of processed blood materials (PBMs) and their use in the performance evaluation of glucose meters. Two PBMs obtained by the fixed-cell method were analyzed for homogeneity, stability, and commutability. The compatibility of ten pairs between mass spectrometry and each glucose meter was categorized as compatible (mean paired difference ≤ 5%) and incompatible (mean paired difference > 5%). The performance of glucose meter 1 (n = 767) and glucose meter 2 (n = 266) was assessed. The glucose in the PBMs remained homogenized and stable for at least 180 days. Six out of ten pairs had commutable PBMs. Commutability of PBMs was observed in both well-compatible and incompatible glucose results. Target glucose values from mass spectrometry were significantly different (p ≤ 0.05) from consensus values in one group of glucose meters. When commutable PBMs were used, glucose meter 1 showed better performance than glucose meter 2, and the percentage of satisfaction was associated when using target values for glucose from mass spectrometry and consensus values, but the performance of glucose meter 2 was not associated. PBM from a fixed-cell method could be mass produced with acceptable homogeneity and stability. Commutability testing of PBMs is required prior to use in the performance evaluation of glucose meters, as the commutability of glucose in the PBMs obtained by a fixed-cell method was variable and depended on the individual glucose meter.

Precise glucose measurement in sodium fluoride-citrate plasma affects estimates of prevalence in diabetes and prediabetes

OBJECTIVES

Estimates of glucose concentrations vary among types of blood samples, which impact on the assessment of diabetes prevalence. Guidelines recommend a conversion factor to calculate plasma glucose from measurements of glucose in whole blood. The American Diabetes Association recommends the use of blood drawing tubes containing sodium fluoride (NaF) and citrate, which have not yet been evaluated regarding possible differences in glucose concentration and conversion factors. Thus, we compared glucose measurements in NaF-citrate plasma and venous whole blood and estimated the impact of differences on diabetes and prediabetes prevalence.

METHODS

Glucose differences were calculated by Bland-Altman analysis with pairwise comparison of glucose measurements from whole blood and NaF-citrate plasma (n=578) in clinical studies of the German Diabetes Center. Subsequently, we computed the impact of the glucose difference on diabetes and prediabetes prevalence in the population-based National Health and Nutrition Examination Survey (NHANES).

RESULTS

Even upon conversion of whole blood to plasma glucose concentrations using the recommended conversion factor, mean glucose concentration difference remained 4.72 % higher in NaF-citrate plasma. Applying the higher glucose estimates, increases the population-based diabetes and prediabetes prevalence by 13.67 and 33.97 % or more than 7.2 and 13 million people in NHANES, respectively. Additional economic burden could be about 20 $ billion per year due to undiagnosed diabetes.

CONCLUSIONS

The recommended conversion factor is not valid for NaF-citrate plasma. Systematic bias of glucose measurements due to sampling type leads to clinically relevant higher estimates of diabetes and prediabetes prevalence.

Non-enzymatic glucose detection with screen-printed chemiresistive sensor using green synthesised silver nanoparticle and multi-walled carbon nanotubes-zinc oxide nanofibers

Non-enzymatic screen-printed chemiresistive interdigitated electrodes (SPCIE) were designed and fabricated using a low-cost screen-printing method for detection of the glucose. The interdigitated electrodes (IDE) pattern was printed using conductive graphene ink on the glossy surface of the photo paper. The proposed glossy photo paper-based SPCIE are functionalized with multi-walled carbon nanotubes-zinc oxide (MWCNTs-ZnO) nanofibers to create the chemiresistive matrix. Further, to bind these nanofibers with the graphene electrode surface, we have used the green synthesized silver nanoparticles (AgNPs) with banana flower stem fluid (BFSF) as a binder solution. AgNPs with BFSF form the conductive porous natural binder layer (CPNBL). It does not allow to increase the resistivity of the deposited material on graphene electrodes and also keeps the nanofibers intact with paper-based SPCIE. The synthesized material of MWCNT-ZnO nanofibers and green synthesized AgNPs with BFSF as a binder were characterized by Ultraviolet-visible spectroscopy (UV-vis), scanning electron microscope (SEM), x-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). The amperometric measurements were performed on the proposed SPCIE sensor to detect the glucose sample directly. The innovative paper-based SPCIE glucose sensor exhibits a linear corelation between current measurements and glucose concentration in the range between 45.22μm and 20 mm, with a regression coefficient (R2) of 0.9902 and a lower limit of detection (LoD) of 45.22μm (n= 5). The sensitivity of the developed SPCIE sensor was 2178.57μAmM-1cm-2, and the sensor's response time determined was approximately equal to 18 s. The proposed sensor was also tested for real blood serum sample, and relative standard deviation (RSD) was found equal to 2.95%.

4D-printed needle panel meters coupled with enzymatic derivatization for reading urea and glucose concentrations in biological samples

On-site analytical techniques continue being developed with advances in modern technology. To demonstrate the applicability of four-dimensional printing (4DP) technologies in the direct fabrication of stimuli-responsive analytical devices for on-site determination of urea and glucose, we used digital light processing three-dimensional printing (3DP) and 2-carboxyethyl acrylate (CEA)-incorporated photocurable resins to fabricate all-in-one needle panel meters. When adding a sample having a value of pH above the pKa of CEA (ca. 4.6-5.0) into the fabricated needle panel meter, the [H+]-responsive layer of the needle, printed using the CEA-incorporated photocurable resins, swelled as a result of electrostatic repulsion among the dissociated carboxyl groups of the copolymer, leading to [H+]-dependent bending of the needle. When coupled with a derivatization reaction (urease-mediated hydrolysis of urea to decrease [H+]; glucose oxidase-mediated oxidization of glucose to increase [H+]), the bending of the needle allowed reliable quantification of urea or glucose when referencing pre-calibrated concentration scales. After method optimization, the method's detection limits for urea and glucose were 4.9 and 7.0 μM, respectively, within a working concentration range from 0.1 to 10 mM. We verified the reliability of this analytical method by determining the concentrations of urea and glucose in samples of human urine, fetal bovine serum, and rat plasma with spike analyses and comparing the results with those obtained using commercial assay kits. Our results confirm that 4DP technologies can allow the direct fabrication of stimuli-responsive devices for quantitative chemical analysis, and that they can advance the development and applicability of 3DP-enabling analytical methods.

