High concordance of blood glucose measurement in cats between a beta prototype glucometer device and a reference laboratory standard in a clinical setting

OBJECTIVE

The objective of this study was to evaluate the accuracy of a beta prototype version of a new portable blood glucose meter in feline patients.

ANIMALS

60 client-owned cats.

METHODS

In this prospective study, 3-mL blood samples were collected from each cat and analyzed in triplicate using a beta prototype device (AlphaTRAK 3 [AT3]) and by a reference lab standard immediately after collection. Accuracy of the AT3 device was determined in accordance with the International Organization of Standardization (ISO) 15197:2013 criteria, including Bland-Altman plotting and consensus error grid analysis. A Passing-Bablok regression analysis was also performed.

RESULTS

96% of feline measurements fell within the ISO accuracy threshold, and 100% of measurements fell within zones A and B of the consensus error grid, meeting the ISO accuracy requirements. There was no significant bias in the data according to the Bland-Altman analysis. Within the full range of glucose concentrations (20 to 750 mg/dL) the correlation coefficient between the AT3 and the reference lab standard was 0.99. There was no significant constant or proportional bias present in the data.

CLINICAL RELEVANCE

The AT3 device met the ISO requirements and is accurate for measurement of blood glucose concentrations in cats.

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.

An Empirical Review of Key Glucose Monitoring Devices: Product Iterations and Patent Protection

INTRODUCTION

Each year, people with diabetes and their insurers or governments spend billions of dollars on blood glucose monitors and their associated components. These monitors have evolved substantially since their introduction in the 1970s, and manufacturers frequently protect original medical devices and their modifications by applying for and obtaining patent protection.

RESEARCH DESIGN AND METHODS

We tracked the product iterations of five widely used blood glucose monitors-manufactured by LifeScan, Dexcom, Abbott, Roche, and Trividia-from information published by the U.S. Food and Drug Administration (FDA), and extracted relevant U.S. patents.

RESULTS

We found 384 products made by the five manufacturers of interest, including 130 devices cleared through the 510(k) pathway, 251 approved via the premarket approval (PMA) pathway or via PMA supplements, and three for which de novo requests were granted. We identified 8095 patents potentially relevant to these devices, 2469 (31%) of which were likely to have expired by July 2021.

CONCLUSIONS

Manufacturers of blood glucose monitoring systems frequently modified their devices and obtained patent protection related to these device modifications. The therapeutic value of these new modifications should be critically evaluated and balanced against their additional cost. Older glucose monitoring devices that were marketed in decades past are now in the public domain and no longer protected by patents. Newer devices will join them as their patents expire. Increased demand from people with diabetes and the health care system for older, off-patent devices would provide an incentive for the medical device industry to make these devices more widely available, enabling good care at lower cost when such devices are substantially equivalent in effectiveness and safety. In turn, availability and awareness of older, off-patent devices could help stimulate such demand.

Quality improvement efforts in a safety net institution: Increased diabetes screening is associated with lower HbA1c at diagnosis and improved HbA1c outcomes in youth with type 2 diabetes

OBJECTIVES

Evaluate whether increased diabetes screening in youth is associated with lower HbA1c at T2D diagnosis and improved HbA1c outcomes in youth.

RESEARCH DESIGN AND METHODS

Diabetes screening rates from 2009 to 2018 were calculated. Electronic medical records identified obese youth ages 8-18 with first HbA1c ≥6.5% from 2009 to 2018; chart review confirmed incident T2D. Demographics, BMI and HbA1c values, and use of glucometer and diabetes medications were collected.

RESULTS

142 youth had T2D. Median age was 14 years (range 8-18); 58% were female. 46% were identified on first HbA1c testing. 69 (49%) had 1st HbA1c 6.5%-6.9%, 43 (30%) 7.0%-7.9%, and 30 (21%) ≥8%. Follow-up from 1st to last HbA1c was median 2.6 years (range 0-10). 121 youth had follow-up testing ≥1 year after diagnosis; of these, 87 (72%) had persistent T2D-range HbA1c or were taking diabetes medications. 85% of youth with 1st HbA1c ≥7% had persistent T2D versus 52% of those with 1st HbA1c <7% (p < 0.001). Poorly controlled diabetes at last test was present in 19% of youth with baseline HbA1c 6.5%-6.9%, 30% with 7.0%-7.9%, and 63% with ≥8% (p < 0.001). 47 (68%) with HbA1c <7% were prescribed a glucometer; 9% of youth prescribed a meter and 41% of youth not prescribed a meter had poorly controlled diabetes at last test (p = 0.009).

CONCLUSIONS

Youth with HbA1c <7% at diagnosis were less likely to have poorly controlled diabetes at follow-up. Prescription of glucometers for youth with HbA1c in this range was associated with improved HbA1c outcomes and deserves further study including components of glucometer teaching.

Battery-Less NFC Potentiostat for Electrochemical Point-of-Care Sensors Based on COTS Components

This work studies the feasibility of using a battery-less Near-Field Communication (NFC) potentiostat for the next generation of electrochemical point-of-care sensors. A design based on an NFC microchip, a microcontroller, and a custom potentiostat based on an operational amplifier is presented. A proof-of-concept prototype has been designed and used to quantify glucose concentration using commercial glucose test strips from chronoamperometry measurements. The device is harvested and the sensor is read using a mobile phone. The prototype uses an antenna loop covered with ferrite sheets to ensure stable operation of the electronics when the mobile phone is used as reader. The use of ferrite reduces the detuning caused by the proximity of the metal parts of the mobile phone. A comparison with a commercial glucometer device is provided. Results obtained using a commercial glucometer and those provided by the proposed potentiostat show an excellent agreement.