Accuracy of Point-of-Care Blood Glucometers in Neonates and Critically Ill Adults

PURPOSE

Inpatient glycemic management has become a common issue because of the increasing number of hospitalized patients with hyperglycemia. Point-of-care devices can enable timely inpatient glucose monitoring, which may lead to better outcomes. The accuracy of point-of-care testing in various clinical scenarios has been questioned, particularly in neonates and critically ill patients. This study aimed to evaluate the accuracy of the CONTOUR PLUS and CONTOUR PLUS ONE glucometers (new wireless systems that link to a smart mobile device) when used as point-of-care devices for blood glucose monitoring in neonates and critically ill adults in inpatient settings.

METHODS

This cross-sectional study was conducted at a medical center in central Taiwan and enrolled patients admitted to the neonatal intensive care unit, sick child room, or respiratory intensive care unit between November 2020 and April 2021. Neonates with suspected infection or abnormal blood coagulation and adults who had abnormal blood coagulation, were pregnant, had received organ transplants, or had undergone massive blood transfusions were excluded. The accuracy of the glucometers was determined based on the following criteria of the International Organization for Standardization (ISO) standard: 15197:2013.

FINDINGS

Overall, 114 neonates (mean age, 4.2 days [range, 0-28 days]; 65 boys [57.0%]) and 106 hospitalized critically ill adults (mean age, 68.2 years [range, 27-94 years]; 72 men [67.9%]) were enrolled in this study. The glucose values obtained with each glucometer had good precision, and all findings met the reference criteria of the within-lot results. All measurements of the neonates' venous blood by each glucometer met the accuracy criteria specified by ISO standard 15197:2013. Furthermore, 98.1% and 97.2% of the arterial blood glucose measurements for critically ill adults obtained with CONTOUR PLUS and CONTOUR PLUS ONE met the accuracy criteria, respectively.

IMPLICATIONS

Both glucose management systems met the accuracy criteria for venous blood from neonates and arterial blood from critically ill adults. Thus, the use of these 2 point-of-care devices in inpatient settings, including for neonates and critically ill adults, can be recommended to minimize limitations associated with the clinical application of point-of-care testing in glucose management. The wireless connection may play a role in the subsequent development of institution-wide virtual glycemic management under the supervision of a team of endocrinologists.

How Can Point-of-Care Technologies Support In-Hospital Diabetes Care?

People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quality framework are critical to ensuring accuracy and veracity of results and preventing erroneous clinical decision making. POC results can be used for self-management of glucose levels in those well-enough and/or by healthcare professionals to identify unsafe levels. Connectivity of POC results to electronic health records further offers the possibility of utilising these results proactively to identify patients 'at risk' in real-time and for audit purposes. In this article, the key considerations when implementing POC tests for diabetes in-patient management are reviewed and potential to drive improvements using networked glucose and ketone measurements are discussed. In summary, new advances in POC technology should allow people with diabetes and the teams looking after them whilst in hospital to integrate to provide safe and effective care.

Using Technology to Improve Diabetes Care in Hospital: The Challenge and the Opportunity

The past 10 years have seen a revolution in technology improving the lives of people with diabetes. This has implications for diabetes care in hospitalized inpatients. These technological developments have the potential to significantly improve the care of people with diabetes in hospital. Combining point of care glucose monitoring, electronic prescribing, electronic observations with electronic referral, and electronic health records allow teams to daily oversee the whole hospital population. To make the most of these tools as well as developing the use of pumps and glucose sensors in hospital, the diabetes team needs to work in new ways. To date, very little work has described how these should be combined. We describe how this technology can be combined to improve diabetes care in hospital.

Comparative assessment of blood glucose monitoring techniques: a review

Monitoring blood glucose levels is a vital indicator of diabetes mellitus management. The mainstream techniques of glucometers are invasive, painful, expensive, intermittent, and time-consuming. The ever-increasing number of global diabetic patients urges the development of alternative non-invasive glucose monitoring techniques. Recent advances in electrochemical biosensors, biomaterials, wearable sensors, biomedical signal processing, and microfabrication technologies have led to significant research and ideas in elevating the patient's life quality. This review provides up-to-date information about the available technologies and compares the advantages and limitations of invasive and non-invasive monitoring techniques. The scope of measuring glucose concentration in other bio-fluids such as interstitial fluid (ISF), tears, saliva, and sweat are also discussed. The high accuracy level of invasive methods in measuring blood glucose concentrations gives them superiority over other methods due to lower average absolute error between the detected glucose concentration and reference values. Whereas minimally invasive, and non-invasive techniques have the advantages of continuous and pain-free monitoring. Various blood glucose monitoring techniques have been evaluated based on their correlation to blood, patient-friendly, time efficiency, cost efficiency, and accuracy. Finally, this review also compares the currently available glucose monitoring devices in the market.

The association of hyperglycemia with the development of infectious complications in adult Filipino patients with acute lymphoblastic leukemia

INTRODUCTION

Hyperglycemia occurs in Acute Lymphoblastic Leukemia (ALL) due to chemotherapeutic agents and may be stress-induced. Given the potential impact of hyperglycemia on the clinical outcomes of ALL patients, we sought to determine the association of hyperglycemia with the development of infectious complications.

METHODS

This is a retrospective cohort involving adult Filipino ALL patients admitted at a tertiary referral center. Patients were stratified according to blood glucose levels and infections were classified into microbiologically and clinically defined infections. Logistic regression was performed to determine whether hyperglycemia was associated with the development of infectious complications.

RESULTS

Of the 174 patients admitted for ALL, only 76 patients (44%) underwent blood glucose monitoring and were thus included in this study. Hyperglycemia was observed in 64 patients (84.21%). Infectious complications were seen in 56 patients (73.68%), of whom 37 patients (48.68%) had microbiologically defined infections and 19 (25%) had clinically defined infections. The respiratory tract was the most common site of infection and gram-negative bacteria were the predominant isolates. Hyperglycemia significantly increased the likelihood of infectious complications, particularly at blood glucose levels ≥ 200 mg/dL.