Analytical validation of a portable human Accu-Chek glucometer in honeybee hemolymph

Glucose and trehalose are the main energy sources used by honeybees (Apis mellifera) for daily activities. However, there is no validated point-of-care method to reliably measure both sugars. We performed an analytical validation of a portable human glucometer (Accu-Chek; Roche) for glucose measurement in honeybee hemolymph compared to a reference method (GluCH, UniCel DxC 600; Beckman Coulter). We used 30 pooled hemolymph samples collected from the antennae of anesthetized honeybees and diluted 1:4 in 0.9% saline. We evaluated dilution linearity, spike recovery, and inter- and intra-assay imprecision. Glucose concentration was measured over time (2 h, 4 h, 8 h, 12 h, 1 d, 2 d, 3 d, 7 d, 21 d, 28 d) at various storage temperature (25°C, 4°C, -20°C, -80°C). The trehalose concentration was measured indirectly by trehalase hydrolyzation. Glucose concentrations measured by both instruments had a strong correlation (0.985, p < 0.0001) and a bias of -7.33 mmol/L (±1.96SD: 13.70 to -28.36), with linear agreement at <20 mmol/L (physiologic value: 100 mmol/L). The accuracy of the glucometer decreased at >20 mmol/L. Recovery of 115-130% of diluted spikes indicated good specificity. Inter- and intra-assay imprecision were 2.50% and 2.21%, respectively. Glucose concentrations fluctuated in stored samples dependent on time and temperature; however, glucose concentrations were constant with storage at -80°C for ≥28 d. The Accu-Chek glucometer is an adequate instrument to measure honeybee glucose concentration in hemolymph diluted with 0.9% NaCl, with good accuracy and precision at <20 mmol/L. Hemolymph storage at -80°C is suitable for long-term conservation of glucose.

Glucometer Usability for 65+ Type 2 Diabetes Patients: Insights on Physical and Cognitive Issues

Background: Self-monitoring of blood glucose (SMBG) is of paramount relevance for type 2 diabetes mellitus (T2DM) patients. However, past evidence shows that there are physical and cognitive issues that might limit the usage of glucometers by T2DM patients aged 65 years and over. Objective: Our aim was to investigate the physical and cognitive issues related to the usage of glucometers by T2DM patients aged 65 years and over. Materials and Methods: The extant literature was analysed to define an original framework showing the logical nexus between physical and cognitive issues and quality of life. Then we collected evidence addressing the specific case of the Accu-Chek^® Instant glucometer produced by Roche Diabetes Care GmbH, which implements new features claiming to improve usability. We conducted 30 interviews with T2DM patients aged 65 years and over, three interviews with senior nurses, and a focus group with three senior physicians and three senior nurses. Results: From the interviews, both patients and nurses declared that they were generally satisfied with the Accu-Chek^® Instant glucometer's characteristics. In the focus group, the results were commented on and, in the light of some diverging answers, improvements have been set up for future implementation. Conclusions: Our study produces evidence and future suggestions about the usage of glucometers by type 2 diabetes patients aged 65 years and over.

Efficacy of Digitally Supported and Real-Time Self-Monitoring of Blood Glucose-Driven Counseling in Patients with Type 2 Diabetes Mellitus: A Real-World, Retrospective Study in North India

PURPOSE

Poor glycemic control is prevalent in patients with type 2 diabetes mellitus (T2DM) in India. This study aims to understand the effectiveness of a smartphone-connected glucometer, real-time feedback, and contextualized counseling on glycemic control and hypoglycemic episodes in T2DM patients.

METHODS

This retrospective, multicenter study reviewed the medical records of T2DM patients belonging to several cities of north India, who were digitally engaged with a smartphone-connected glucometer and who had received at least one counseling session between September 2019 and July 2020. Intervention included self-monitoring of blood glucose (SMBG) using a smartphone-connected glucometer enabled with real-time transmission of information to certified diabetes educators (CDE) and their corresponding counseling based on SMBG findings.

RESULTS

Of 7111 adult T2DM patients included in this study, majority (75%) of the patients received a single session of counseling, and the remaining patients received 2 (16.7%), 3 (5%), 4 (2%), or ≥5 (1.3%) sessions. The mean age of the patients was 51.6 years, and the majority (77.9%) were males. Digital monitoring of BG and counseling with CDE significantly reduced the mean fasting (by 9.6%), pre-prandial (by 9.9%), and post-prandial (by 9.2%) BG values in 53%, 52%, and 54% of patients, respectively. The majority (81.4%) of patients showed no hypoglycemic episode (≤70 mg/dL) post-counseling. The hypoglycemia episodes observed with FBG, pre-prandial, and post-prandial BG values were reduced significantly by 58.5%, 48.1%, and 61.8%, respectively, post-counseling.

CONCLUSION

Digitally supported and real-time SMBG-driven counselling was effective in glycemic control and reduction of hypoglycemic episodes in T2DM patients in India. Moreover, reduction in hypoglycemia may be due to back end real-time support of CDE intervention.

RF Remote Blood Glucose Sensor and a Microfluidic Vascular Phantom for Sensor Validation

Diabetes has become a major health problem in society. Invasive glucometers, although precise, only provide discrete measurements at specific times and are unsuitable for long-term monitoring due to the injuries caused on skin and the prohibitive cost of disposables. Remote, continuous, self-monitoring of blood sugar levels allows for active and better management of diabetics. In this work, we present a radio frequency (RF) sensor based on a stepped impedance resonator for remote blood glucose monitoring. When placed on top of a human hand, this RF interdigital sensor allows detection of variation in blood sugar levels by monitoring the changes in the dielectric constant of the material underneath. The designed stepped impedance resonator operates at 3.528 GHz with a Q factor of 1455. A microfluidic device structure that imitates the blood veins in the human hand was fabricated in PDMS to validate that the sensor can measure changes in glucose concentrations. To test the RF sensor, glucose solutions with concentrations ranging from 0 to 240 mg/dL were injected into the fluidic channels and placed underneath the RF sensor. The shifts in the resonance frequencies of the RF sensor were measured using a network analyzer via its S11 parameters. Based on the change in resonance frequencies, the sensitivity of the biosensor was found to be 264.2 kHz/mg·dL-1 and its LOD was calculated to be 29.89 mg/dL.

Impact of muscle mass on blood glucose level

OBJECTIVES

At present, diabetes is one of the leading causes of mortality across the world. It was hypothesized that muscle mass could have a significant influence on blood glucose level and this corelation if established successfully could pave way for novel treatment modalities for type 2 diabetes mellitus (T2DM). In the present study, the association between muscle mass and blood glucose level was examined in a healthy population who was not having T2DM at baseline and was undergoing a regular course of exercise.

METHODS

The clinical study was performed involving 53 healthy male populations between 10 and 60 years of age. The participants were sampled in accordance with the quantitative experimental study design, using nonprobability sampling techniques. The independent variable measured among the subjects included muscle mass and blood glucose level, using bioelectrical impedance and a simple glucometer respectively. Subgroup analysis amongst different substantial parameters including body mass index (BMI), myostatin inhibitor usage, and age factor that could affect the muscle mass and glucose level correlation were also studied simultaneously.