CONCLUSION

Hyperglycemia is associated with an increased likelihood of infectious complications in Filipino ALL patients. With sepsis being one of the main causes of mortality in this population, our study provides compelling evidence for us to consider routine blood glucose monitoring in order to manage and potentially decrease the occurrence of infections in these patients.

Ultrafast PCR Detection of COVID-19 by Using a Microfluidic Chip-Based System

With the evolution of the pandemic caused by the Coronavirus disease of 2019 (COVID-19), reverse transcriptase-polymerase chain reactions (RT-PCR) have invariably been a golden standard in clinical diagnosis. Nevertheless, the traditional polymerase chain reaction (PCR) is not feasible for field application due to its drawbacks, such as time-consuming and laboratory-based dependence. To overcome these challenges, a microchip-based ultrafast PCR system called SWM-02 was proposed to make PCR assay in a rapid, portable, and low-cost strategy. This novel platform can perform 6-sample detection per run using multiple fluorescent channels and complete an ultrafast COVID-19 RT-PCR test within 40 min. Here, we evaluated the performance of the microdevice using the gradient-diluted COVID-19 reference samples and commercial PCR kit and determined its limit-of-detection (LoD) as 500 copies/mL, whose variation coefficients for the nucleocapsid (N) gene and open reading frame 1 ab region (ORF1ab) gene are 1.427% and 0.7872%, respectively. The system also revealed an excellent linear correlation between cycle threshold (Ct) values and dilution factors (R2 > 0.99). Additionally, we successfully detected the target RNAs and internal gene in the clinical samples by fast PCR, which shows strong consistency with conventional PCR protocol. Hence, with compact dimension, user-friendly design, and fast processing time, SWM-02 has the capability of offering timely and sensitive on-site molecular diagnosis for prevention and control of pathogen transmission.

CGM in the Hospital: Is It Ready for Prime Time?

PURPOSE OF REVIEW

The use of continuous glucose monitoring (CGM) in the hospital setting is growing with more patients using these devices at home and when admitted to the hospital, especially during the COVID-19 pandemic.

RECENT FINDINGS

Historically, most evidence for CGM use in the inpatient setting was limited to small studies utilizing outdated CGM technology and analyzing accuracy of sensor measurements. Previous studies have shown reduced sensor accuracy during extreme hypo- or hyperglycemia, rapid fluctuations of glucose, compression of the sensor itself, and in those who are critically ill. Studies that are more recent have shown CGM to have adequate accuracy and may be effective in reducing hypoglycemia in hospitalized patients; some studies have also showed improvement in time in target glycemic range. Furthermore, CGM may reduce nursing workload, cost of inpatient care, and use of personal protective equipment and face-to-face patient care especially for patients during the COVID-19 pandemic. This review will describe the evidence for use of CGM in hospitalized critically ill or non-critically ill patients, address accuracy and safety considerations, and outline paths for future implementation.

Application of Nanomaterials in the Prevention, Detection, and Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA)

Due to differences in geographic surveillance systems, chemical sanitization practices, and antibiotic stewardship (AS) implementation employed during the COVID-19 pandemic, many experts have expressed concerns regarding a future surge in global antimicrobial resistance (AMR). A potential beneficiary of these differences is the Gram-positive bacteria MRSA. MRSA is a bacterial pathogen with a high potential for mutational resistance, allowing it to engage various AMR mechanisms circumventing conventional antibiotic therapies and the host’s immune response. Coupled with a lack of novel FDA-approved antibiotics reaching the clinic, the onus is on researchers to develop alternative treatment tools to mitigate against an increase in pathogenic resistance. Mitigation strategies can take the form of synthetic or biomimetic nanomaterials/vesicles employed in vaccines, rapid diagnostics, antibiotic delivery, and nanotherapeutics. This review seeks to discuss the current potential of the aforementioned nanomaterials in detecting and treating MRSA.

Artifactual hypoglycemia in a patient with systemic sclerosis

Artifactual hypoglycemia, defined as a discrepancy between different laboratory measurements and actual blood glucose levels, can occur due to clinical conditions affecting the capillary microcirculation leading to falsely low blood glucose assessment. Systemic sclerosis, hallmarked by auto-immunity, fibrosis of the skin and/or internal organs and small vessel vasculopathy, can interfere with capillary point-of-care (POC) glycemia measurements, leading to the misdiagnosis of hypoglycemia. We report an 87-year-old woman with recurrent, asymptomatic hypoglycemia of unknown cause. Clinical examination revealed multiple features of limited cutaneous systemic sclerosis causing microvascular damage leading to artifactual hypoglycemia. Artifactual hypoglycemia is rarely considered by physicians and knowledge of its causes is generally lacking. Early identification of causes of inaccurate glycemia assessment can prevent unnecessary investigations and treatment. In the future, continuous glucose monitoring (CGM) could become a reliable alternative for inpatient glucose monitoring.

First Use of Clozapine Point of Care Testing in Acute Inpatient Psychiatry: Preliminary Report

Clozapine is the antipsychotic of choice in treatment-resistant schizophrenia. Serum clozapine concentration testing is essential to monitor adherence, adjust dosing, and ensure treatment safety. However, patients who are acutely unwell are frequently reluctant to undergo blood testing requiring venipuncture. Also, conventional laboratory-based measurement of clozapine plasma levels can take days, thus contributing to the suboptimal use of clozapine when it is most needed. We pioneered clozapine whole-blood point of care (POC) testing in the acute inpatient setting in the treatment of a group of actively psychotic patients receiving clozapine during the outbreak of the COVID-19 pandemic. POC clozapine testing using automated homogenous immunoassay requires only finger prick blood sampling and is more acceptable to patients. As it produces results in minutes, clozapine POC testing serves to promptly ascertain adherence with treatment and inform therapeutic dosing. POC testing offered a more practical, less invasive, and quicker alternative to conventional methods of monitoring clozapine levels. Near immediate availability of clozapine levels expedited clinical decisions and helped ensure safe clozapine prescribing to our severely psychotic patients in a time of crisis. By facilitating patients' early safe discharge from the hospital, clozapine POC testing also reduced length of hospitalization.

Flexible Enzymatic Glucose Electrochemical Sensor Based on Polystyrene-Gold Electrodes

Metabolic disorders such as the highly prevalent disease diabetes require constant monitoring. The health status of patients is linked to glucose levels in blood, which are typically measured invasively, but can also be correlated to other body fluids such as sweat. Aiming at a reliable glucose biosensor, an enzymatic sensing layer was fabricated on flexible polystyrene foil, for which a versatile nanoimprinting process for microfluidics was presented. For the sensing layer, a gold electrode was modified with a cysteine layer and glutaraldehyde cross-linker for enzyme conformal immobilization. Chronoamperometric measurements were conducted in PBS buffered glucose solution at two potentials (0.65 V and 0.7 V) and demonstrated a linear range between 0.025 mM to 2mM and an operational range of 0.025 mM to 25 mM. The sensitivity was calculated as 1.76µA/mM/cm² and the limit of detection (LOD) was calculated as 0.055 mM at 0.7 V. An apparent Michaelis–Menten constant of 3.34 mM (0.7 V) and 0.445 mM (0.65 V) was computed. The wide operational range allows the application for point-of-care testing for a variety of body fluids. Yet, the linear range and low LOD make this biosensor especially suitable for non-invasive sweat sensing wearables.

Challenge of diabetes mellitus and researchers’ contributions to its control

The aim of this review study was to assess the past significant events on diabetes mellitus, transformations that took place over the years in the medical records of treatment, countries involved, and the researchers who brought about the revolutions. This study used the content analysis to report the existence of diabetes mellitus and the treatments provided by researchers to control it. The focus was mainly on three main types of diabetes (type 1, type 2, and type 3 diabetes). Ethical consideration has also helped to boost diabetic studies globally. The research has a history path from pharmaceuticals of organic-based drugs to metal-based drugs with their nanoparticles in addition to the impacts of nanomedicine, biosensors, and telemedicine. Ongoing and future studies in alternative medicine such as vanadium nanoparticles (metal nanoparticles) are promising.

Complete Blood Count as point of care testing QBC STAR™: Preliminary evaluation

INTRODUCTION

Point of care testing (POCT) represents a valuable option when laboratory data shall be urgently available for timely clinical management, with a turnaround time (TAT) that is unfeasible using conventional laboratory instrumentation. This study was aimed to compare the performance of QBC STAR™ compared to Sysmex XN-module and the reference optical microscopy (OM) assessment.

MATERIAL AND METHODS

One hundred peripheral blood samples, collected in K₃ EDTA tubes, and 50 capillary blood samples obtained by finger stick were analyzed with QBC STAR™, Sysmex XN-module, and OM. Data were compared with Passing-Bablok regression and Bland-Altman plots.

RESULTS

The Passing-Bablok regression analysis (QBC STAR™ capillary sample vs XN-module) yielded slopes comprised between 0.30 and 1.37, while the intercepts ranged between -17.57 and 232.6. Bland-Altman plots yielded relative bias comprised between -4.87% (for MN QBC STAR™ capillary sample vs XN-module) and 27% (PLT QBC STAR™ capillary sample vs XN-module). A significant bias was found for all parameters except MN and WBC, RBC in all and pediatric samples, and HB in adults samples.

CONCLUSION

The results of this analytical evaluation suggest that QBC STAR™ may not be the ideal tool for performing complete blood count analysis for diagnostic purposes, while it could be more useful in urgent/emergent conditions, such as for rapid monitoring of some hematological parameters (eg, WBC and HB).

Patient-based quality control for glucometers: using the moving sum of positive patient results and moving average

Introduction

The capability of glucometer internal quality control (QC) in detecting varying magnitude of systematic error (bias), and the potential use of moving sum of positive results (MovSum) and moving average (MA) techniques as potential alternatives were evaluated.

Materials and methods

The probability of error detection using routine QC and manufacturer’s control limits were investigated using historical data. Moving sum of positive results and MA algorithms were developed and optimized before being evaluated through numerical simulation for false positive rate and probability of error detection.

Results

When the manufacturer’s default control limits (that are multiple times higher than the running standard deviation (SD) of the glucometer) was used, they had 0-75% probability of detecting small errors up to 0.8 mmol/L. However, the error detection capability improved to 20-100% when the running SD of the glucometer was used. At a binarization threshold of 6.2 mmol/L and block sizes of 200 to 400, MovSum has a 100% probability of detecting a bias that is greater than 0.5 mmol/L. Compared to MovSum, the MA technique had lower probability of bias detection, especially for smaller bias magnitudes; MA also had higher false positive rates.

Conclusions

The MovSum technique is suited for detecting small, but clinically significant biases. Point of care QC should follow conventional practice by setting the control limits according to the running mean and SD to allow proper error detection. The glucometer manufacturers have an active role to play in liberalizing QC settings and also enhancing the middleware to facility patient-based QC practices.

Reliability of the Dexcom G6 Continuous Glucose Monitor During Hyperbaric Oxygen Exposure

Background: People with diabetes-related ulcers may benefit from hyperbaric oxygen (HBO₂) therapy and from continuous glucose monitors (CGM). Although blood glucose (BG) meters based on glucose oxidase (GO) report erroneously low values at high pO₂, BG meters based on glucose dehydrogenase (GD) do not. We therefore examined the performance of a GO-based CGM system in comparison to GO-based and GD-based BG systems in normobaric air (NBAir), hyperbaric air (HBAir), and HBO₂ environments. Materials and Methods: Twenty-six volunteers without diabetes mellitus (DM) wore Dexcom G6 CGM systems and provided periodic blood samples before, during, and after a standard HBO₂ treatment consisting of three 30-min intervals of HBO₂ separated by two 5-min intervals of HBAir. Accuracy of the CGM and GO-based BG meter were assessed by comparisons with the GD-based values. Results: The mean absolute relative difference for the CGM system was 15.96% and for the GO-based meter was 8.52%. Compared to NBAir, HBO₂ exposure resulted in significantly higher CGM values (+3.76 mg/dL, P < 0.001) and significantly lower GO-based meter values (-10.38 mg/dL, P < 0.001). Pre-HBO₂ and post-HBO₂ values obtained in NBAir were also significantly different when measured by CGM (+4.13 mg/dL, P = 0.015) or the GO-based meter (-9.04 mg/dL, P < 0.001). Conclusions: In volunteers without DM, HBO₂ exposure results in statistically significant differences in glucose measurements obtained with GO-based devices, but not a GD-based device. Standard HBO₂ treatment results in statistically significant effects on glucose concentrations. These differences are of unlikely clinical significance.