RESULTS

The study findings demonstrated a negative correlation between muscle mass and glucose utilization levels. There was a significant difference in the mean muscle mass of the participants which was 36.2453, and the mean glucose utilization level which was 15.1493%. Pearson correlation between the muscle mass and percentage of glucose utilization of the participants indicated a significant difference (since p-value <0.05) between these two studied parameters.

CONCLUSIONS

The study finding suggests an inverse association of the skeletal muscle mass with blood glucose level which encourages the implication of muscle-building exercises as the preventive measure for T2DM.

A Pilot Trial to Evaluate the Accuracy of a Novel Non-Invasive Glucose Meter

The non-invasive self-monitoring of blood glucose (SMBG) has been the subject of intense investigation over recent decades. We conducted a pilot study designed to examine a novel non-invasive glucometer, the HGR GWave, utilizing radiofrequency (RF) sensing. Blood glucose levels assessed by this HGR prototype were compared to measurements performed by a hexokinase core laboratory assay during an oral glucose tolerance test (oGTT) for 5 subjects with type 2 diabetes. The HGR glucose meter readings were also compared to two Abbot Freestyle^® glucose meters, which were also used for calibration. The accuracy of the results was evaluated through the calculation of relative absolute difference (RAD), specified percentage differences between 43 reference glucose measurements, and using comparator measurements. The median RAD was −4.787. We detected 79.04%, 92.99% and 97.64% of HGR readings within ±10%, ±15% and ±20% of the reference glucose measurements. The HGR readings had a high correlation with reference lab glucose measurements with R² = 0.924 (95% CI 0.929–0.979; p < 0.0001). When compared to the Freestyle^® glucose meters 94.3% and 100% of the readings were within ±5% and ±10%, with R² = 0.975 (0.975–0.994; p < 0.0001). The HGR prototype glucose meter was found to be accurate in detecting real-time blood glucose during an oGTT in this small pilot study. A study with a broader range of blood glucose levels is needed to further assess its accuracy and its suitability for clinical use.

Successful Insulin Glargine Treatment in Two Pet Guinea Pigs with Suspected Type 1 Diabetes Mellitus

Simple Summary

This is the first case report of two guinea pigs with insulin-dependent diabetes mellitus (DM) successfully treated with long-acting basal insulin glargine. Both animals presented with typical symptoms and laboratory changes like polyphagia, glucosuria and highly elevated blood glucose levels that suggested the presence of a diabetes mellitus. One of the guinea pigs had asymmetric bilateral cataracts. Mostly, a disorder resembling type II-DM in humans seems to be prevalent in guinea pigs. In this case, the animals did not respond to the standard treatment of a dietary change but responded promptly to insulin treatment. The diabetes has remained controlled for over 1.5 years now. Thus far, there is only sparse scientific information on spontaneous type I diabetes mellitus and treatment modalities in pet guinea pigs. We discuss the current literature including up to date diagnosis, treatment, monitoring with the evaluation of different glucometers and long-time follow-up. Moreover, individual ophthalmic abnormalities and management regarding suspected diabetic cataracts are described in detail.

Abstract

Scientific information on spontaneous type I diabetes mellitus (DM) and treatment modalities in guinea pigs is scarce. As most diabetic guinea pigs are overweight and respond to dietary changes, a disorder resembling type II-DM in humans seems to be most prevalent in this species. In the present report, a nine-month-old female intact guinea pig (GP1) was presented because of a cataract and polyphagia. The physical examinations in GP1 and its littermate, GP2, were unremarkable. Laboratory tests revealed hyperglycemia, hyperlipidemia, elevated fructosamine concentrations, and glucosuria in GP1 and GP2. Not responding to dietary changes, an insulin-dependent diabetes mellitus was suspected in both animals. Treatment with 0.5 IU of glargine insulin (Lantus^®) per guinea pig subcutaneously (s.c.) once daily was initiated in both animals. Monitoring included repeated clinical evaluations and the measurement of plasma glucose and fructosamine concentrations. Capillary glucose concentration was measured using a glucometer, and glucosuria was monitored by dipstick. Blood glucose concentrations decreased quickly in both GPs, and glucosuria resolved. Including several dose adjustments, DM remained controlled for over 1.5 years. Bilateral cataracts and lens-induced uveitis in GP1 were medically managed with only slight progression. This is the first report of guinea pigs with insulin-dependent diabetes mellitus that were successfully treated with long-acting basal insulin glargine.

What We Should Consider in Point of Care Blood Glucose Test; Current Quality Management Status of a Single Institution

Background and Objectives: Point of care test (POCT) is generally performed by non-laboratory staff who often lack an understanding on the quality control and quality assurance programs. The purpose of this study was to understand the current status of quality management of point of care (POC) blood glucose testing in a single institution where non-laboratory staff perform the tests. Materials and Methods: From July to August 2020, management status of glucometer, test strips, quality control (QC) materials, quality assurance program, and operators’ response to processing of displayed results was monitored in all Soonchunhyang University Bucheon hospital departments that performed POC blood glucose test. Results of the POC blood glucose test conducted from January 2019 to May 2020 were analyzed retrospectively. Results: A total 124 glucometers were monitored in 47 departments. Insufficient management of approximately 50% of blood sugar, test strips, and QC materials was observed. Although daily QC was conducted by 95.7% of the departments, the QC records were inaccurate. The method of recording test results varied with departments and operators. Various judgments and troubleshooting were performed on the unexpected or out of measurable range results, including some inappropriate processes. In POC blood glucose test results review, 4568 atypical results were identified from a total of 572,207 results. Conclusions: Sufficient training of the non-laboratory staff and ongoing assessment of competency through recertification is needed to maintain acceptable levels of POCT quality. In this study, various problems were identified in glucometer and reagent management, QC and post-analytic phase. We believe that these results provide meaningful basal information for planning effective operators’ training and competency evaluation, and the development of an efficient POCT quality management system.

One Drop App With an Activity Tracker for Adults With Type 1 Diabetes: Randomized Controlled Trial

BACKGROUND

In 2017, mobile app support for managing diabetes was available to 64% of the global population of adults with diabetes. One Drop's digital therapeutics solution includes an evidence-based mobile app with global reach, a Bluetooth-connected glucometer, and in-app coaching from Certified Diabetes Educators. Among people with type 1 diabetes and an estimated hemoglobin A_1c level≥7.5%, using One Drop for 3 months has been associated with an improved estimated hemoglobin A_1c level of 22.2 mg/dL (-0.80%). However, the added value of integrated activity trackers is unknown.