Accuracy and stability of an arterial sensor for glucose monitoring in a porcine model using glucose clamp technique

Intravascular glucose sensors have the potential to improve and facilitate glycemic control in critically ill patients and might overcome measurement delay and accuracy issues. This study investigated the accuracy and stability of a biosensor for arterial glucose monitoring tested in a hypo- and hyperglycemic clamp experiment in pigs. 12 sensors were tested over 5 consecutive days in 6 different pigs. Samples of sensor and reference measurement pairs were obtained every 15 minutes. 1337 pairs of glucose values (range 37–458 mg/dl) were available for analysis. The systems met ISO 15197:2013 criteria in 99.2% in total, 100% for glucose <100 mg/dl (n = 414) and 98.8% for glucose ≥100 mg/dl (n = 923). The mean absolute relative difference (MARD) during the entire glycemic range of all sensors was 4.3%. The MARDs within the hypoglycemic (<70 mg/dl), euglycemic (≥70–180 mg/dl) and hyperglycemic glucose ranges (≥180 mg/dl) were 6.1%, 3.6% and 4.7%, respectively. Sensors indicated comparable performance on all days investigated (day 1, 3 and 5). None of the systems showed premature failures. In a porcine model, the performance of the biosensor revealed a promising performance. The transfer of these results into a human setting is the logical next step.

Glucose point-of-care meter operators competency: An assessment checklist

Background and objectives

Glucose point-of-care testing meters are essential technology ubiquitous in hospitals. They are operated by non-specialized staff who are assessed through an auto-recertification process that is dependent on operators successfully producing expected outcomes. Alternatively, we suggest that operator practices be directly observed using a competency assessment checklist.

Method

We designed a checklist based on literature and manufacturers’ instructions and tested it by observing 30 operators at two sites (three hospitals) over two months in 2018.

Results

Despite all operators being auto-recertified, the checklist revealed that only 20% met the 80% threshold of compliance to standards. Moreover, the site with a POCT coordinator had a compliance rate of 82% versus 67% for the site that did not.

Discussion

The checklist is more reliable than auto-recertification in assessing operators’ competence. It also highlights areas for process improvement and provides an opportunity to give personalized feedback to operators.

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Develop and test the use of a standardized checklist for assessing operator’s competency with glucose point-of-care testing.

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All glucose meter operators observed were auto-recertified but only 20% of operators met the 80% compliance threshold.

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This approach helps identify individual training needs and areas for organizational process improvements.

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A dedicated POCT coordinator may foster operators’ competency by supporting communication.

Clinical Reliability of Point-of-Care Glucose Testing in Critically Ill Patients

BACKGROUND

Point-of-care (POC) glucometers are commonly used in intensive care units (ICUs). The Centers for Medicare & Medicaid Services have called into question the accuracy of POC glucometers in critically ill patients. This study sought to identify specific characteristics within our facility's ICU patients that were associated with inaccuracies in POC glucose measurements.

METHODS

We conducted a prospective cohort study that compared POC capillary blood glucose samples with venous samples collected in our ICU. All nonpregnant patients >18 years old admitted to the ICU with orders for daily laboratory testing that included blood glucose were eligible for inclusion.

RESULTS

A total of 46 patients were enrolled and 85 samples were collected. The mean difference between venous and POC samples was 5.23 mg/dL (95% CI, 3.16-7.3 mg/dL). Measurement inaccuracies would have altered treatment in 7/85 instances (8.2%). The only clinically significant inaccuracy found was the omission of 2 units of insulin in 1 hyperglycemic patient. Measurement inconsistencies generally underestimated low blood glucose values (2/2 instances) and overestimated high blood glucose values (4/5 instances).

CONCLUSIONS

In our study, the mean difference between venous and POC glucose samples was small. Similarly, measurement inaccuracies that would have altered treatment were rare and only one instance was deemed clinically significant. We conclude that POC capillary glucose testing within our cohort and in similar critically ill patients is likely safe and effective.

Current status of point-of-care diagnostic devices in the Indian healthcare system with an update on COVID-19 pandemic

Point-of-care (POC) diagnostic device is an instrument that is used to acquire particular clinical information of patients in clinical as well as resource-limited settings. The conventional clinical diagnostic procedure requires high-end and costly instruments, an expert technician for operation and result interpretation, longer time, etc. that ultimately makes it exhausting and expensive. Although there are a lot of improvements in the medical facilities in the Indian healthcare system, the use of POC diagnostic devices is still in its nascent phase. This review illustrates the status of POC diagnostic devices currently used in clinical setups along with constraints in their use. The devices and technologies that are in the research and development phase across the country that has tremendous potential to elevate the clinical diagnostics scenario along with the diagnosis of ongoing COVID-19 pandemic are emphasized. The implications of using POC diagnostic devices and the future objectives for technological advancements that may eventually uplift the status of healthcare and related sectors in India are also discussed here.

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Need for POC devices in the Indian healthcare system.

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Barriers in using POC devices.

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Categorical classification of POC devices used in clinical settings.

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Current Indian research and developments in POC diagnosis along with update on COVID-19.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy

The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery

BACKGROUND

Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described.

OBJECTIVE

To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection.

METHODS

We retrospectively identified patients undergoing operative management of SSIs occurring after spinal surgery for degenerative pathologies. These patients were individually matched to controls based upon age, surgical invasiveness, ICD-10CM, race, and sex. Cases and controls were compared regarding medical comorbidities (including diabetes), postoperative hyperglycemia, and operative time.

RESULTS

Patients in the infection group were found to have a higher BMI (33.7 vs 28.8), higher prevalence of DM2 (48.5% vs 14.7%), and longer inpatient stay (8.8 vs 4.3 d). They also had higher average (136.6 vs 119.6 mg/dL) and peak glucose levels (191.9 vs 153.1 mg/dL), as well as greater variability in glucose levels (92.1 vs 58.1 mg/dL). Multivariable logistic regression identified BMI (odds ratio [OR] = 1.13), diabetes mellitus (OR = 2.12), average glucose on the first postoperative day (OR = 1.24), peak postoperative glucose (OR = 1.31), and maximal daily glucose variation (OR = 1.32) as being significant independent predictors of postoperative surgical site infection.

CONCLUSION

Postoperative hyperglycemia and poor postoperative glucose control are independent risk factors for surgical site infection following surgery for degenerative spine disease. These data suggest that, particularly among high-risk diabetic patients, strict perioperative glucose control may decrease the risk of SSI.

Point-of-care testing in diabetes management

The prevalence of diabetes mellitus (DM) has rapidly increased over the last decades, reaching epidemic magnitudes, particularly in lowand middle-income countries. Point-of-care (POC) technology enables decision making near or at the site of patient care. Portable blood glucose meters and HbA1c testing are used by the healthcare provider and millions of patients with diabetes to monitor the safety and effectiveness of the diabetes treatment. However, POC capillary blood glucose and POC HbA1c testing are not recommended for diabetes diagnosis. Rather, they have been used for screening diabetes in lowand middle-income countries to decrease the disease burden.

Unit conversions between LOINC codes

Logical Observation Identifiers Names and Codes (LOINC) is the most widely used controlled vocabulary to identify laboratory tests. A given laboratory test can often be reported in more than 1 unit of measure (eg, grams or moles), and LOINC defines unique codes for each unit. Consequently, an identical laboratory test performed by 2 different clinical laboratories may have different LOINC codes. The absence of unit conversions between compatible LOINC codes impedes data aggregation and analysis of laboratory results. To develop such conversions, a computational process was developed to review the LOINC standard for potential conversions, and multiple expert reviewers oversaw and finalized the conversion list. In all, 285 bidirectional conversions were identified, including conversions for routine clinical tests such as sodium, magnesium, and human immunodeficiency virus (HIV). Unit conversions were applied to the aggregation of laboratory test results to demonstrate their usefulness. Diverse informatics projects may benefit from the ability to interconvert compatible results.

Nanomaterial-based optical and electrochemical techniques for detection of methicillin-resistant Staphylococcus aureus: a review

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a number of life-threatening complications in humans. Mutations in the genetic sequence of S. aureus due to the presence of certain genes results in resistance against β-lactamases. Thus, there is an urgent need for developing highly sensitive techniques for the early detection of MRSA to counter the rise in resistant strains. This review (142 refs.) extensively covers literature reports on nanomaterial-based optical and electrochemical sensors from the year 1983 to date, with particularly emphasis on recent advances in electrochemical sensing (such as voltammetry and impedimetric) and optical sensing (such as colorimetry and fluorometry) techniques. Among the electrochemical methods, various nanomaterials were employed for the modification of electrodes. Whereas, in optical assays, formats such as enzyme linked immunosorbent assay, lateral flow assays or in optical fiber systems are common. In addition, novel sensing platforms are reported by applying advanced nanomaterials which include gold nanoparticles, nanotitania, graphene, graphene-oxide, cadmium telluride and related quantum dots, nanocomposites, upconversion nanoparticles and bacteriophages. Finally, closing remarks and an outlook conclude the review. Graphical abstract Schematic of the diversity of nanomaterial-based methods for detection of methicillin-resistant Staphylococcus aureus (MRSA). AuNPs: gold nanoparticles; QDs: quantum dots; PVL: Panton-Valentine leukocidin; mecA gene: mec-gene complex encoding methicillin resistance.

Recommendations for in-clinic PoCT for diabetes management in India

A panel of expert diabetologist clinicians developed consensus standards to address the quality gaps inclinic point of care testing (PoCT) especially pertaining to diabetes care and management in India. The following summarized principles were established- 1. PoCT definition, 2. Advantages and critical aspects of PoCT including guideline recommendations and accreditations, analytical factors (pre &post analytical included) and consensus reached for an ideal PoC analyzer and 3. Key recommendations on in-clinic PoCT implementation by the panel. The experts suggested next steps that included key comparative (PoCT vs NGSP accredited lab) and patient benefit studies on PoCT.

Appropriateness of Using Tests for Blood Glucose and Diabetic Complications in Clinical Practice: Experiences in a Hospital in Thailand

BACKGROUND This study aimed to evaluate how the tests for blood glucose (BG) and diabetic complications have been utilized in a hospital in Thailand. MATERIAL AND METHODS Patient medical records having the results of BG, HbA1c, and/or urine microalbumin presented and the records of DM patients having the results of serum lipids, serum LDL-C, and/or serum creatinine presented were selected. The data of diagnosis, ordered tests, and testing results in these records were extracted for evaluation. RESULTS This study recruited 1066 patients diagnosed with DM and 3081 patients diagnosed with other diseases. Point-of-care testing (POCT) for BG was repeatedly used in 371 non-DM cases; most of its results were normal. The results of BG and HbA1c were often used together. There was a good relationship between them, and these test results indicated poor glycemic control in 58% of DM cases. In non-DM cases, the test results agreed, indicating normoglycemia in 17.32%, pre-diabetes in 20.47%, and diabetes in 21.78%. To prevent diabetic nephropathy, serum creatinine was frequently used, whereas urine microalbumin, the recommended test, was underutilized. The result of LDL-C from both direct measurement and calculation were used; however, based on the same guidelines, the results of measured LDL-C indicated risk of cardiovascular diseases in a higher percentage of DM cases than did the results of calculated LDL-C. CONCLUSIONS The use of POCT for BG in hospitalized patients may be inappropriate. The utilization of urine microalbumin should be promoted to effectively prevent diabetic nephropathy.