OBJECTIVE

We conducted a pragmatic, remotely administered randomized controlled trial to evaluate One Drop with a new-to-market activity tracker against One Drop only on the 3-month hemoglobin A_1c level of adults with type 1 diabetes.

METHODS

Social media advertisements and online newsletters were used to recruit adults (≥18 years old) diagnosed (≥1 year) with T1D, naïve to One Drop's full solution and the activity tracker, with a laboratory hemoglobin A_1c level≥7%. Participants (N=99) were randomized to receive One Drop and the activity tracker or One Drop only at the start of the study. The One Drop only group received the activity tracker at the end of the study. Multiple imputation, performed separately by group, was used to correct for missing data. Analysis of covariance models, controlling for baseline hemoglobin A_1c, were used to evaluate 3-month hemoglobin A_1c differences in intent-to-treat (ITT) and per protocol (PP) analyses.

RESULTS

The enrolled sample (N=95) had a mean age of 41 (SD 11) years, was 73% female, 88% White, diagnosed for a mean of 20 (SD 11) years, and had a mean hemoglobin A_1c level of 8.4% (SD 1.2%); 11% of the participants did not complete follow up. Analysis of covariance assumptions were met for the ITT and PP models. In ITT analysis, participants in the One Drop and activity tracker condition had a significantly lower 3-month hemoglobin A_1c level (mean 7.9%, SD 0.60%, 95% CI 7.8-8.2) than that of the participants in the One Drop only condition (mean 8.4%, SD 0.62%, 95% CI 8.2-8.5). In PP analysis, participants in the One Drop and activity tracker condition also had a significantly lower 3-month hemoglobin A_1c level (mean 7.9%, SD 0.59%, 95% CI 7.7-8.1) than that of participants in the One Drop only condition (mean 8.2%, SD 0.58%, 95% CI 8.0-8.4).

CONCLUSIONS

Participants exposed to One Drop and the activity tracker for the 3-month study period had a significantly lower 3-month hemoglobin A_1c level compared to that of participants exposed to One Drop only during the same timeframe. One Drop and a tracker may work better together than alone in helping people with type 1 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03459573; https://clinicaltrials.gov/ct2/show/NCT03459573.

Comparison of 2 portable human glucometers for the measurement of blood glucose concentration in White New Zealand rabbits

We compared measurements of blood glucose concentrations in 30 healthy adult White New Zealand rabbits using 2 commercial portable glucometers (PGM1 and PGM2) and a laboratory chemical analyzer. Results were analyzed with Pearson correlation, Passing-Bablok regression analysis, Bland-Altman analysis, and a modified error grid. Measurements with PGM1 were significantly correlated (r = 0.37) with those obtained from the laboratory reference method (RM); Bland-Altman and Passing-Bablok analyses indicated no significant systematic or proportional differences (mean difference of -0.26, 95% CI of mean difference of -0.54 to 0.01, and LOA of -1.70 to 1.17); and error grid resulted in 100% of measurements in zone A. No significant correlation (r = -0.05) was detected between PGM2 and RM; Bland-Altman and Passing-Bablok analyses results indicated a mean difference of 2.14, 95% CI of mean difference of 1.67-2.60, and limit of agreement of -0.32 to 4.59, which overestimated blood glucose concentration, with 53% of glucose measurements in error grid zone A and 47% in zone B. PGM1 was considered accurate in normoglycemic rabbits, whereas the use of PGM2 could result in overestimations of glycemia.

Performance evaluation of three i-SENS glucometers using arterial blood samples compared with the YSI 2300 Glucose Analyzer

Background

Capillary blood is the most commonly used sample for point‐of‐care (POC) glucometers. However, in critically ill patients, the glucose levels measured from capillary blood may not be reliable. Thus, we aimed to evaluate and compare the accuracy of glucose levels measured with POC glucometers and the YSI 2300 glucose analyzer using leftover arterial blood samples.

Methods

In total, 100 leftover heparinized arterial blood samples were used to evaluate the performance of three i‐SENS glucometers (BAROzen H Expert plus, CareSens PRO, and CareSens H Beat) and the ACCU‐CHEK^® Inform II glucometer. The reference value was obtained using the YSI 2300 glucose analyzer. The results were analyzed based on International Organization for Standardization 15197:2013 guidelines.

Results

More than 95% of results obtained using POC glucometers were within ±15 mg/dL of the reference value for glucose concentrations <100 mg/dL and within ±15% of the reference value for glucose concentrations ≥100 mg/dL. In the consensus error grid analysis, more than 99% of results were found to be within zones A and B. An excellent correlation was found between the values obtained using POC glucometers and the YSI 2300 glucose analyzer (R² > .99).

Conclusion

The i‐SENS glucometers showed stable and accurate results when leftover arterial blood samples were used. Therefore, POC glucometers could be useful in critical care settings, such as intensive care units, where arterial samples are routinely used.

Evaluation of the Freestyle Optium Neo H point-of-care device for measuring blood glucose concentrations in sick calves

Background

Data on the performance of a glucometer in calves with different diseases are currently lacking.

Objective

The primary objective of this study was to evaluate the reliability of a point of care glucometer in calves affected by different diseases relative to a traditional bench‐top autoanalyzer.

Animals

One hundred ninety‐six calves with different disorders in a referral hospital.

Methods

Prospective study. Venous blood samples were used for the determination of glucose concentrations in blood and plasma using the Freestyle Optium Neo H and autoanalyzer, respectively. Data were subjected to Passing‐Bablok regression and Bland‐Altman plots. The Freestyle Optium Neo H was the test method and the autoanalyzer was the reference method. The diagnostic performance of the glucometer relative to the autoanalyzer was assessed using 3 different plasma glucose concentrations.

Results

The Passing‐Bablok regression for the glucometer against the reference method revealed the presence of both proportional bias (1.12; 95% confidence interval [CI], 1.07‐1.18) and constant bias (−11.25; 95% CI, −16.0 to −7.70). The glucometer yielded 92.2%‐100% sensitivity and 86.4%‐96% specificity for the assessing glucose concentration based on different concentration thresholds.