A Real-World Setting Study: Which Glucose Meter Could Be the Best for POCT Use? An Easy and Applicable Protocol During the Hospital Routine

The aim of this retrospective study is to evaluate the reliability and robustness of six glucose meters for point-of-care testing in our wards using a brand-new protocol. During a 30-days study period a total of 50 diabetes patients were subjected to venous blood sampling and glucose meter blood analysis. The results of six glucose meters were compared with our laboratory reference assay. GlucoMen Plus (Menarini) with the 82% of acceptable results was the most robust glucose meter. Even if the Passing-Bablok analysis demonstrates the presence of constant systematic errors and the Bland-Altman test highlighted a possible overestimation, the surveillance error grid analysis showed that this glucose meter can be used safely. We proved that portable glucose meters are not always reliable in routinely clinical settings.

'Plug-and-Power' Point-of-Care diagnostics: A novel approach for self-powered electronic reader-based portable analytical devices

This paper presents an innovative approach in the portable Point-of-Care diagnostics field, the Plug-and-Power concept. In this new disposable sensor and plug-and-play reader paradigm, the energy required to perform a measurement is always available within the disposable test component. The reader unit contains all the required electronic modules to run the test, process data and display the result, but does not include any battery or power source. Instead, the disposable part acts as both the sensor and the power source. Additionally, this approach provides environmental benefits related to battery usage and disposal, as the paper-based power source has non-toxic redox chemistry that makes it eco-friendly and safe to follow the same waste stream as disposable test strips. The feasibility of this Plug-and-Power approach is demonstrated in this work with the development of a self-powered portable glucometer consisting of two parts: a test strip including a paper-based power source and a paper-based biofuel cell as a glucose sensor; and an application-specific battery-less electronic reader designed to extract the energy from the test strip, process the signal provided and show the glucose concentration on a display. The device was tested with human serum samples with glucose concentrations between 5 and 30 mM, providing quantitative results in good agreement with commercial measuring instruments. The advantages of the present approach can be extended to any kind of biosensors measuring different analytes and biological matrices, and in this way, strengthen the goals of Point-of-Care diagnostics towards laboratory decentralization, personalized medicine and improving patient compliance.

The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital

BACKGROUND

 The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China.

METHODS

The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting.

RESULTS

A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment.

CONCLUSION

Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.

Comparison of Space Glucose Control and Routine Glucose Management Protocol for Glycemic Control in Critically Ill Patients: A Prospective, Randomized Clinical Study

Background:

The Space Glucose Control (SGC) system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose (BG) level safely. The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8–8.9 mmol/L in the critically ill patients.

Methods:

It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia (BG ≥ 9.0 mmol/L). Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days. Target BG for both groups was 5.8–8.9 mmol/L. The primary outcome was the percentage time in the target range.

Results:

The percentage time within BG target range in the SGC group (69 ± 15%) was significantly higher than in the routine management group (52 ± 24%; P < 0.01). No measurement was ≤2.2 mmol/L, and there was only one episode of hypoglycemia (2.3–3.3 mmol/L) in each group. The average BG was significantly lower in the SGC group (7.8 ± 0.7 mmol/L) than in the routine management group (9.1 ± 1.6 mmol/L, P < 0.001). Target BG level was reached earlier in the SGC group than routine management group (2.5 ± 2.9 vs. 12.1 ± 15.3 h, P = 0.001). However, the SGC group performed worse for daily insulin requirement (59.8 ± 39.3 vs. 28.4 ± 36.7 U, P = 0.001) and sampling interval (2.0 ± 0.5 vs. 3.7 ± 0.5 h, P < 0.001) than the routine management group did. Multiple linear regression showed that the intervention group remained a significant individual predictor (P < 0.001) of the percentage time in target range.

Conclusions:

The SGC system, with a BG target of 5.8–8.9 mmol/L, resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia. However, the workload was increased.

Trial Registration:

http://www.clinicaltrials.gov, NCT 02491346; https://www.clinicaltrials.gov/ct2/show/NCT02491346?term=NCT02491346&cond=Hyperglycemia&cntry1=ES%3ACN&rank=1.

Analysis of rural health centres preparedness for the management of diabetic patients in Malawi

Objective

There is limited data on the quality of primary care management for diabetes mellitus across Africa. The study was aimed at assessing the availability of basic supplies for the rapid diagnosis, treatment and management of diabetes in Malawian rural health facilities. This cross-sectional study was conducted in 55 public and private health centers from 19 districts using a structured questionnaire and checklist to interview the pharmacy personnel or officer in-charge of the health centers. We focused on availability of information, diagnosis and treatment materials for diabetes.

Results

Of the 55 health facilities surveyed, 21, 23 and 11 were located in the central, southern and northern regions of Malawi, respectively. Overall, 38% (21/55) of the health centres had glucometers, while 24% (13/55) had urine glucose dipsticks. Only 4% (2/55) of the health centres had recommended first-line medicines for treatment of type 1 and type 2 diabetes. No health centre had diabetes patient records and information, education and communication materials. Most rural health centers in Malawi lack basic health commodities for the screening, diagnosis and treatment of diabetes and this impedes on their effective management of growing diabetes burden. Therefore, health care systems need to adequately equip primary care facilities.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3369-7) contains supplementary material, which is available to authorized users.

Lab-on-chip technology for chronic disease diagnosis

Various types of chronic diseases (CD) are the leading causes of disability and death worldwide. While those diseases are chronic in nature, accurate and timely clinical decision making is critically required. Current diagnosis procedures are often lengthy and costly, which present a major bottleneck for effective CD healthcare. Rapid, reliable and low-cost diagnostic tools at point-of-care (PoC) are therefore on high demand. Owing to miniaturization, lab-on-chip (LoC) technology has high potential to enable improved biomedical applications in terms of low-cost, high-throughput, ease-of-operation and analysis. In this direction, research toward developing new LoC-based PoC systems for CD diagnosis is fast growing into an emerging area. Some studies in this area began to incorporate digital and mobile technologies. Here we review the recent developments of this area with the focus on chronic respiratory diseases (CRD), diabetes, and chronic kidney diseases (CKD). We conclude by discussing the challenges, opportunities and future perspectives of this field.

Bridging technology and clinical practice: innovating inpatient hyperglycaemia management in non-critical care settings

Emerging evidence shows that suboptimal glycaemic control is associated with increased morbidity and length of stay in hospital. Various guidelines for safe and effective inpatient glycaemic control in the non-critical care setting have been published. In spite of this, implementation in practice remains limited because of the increasing number of people with diabetes admitted to hospital and staff work burden. The use of technology in the outpatient setting has led to improved glycaemic outcomes and quality of life for people with diabetes. There remains an unmet need for technology utilisation in inpatient hyperglycaemia management in the non-critical care setting. Novel technologies have the potential to provide benefits in diabetes care in hospital by improving efficacy, safety and efficiency. Rapid analysis of glucose measurements by point-of-care devices help facilitate clinical decision-making and therapy adjustment in the hospital setting. Glucose treatment data integration with computerized glucose management systems underpins the effective use of decision support systems and may streamline clinical staff workflow. Continuous glucose monitoring and automation of insulin delivery through closed-loop systems may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia whilst reducing staff workload. This review summarizes the evidence with regard to technological methods to manage inpatient glycaemic control, their limitations and the future outlook, as well as potential strategies by healthcare organizations such as the National Health Service to mediate the adoption, procurement and use of diabetes technologies in the hospital setting.

A comparative assessment of the glucose monitor (SD Codefree) and auto analyzer (BT-3000) in measuring blood glucose concentration among diabetic patients

OBJECTIVE

The aim of this study was to determine how well the measurements from a glucometer (SD Codefree) correlated with those from a standard auto analyser (BT-3000) using blood samples from diabetic and non-diabetic patients at the Bolgatanga Regional Hospital in Ghana. A cross-sectional study was conducted with a total of 150 randomly selected patients; 100 diabetic patients (4 type 1 and 96 type II) and 50 non diabetic patients. Ante-cubital venous and finger pricked blood samples were obtained from the patients following standard procedures, and blood glucose concentrations were determined using the two methods respectively.

RESULTS

Data generated was entered and analysed using SPSS version 20. The mean glucose concentration for the diabetic patients (n = 100) using the glucometer were not significantly different from that of the auto analyser (10.16 ± 3.708 mmol/L vs. 9.458 ± 3.204 mmol/L, p = 0.154), though the glucometer generally overestimated the glucose concentration. Similarly, readings for non-diabetics were comparable between the two methods (5.286 ± 0.477 mmol/L vs. 5.092 ± 0.525 mmol/L, p = 0.057). The correlation between the two methods was good and highly significant (r = 0.862, p < 0.001) with both methods depicting high sensitivity and specificity in measuring blood glucose levels among diabetics as indicated by the ROC curve.

Blood Gas Analyzer Accuracy of Glucose Measurements

OBJECTIVE

To investigate the comparability of glucose levels measured with blood gas analyzers (BGAs) and by central laboratories (CLs).

MATERIAL AND METHODS

Glucose measurements obtained between June 1, 2007, and March 1, 2016, at the Vanderbilt University Medical Center were reviewed. The agreement between CL and BGA results were assessed using Bland-Altman, consensus error grid (CEG), and surveillance error grid (SEG) analyses. We further analyzed the BGAs' performance against the US Food and Drug Administration (FDA) 2014 draft guidance and 2016 final guidance for blood glucose monitoring and the International Organization for Standardization (ISO) 15197:2013 standard.

RESULTS

We analyzed 2671 paired glucose measurements, including 50 pairs of hypoglycemic values (1.9%). Bland-Altman analysis yielded a mean bias of -3.1 mg/dL, with 98.1% of paired values meeting the 95% limits of agreement. In the hypoglycemic range, the mean bias was -0.8 mg/dL, with 100% of paired values meeting the 95% limits of agreement. When using CEG analysis, 99.9% of the paired values fell within the no risk zone. Similar results were found using SEG analysis. For the FDA 2014 draft guidance, our data did not meet the target compliance rate. For the FDA 2016 final guidance, our data partially met the target compliance rate. For the ISO standard, our data met the target compliance rate.

CONCLUSION

In this study, the agreement for glucose measurement between common BGAs and CL instruments met the ISO 2013 standard. However, BGA accuracy did not meet the stricter requirements of the FDA 2014 draft guidance or 2016 final guidance. Fortunately, plotting these results on either the CEG or the SEG revealed no results in either the great or extreme clinical risk zones.

Pre-analytical and analytical aspects affecting clinical reliability of plasma glucose results

The measurement of plasma glucose (PG) plays a central role in recognizing disturbances in carbohydrate metabolism, with established decision limits that are globally accepted. This requires that PG results are reliable and unequivocally valid no matter where they are obtained. To control the pre-analytical variability of PG and prevent in vitro glycolysis, the use of citrate as rapidly effective glycolysis inhibitor has been proposed. However, the commercial availability of several tubes with studies showing different performance has created confusion among users. Moreover, and more importantly, studies have shown that tubes promptly inhibiting glycolysis give PG results that are significantly higher than tubes containing sodium fluoride only, used in the majority of studies generating the current PG cut-points, with a different clinical classification of subjects. From the analytical point of view, to be equivalent among different measuring systems, PG results should be traceable to a recognized higher-order reference via the implementation of an unbroken metrological hierarchy. In doing this, it is important that manufacturers of measuring systems consider the uncertainty accumulated through the different steps of the selected traceability chain. In particular, PG results should fulfil analytical performance specifications defined to fit the intended clinical application. Since PG has tight homeostatic control, its biological variability may be used to define these limits. Alternatively, given the central diagnostic role of the analyte, an outcome model showing the impact of analytical performance of test on clinical classifications of subjects can be used. Using these specifications, performance assessment studies employing commutable control materials with values assigned by reference procedure have shown that the quality of PG measurements is often far from desirable and that problems are exacerbated using point-of-care devices.