Conclusions and Clinical Importance

The Freestyle Optium Neo H showed proportional and constant biases relative to the reference method. The glucometer showed poor performance according to criteria recommended by the International Standards Organization and the American Society for Veterinary Clinical Pathology. However, the glucometer determined hypoglycemia with high sensitivity and specificity therefore it might be used to diagnose hypoglycemia in calves with different diseases until calf‐specific POC glucometers are developed.

Surveillance Accuracy of Smartphone-Dependent Glucose Meters in the Measurement of Plasma Glucose

BACKGROUND

Along with stand-alone glucose monitors, smartphone-dependent glucose meters (SDGM) are available for self-monitoring of blood glucose (SMBG). These display-less devices, connected to a smartphone, measure glucose and display report on a smartphone screen, which can be easily shared with doctors.

AIM

The aim of this study was to check the accuracy of the available SDGMs in relation to the laboratory reference method.

MATERIALS AND METHODS

Two available SDGMs: BeatO™ and GlucoMe™ were tested. A total of 104 venous blood samples were tested for glucose in SDGMs and by the reference method. The accuracy of the report was checked by the International Standards Organization (ISO), American Diabetes Association (ADA), and Clinical Laboratory Improvement Amendments (CLIA) criteria. Clarke error grid analysis (CEGA) was carried out to find the suitability of SDGM in clinical usage.

RESULTS

Mean plasma glucose (n = 104) level from laboratory report was 106.48 ± 44.58 mg/dL, that from BeatO™ was 105.78 ± 52.6, and GlucoMe™ was 99.72 ± 51.22. The accuracy was lower than that recommended by ISO 2013 (29.8% and 30.77% error in BeatO™ and GlucoMe™, respectively), ADA (63.46% and 74% error in BeatO™ and GlucoMe™, respectively), and CLIA (42.31% and 46.15% error in BeatO™ and GlucoMe™, respectively) criteria. According to CEGA, BeatO™ and GlucoMe™ can guide correct treatment in diabetes mellitus patients for 74% and 71% of measurement, respectively.

CONCLUSION

The accuracy of both the SDGMs was lower than that suggested by ISO, ADA, and CLIA criteria. The result of this study would help patients and doctors in informed choice for the procurement of glucose monitors.

Cellular-Enabled Glucometers and Maternal Glucose Control: A Quality Improvement Initiative

BACKGROUND

Management of diabetes in pregnancy is burdensome due to self-glucose monitoring, recording, and reporting demands. Cellular-enabled glucometers provide real-time transmission of glucose values independent of internet access and cell phone data plans. We describe a quality improvement (QI) intervention that introduced cellular-enabled glucometers for use during pregnancies complicated by diabetes.

METHODS

Our aim was to improve maternal glucose control in a cohort of insulin-requiring pregnant women enrolled in a telemedicine diabetes program. During initial establishment of a QI program, women were offered cellular-enabled glucometers but could elect to keep their standard meter. The primary outcome evaluated was glycosylated hemoglobin A1c (HbA1c) at delivery.

RESULTS

Baseline characteristics including initial HbA1c were similar between women using a standard glucometer (n = 45) and those using a cellular-enabled glucometer (n = 72). Women who used a cellular-enabled glucometer had a lower HbA1c at delivery compared to those using a standard glucometer (5.8% vs 6.3%, P = .03). This improvement was particularly notable for women with poor glucose control (defined as HbA1c >6.5%) at initial obstetric visit. Women with poor glucose control who used a cellular-enabled glucose monitor had significantly lower HbA1c at delivery (6.0% vs 6.8%, P = .03) and greater change from initial visit compared to those using a standard glucometer (-2.6% vs -1.4%, P = .02). No statistically significant differences were detected in tracked neonatal outcomes.

CONCLUSION

For pregnancies complicated by insulin-requiring diabetes, use of cellular-enabled glucometers as part of a perinatal diabetes program improves glucose control at delivery with timely transmission of accurate values throughout gestation.

Inaccurate point-of-care blood glucose measurement in a dog with secondary erythrocytosis

BACKGROUND

Point-of-care (POC) portable blood glucose meters (PBGMs) are convenient and inexpensive tools for assessing patient blood glucose concentrations. They are often used to quickly diagnose hypoglycemia or collect serial glucose readings in diabetic patients. However, POC meters have been previously identified in human and veterinary literature to be inaccurate when utilized in patients with abnormal HCT. This problem may not be reflected in manufacturer guidelines referenced by practitioners in the POC setting.

KEY FINDINGS

A 1.5-year-old dog, previously diagnosed with multiple congenital cardiac malformations, right-to-left cardiac shunting and secondary erythrocytosis, presented to a veterinary emergency center minimally responsive and without detectable pulses. PBGM measurement identified hypoglycemia. Following stabilization of the dog, serial glucose assessments showed discordant results between PBGMs and the reference laboratory biochemistry analyzer. A pathological cause for hypoglycemia was not identified and PBGM readings were determined to be erroneously low due to the dog's abnormally high HCT.

SIGNIFICANCE

This case demonstrates the limitations of using PBGMs to assess blood glucose in a dog with secondary erythrocytosis. The report emphasizes the need for judicious use of PBGMs in critically ill patients and that these glucometers may not be reliable in patients with abnormal HCT values.

Real-Time Noninvasive Measurement of Glucose Concentration Using a Modified Hilbert Shaped Microwave Sensor

We developed a microwave glucose sensor based on the modified first-order Hilbert curve design and measured glucose concentration in aqueous solutions by using a real-time microwave near-field electromagnetic interaction technique. We observed S₂₁ transmission parameters of the sensor at resonant frequencies depend on the glucose concentration. We could determine the glucose concentration in the 0-250 mg/dL concentration range at an operating frequency of near 6 GHz. The measured minimum detectable signal was 0.0156 dB/(mg/dL) and the measured minimum detectable concentration was 1.92 mg/dL. The simulation result for the minimum detectable signal and the minimum detectable concentration was 0.0182 dB/(mg/dL) and 1.65 mg/dL, respectively. The temperature instability of the sensor for human glycemia in situ measurement range (27-34 °C for fingers and 36-40 °C for body temperature ranges) can be improved by the integration of the temperature sensor in the microwave stripline platform and the obtained data can be corrected during signal processing. The microwave signal-temperature dependence is almost linear with the same slope for a glucose concentration range of 50-150 mg/dL. The temperature correlation coefficient is 0.05 dB/°C and 0.15 dB/°C in 27-34 °C and 36-40 °C temperature range, respectively. The presented system has a cheap, easy fabrication process and has great potential for non-invasive glucose monitoring.

Pleural fluid glucose testing using a finger stick glucometer: a novel bedside test

Background

Pleural fluid glucose (PFG) has diagnostic and therapeutic implications for the management of pleural effusion. The literature examining point-of-care testing of PFG is limited, and no studies exist for the bedside measurement of PFG using a glucometer (B-PFG). In this study, we compared the accuracy of B-PFG measurement to standard in-lab measurement (Lab-PFG).

Methods

Patients undergoing thoracentesis or thoracostomy were enrolled. PFG was measured at the bedside with a finger stick blood glucometer (ACCU-CHEK^® Inform II, Roche) and in the laboratory. Two consecutive measurements were taken using the glucometer, and their mean was compared to the glucose concentration measured in the laboratory. Pearson correlation coefficient and Bland-Altman Plot analysis were used to compare the two measurements.

Results

Sixty patients were included. Mean age was 64.1 years. Forty-nine patients had exudative effusions (41% malignant, 26% parapneumonic, and 33% others). There was a significant correlation between the B-PFG and the Lab-PFG (r=0.98, 95% CI of 0.97 to 0.99; P<0.0001). There was good agreement between the B-PFG and the Lab-PFG with a mean difference of 14.8 mg/dL [95% limit of agreement (LOA) of -2.2 to 31.8 mg/dL]. This agreement was even better at glucose values less than 80 mg/dL.

Conclusions

PFG measured at the bedside with a glucometer closely correlates with the laboratory measurement. Further studies are needed prior to incorporating this test in clinical practice.

Twice-Daily vs 4-Times-Daily Glucose Testing in Women With Gestational Diabetes Mellitus: A Pilot Study

OBJECTIVES

In women with gestational diabetes mellitus (GDM), glycemic control is typically assessed by capillary blood glucose (BG) self-monitoring. Currently, the standard method of monitoring is by 4-times-daily self-measurements. The goal of our study was to determine whether twice-daily capillary BG testing is comparable with 4-times-daily testing in women with GDM.

METHODS

Thirty-two women with GDM completed initial dietary counselling and recorded consecutive fasting and 2-h postprandial BG over a 14-day period. We randomly selected 2 of 4 BG measurements on each given day and compared mean (95% confidence interval [CI]) twice-daily vs 4-times-daily BG measurements using paired t tests and Bland-Altman plots. The proportion of 14-day BG measurements above glycemic targets was also compared between twice-daily vs 4-times-daily testing for fasting and postprandial readings.

RESULTS

Comparing twice-daily vs 4-times-daily mean BG, there was a small difference for fasting BG (0.09 mmol/L; 95% CI, 0.03 to 0.14), but not for 2-h postbreakfast (-0.05 mmol/L; 95% CI, -0.17 to 0.06), 2-h postlunch (-0.03 mmol/L; 95% CI, -0.13 to 0.08) or 2-h postdinner (0.05 mmol/L; 95% CI, -0.09 to 0.19) BG. Bland-Altman plots showed general agreement and minimal bias between twice-daily vs 4-times-daily BG, whether fasting or postprandial. There was no significant difference in the proportion of 14-day BG measurements above glycemic targets comparing twice-daily vs 4-times-daily testing in the fasting or postprandial states.

CONCLUSIONS

Twice-daily BG testing appears to generate 14-day average values similar to 4-times-daily BG testing. In women with GDM, whose BG is in target range, twice-daily BG monitoring may reduce inconvenience and cost.

Comment on "accuracy and precision of four main glucometers used in a sub-Saharan African country: a cross-sectional study" by Choukem et al

In their article, Choukem et al. report of assessments of the analytical quality of blood glucose monitoring systems. Although there are some commendable aspects regarding the methodology, some major shortcomings could preclude the conclusions drawn by Choukem et al. Nevertheless, independent assessments of the performance of blood glucose monitoring systems are an important issue.

Analysis of kombucha to teach biochemical concepts and techniques to undergraduate students

Laboratory exercises for undergraduate biochemistry students are described in which changes in sugar content during fermentation of the trendy beverage kombucha are analyzed by three methods: thin layer chromatography, a 3,5-dinitrosalicylic acid assay, and a standard commercial blood glucose meter. Each of the three analyses can be completed in a typical laboratory session lasting two to three hours. The exercises are designed to reinforce concepts typically covered in an undergraduate biochemistry course as well as to teach a variety of laboratory techniques. The exercises have been used with positive results in an upper level biochemistry laboratory course for junior/senior students majoring in chemistry or biology. © 2019 International Union of Biochemistry and Molecular Biology, 47(4):459-467, 2019.

Development of a "Dual Gates" Locked, Target-Triggered Nanodevice for Point-of-Care Testing with a Glucometer Readout

Developing a facile and sensitive sensing platform is of importance for point-of-care testing (POCT). Herein, a sensitive and portable POCT platform based on "dual gates" aminated magnetic mesoporous silica nanocomposites (AMMS) bearing polydopamine (PDA)-aptamer (Apt) two-tier shells, as a novel nanodevice, is designed for target detection through a target-triggered glucose (GO) release from AMMS with personal glucometer (PGM) readout. In the absence of target, GO can be firmly captured in pores by the designed "dual gates", which would decrease the high background signal of this system and ensure the accuracy of the detection results. Upon the introduction of the target molecules under acidic conditions (pH 5.5), the subsequent PDA self-degradation and the specific Apt-target reaction can cause the departure of "dual gates" and the opening of pores to release the loaded GO molecules, which could be quantitatively monitored by a portable PGM. It has been demonstrated that such POCT platform shows high sensitivity and excellent selectivity for aflatoxin B1 (AFB1) detection, accompanied by the well-presented reproducibility and stability. Importantly, this sensing platform was further validated by assaying contaminated samples, where the obtained results were well matched with that by HPLC. Regarding the features of portability, high sensitivity, and high throughput detection, the developed platform might find wide applications in POCT.

Transcription Errors of Blood Glucose Values and Insulin Errors in an Intensive Care Unit: Secondary Data Analysis Toward Electronic Medical Record-Glucometer Interoperability

BACKGROUND

Critically ill patients require constant point-of-care blood glucose testing to guide insulin-related decisions. Transcribing these values from glucometers into a paper log and the electronic medical record is very common yet error-prone in intensive care units, given the lack of connectivity between glucometers and the electronic medical record in many US hospitals.

OBJECTIVE

We examined (1) transcription errors of glucometer blood glucose values documented in the paper log and in the electronic medical record vital signs flow sheet in a surgical trauma intensive care unit, (2) insulin errors resulting from transcription errors, (3) lack of documenting these values in the paper log and the electronic medical record vital signs flow sheet, and (4) average time for docking the glucometer.

METHODS

This secondary data analysis examined 5049 point-of-care blood glucose tests. We obtained values of blood glucose tests from bidirectional interface software that transfers the meters' data to the electronic medical record, the paper log, and the vital signs flow sheet. We obtained patient demographic and clinical-related information from the electronic medical record.

RESULTS

Of the 5049 blood glucose tests, which were pertinent to 234 patients, the total numbers of undocumented or untranscribed tests were 608 (12.04%) in the paper log, 2064 (40.88%) in the flow sheet, and 239 (4.73%) in both. The numbers of transcription errors for the documented tests were 98 (2.21% of 4441 documented tests) in the paper log, 242 (8.11% of 2985 tests) in the flow sheet, and 43 (1.64% of 2616 tests) in both. The numbers of transcription errors per patient were 0.4 (98 errors/234 patients) in the paper log, 1 (242 errors/234 patients) in the flow sheet, and 0.2 in both (43 errors/234 patients). Transcription errors in the paper log, the flow sheet, and in both resulted in 8, 24, and 2 insulin errors, respectively. As a consequence, patients were given a lower or higher insulin dose than the dose they should have received had there been no errors. Discrepancies in insulin doses were 2 to 8 U lower doses in paper log transcription errors, 10 U lower to 3 U higher doses in flow sheet transcription errors, and 2 U lower in transcription errors in both. Overall, 30 unique insulin errors affected 25 of 234 patients (10.7%). The average time from point-of-care testing to meter docking was 8 hours (median 5.5 hours), with some taking 56 hours (2.3 days) to be uploaded.

CONCLUSIONS

Given the high dependence on glucometers for point-of-care blood glucose testing in intensive care units, full electronic medical record-glucometer interoperability is required for complete, accurate, and timely documentation of blood glucose values and elimination of transcription errors and the subsequent insulin-related errors in intensive care units.

Accuracy and precision of four main glucometers used in a Sub-Saharan African Country: a cross-sectional study

Introduction

capillary glucose measurement using point-of-care glucometers is an essential part of diabetes care. We determined the technical accuracy, clinical accuracy and precision of commonly available glucometers against standard spectrophotometry in Cameroon.

Methods

a sample of four glucometers was selected. In the 108 diabetic and non-diabetic participants, blood glucose values obtained by glucometers were compared to the reference laboratory method to determine their technical and clinical accuracies. Precision was determined by repeated measurements using standard solutions of different concentrations.

Results

accu-Chek^® Active, CodeFree™, Mylife™ Pura™ and OneTouch^® Ultra^® 2 values had correlation coefficients of 0.96, 0.87, 0.97 and 0.94 respectively with reference values, and biases of 18.7%, 29.1%, 16.1% and 13.8% respectively. All glucometers had ≥ 95% of values located within the confidence limits except OneTouch^® Ultra^®2. Accu-Chek^® Active, CodeFree™, Mylife™ Pura™ and OneTouch^® Ultra^® 2 had 99%, 93.1%, 100% and 98.0% of values in Parke's zones A and B. The coefficients of variation of the glucometers were all below 5% at all standard concentrations, except for Accu-Chek^® Active for glucose concentrations at100 and 200mg/dL.

Conclusion

no glucometer met all the international recommendations for technical accuracy. Accu-Chek™ Active and Mylife™, Pura™ met the International Organization for Standardization 2013 recommendations for clinical accuracy based on Parke's consensus error grid analysis. All glucometers assessed except Accu-Chek^® Active showed a satisfactory level of precision at all concentrations of standard solutions used.

Physicians' Views of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Not on Insulin

This qualitative study examines to what extent and why physicans still prescribe self-monitoring of blood glucose (SMBG) in patients with non-insulin-treated type 2 diabetes (NITT2D) when the evidence shows it increases cost without improving hemoglobin A_1c (HbA_1c), general well being, or health-related quality of life. Semistructured phone interviews with 17 primary care physicians indicated that the majority continue to recommend routine self-monitoring of blood glucose due to a compelling belief in its ability to promote the lifestyle changes needed for glycemic control. Targeting physician beliefs about the effectiveness of self-monitoring of blood glucose, and designing robust interventions accordingly, may help reduce this practice.

Evaluation of a point-of-care blood glucose monitor in healthy goats

OBJECTIVE

To assess agreement between a point-of-care glucometer (POCG) and a laboratory chemistry analyzer for blood glucose measurements in goats.

DESIGN

Prospective study.

SETTING

University teaching hospital.

ANIMALS

Eighteen healthy adult goats.

INVESTIGATIONS

Whole blood samples were obtained via jugular venipuncture prior to premedication with xylazine and butorphanol (T0), following premedication (T20), and after 1 hour of inhalant anesthesia (T60). Each sample was tested with a POCG and a laboratory analyzer (HITA). Agreement was assessed using concordance correlation coefficients and calculation of bias and 95% limits of agreement.

MEASUREMENTS AND MAIN RESULTS

Mean blood glucose concentration at T0 was 3.9 ± 0.6 mmol/L (70 ± 10 mg/dL; POCG) and 2.9 ± 0.4 mmol/dL (53 ± 8 mg/dL; HITA). Glucose concentrations at T20 were 6.7 ± 2.4 mmol/L (121 ± 43 mg/dL) and 5.4 ± 2.1 mmol/L (97 ± 37 mg/dL) and at T60 were 5.7 ± 1.7 mmol/L (102 ± 31 mg/dL) and 4.7 ± 1.3 mmol/L (85 ± 24 mg/dL) when measured with the POCG and HITA, respectively. The POCG overestimated blood glucose compared to the HITA. The bias ± SD was 1.08 ± 0.53 mmol/L (19.4 ± 9.5 mg/dL) (95% LOA 0.04 to 2.11 mmol/L [0.7 to 38.0 mg/dL]) and the concordance correlation coefficient was 0.82. After correcting the results of the POCG using a mixed-effects linear model, the bias was 0.0 ± 0.38 mmol/L (0.0 ± 6.8 mg/dL) (95% LOA ± 0.74 mmol/L [± 13.4 mg/dL]) and the concordance correlation coefficient was 0.98.

CONCLUSIONS

The POCG overestimated blood glucose concentrations in goats, compared to the HITA, but when the POCG concentrations were corrected, the agreement was excellent.

Glycemic control and its associated factors among diabetes mellitus patients at Ayder comprehensive specialized hospital, Mekelle-Ethiopia

Diabetes is one of the largest health emergencies of the twenty-first century and it is increasing with alarming rate throughout the world. Glycemic Control in diabetes patients is an important issue in minimizing diabetes related complications and deaths. Institution based comparative cross-sectional study was conducted from March to April, 2017. Glycated Hemoglobin A1c and biochemical profiles were determined using Huma Meter A1c and ABX PENTRA 400 clinical chemistry analyzer. Independent t-test to compare groups, bivariate and multi variable logistic regression analysis were used. A P-value <0.05 was considered as statistically significance. A total of 336 study participants were enrolled in this study. Overall, 208(61.9%) of the study participants had poor glycemic control. The poor glycemic control was significantly higher in glucometer non-users 120(71.4%) compared to glucometer users 88(52.4%) (P < 0.001). Income, the number of visits, high-triglyceride, high low-density lipoprotein and non-glucometer use were significantly associated with the poor glycemic control.

Comparative Evaluations of Randomly Selected Four Point-of-Care Glucometer Devices in Addis Ababa, Ethiopia

BACKGROUND

Point-of-care glucometer (PoCG) devices play a significant role in self-monitoring of the blood sugar level, particularly in the follow-up of high blood sugar therapeutic response. The aim of this study was to evaluate blood glucose test results performed with four randomly selected glucometers on diabetes and control subjects versus standard wet chemistry (hexokinase) methods in Addis Ababa, Ethiopia.

METHOD

A prospective cross-sectional study was conducted on randomly selected 200 study participants (100 participants with diabetes and 100 healthy controls). Four randomly selected PoCG devices (CareSens N, DIAVUE Prudential, On Call Extra, i-QARE DS-W) were evaluated against hexokinase method and ISO 15197:2003 and ISO 15197:2013 standards.

RESULTS

The minimum and maximum blood sugar values were recorded by CareSens N (21 mg/dl) and hexokinase method (498.8 mg/dl), respectively. The mean sugar values of all PoCG devices except On Call Extra showed significant differences compared with the reference hexokinase method. Meanwhile, all four PoCG devices had strong positive relationship (>80%) with the reference method (hexokinase). On the other hand, none of the four PoCG devices fulfilled the minimum accuracy measurement set by ISO 15197:2003 and ISO 15197:2013 standards. In addition, the linear regression analysis revealed that all four selected PoCG overestimated the glucose concentrations.

CONCLUSIONS

The overall evaluation of the selected four PoCG measurements were poorly correlated with standard reference method. Therefore, before introducing PoCG devices to the market, there should be a standardized evaluation platform for validation. Further similar large-scale studies on other PoCG devices also need to be undertaken.

Design of non-invasive glucose meter using near-infrared technique

Diabetics need to keep track of their blood glucose level and measure it regularly to determine their insulin dose intake and to ensure that glucose level is always within the normal range. In this article, a system that enables the measurement of blood glucose level non-invasively is designed. This article uses a near infra-red (NIR) transmittance spectroscopy, without drawing blood, puncturing the skin, or causing pain. It involves a light source and light detector circuits positioned on a certain region of the body. The attenuated received infra-red signal by the detector is a measure of the blood glucose level of that region. Data are collected from the receiving circuit and sent to a microcontroller using CoolTerm application, then exporting it to Excel Sheet, in which mean values and graphs are obtained. The performance of the circuit with and without Filtering is examined. A downward pattern was noticed, as the glucose concentration in the solution increased, the voltage output decreased, meaning that a less intensity light was detected by the receiving circuit. An improvement in the accuracy of measurements by 17% was achieved, when a notch filter is implemented to cut the voltage components corresponding to the power line noisy signals.

Correlations between gingival crevicular blood glucose and capillary blood glucose: A preliminary report

INTRODUCTION

Oral health plays an important role for screening of many systemic diseases. Hence, dentists play an important role in screening for systemic diseases as well. Early diagnosis of any systemic diseases can prevent long-term complications. Diabetic is one of the common chronic diseases. Hence, the study had been undertaken to evaluate whether gingival crevicular blood (GCB) can be used to screen for diabetes during routine oral health checkups.

MATERIALS AND METHODS

This analytical study included thirty participants who visited the Department of Periodontics, who fulfilled inclusion criteria and were willing to participate. Blood samples were collected by finger stick method and periodontal probing. The glucose levels of both the samples were estimated using glucometer and correlated the levels from both the methods.

RESULTS

Correlation between capillary finger stick blood glucose and GCB glucose was high (0.97) and was significant at 0.01 level.

CONCLUSION

Blood oozing during routine periodontal examination can be used for diabetes mellitus screening in dental office.

Accuracy Evaluation of a CE-Marked Glucometer System for Self-Monitoring of Blood Glucose With Three Reagent Lots Following ISO 15197:2013

Continuous standardized verification of the accuracy of blood glucose meter systems for self-monitoring after their introduction into the market is an important clinically tool to assure reliable performance of subsequently released lots of strips. Moreover, such published verification studies permit comparison of different blood glucose monitoring systems and, thus, are increasingly involved in the process of evidence-based purchase decision making.

A Mobile App for Synchronizing Glucometer Data: Impact on Adherence and Glycemic Control Among Youths With Type 1 Diabetes in Routine Care

BACKGROUND

Many individuals with type 1 diabetes (T1D) upload and review blood glucose data between clinic visits. Mobile phone applications that receive data from a "connected" glucometer and that support pattern management are available and have the capacity to make data upload and review less burdensome. Whether mobile apps can improve diabetes self-management among individuals with type 1 diabetes remains unknown.

METHOD

We analyzed retrospective data on 81 youths with T1D who were trained to use a glucometer-connected mobile app in their self-management. To assess the effect of glucometer synchronization ("sync") rate on hemoglobin A1c (HbA1c), mean blood glucose (mBG), and daily frequency of SMBG, we regressed those clinical outcomes on the frequency of glucometer syncs with the mobile app after controlling for other clinical care variables.

RESULTS

Median age was 14.0 (IQR 10.4-15.9) years, median duration of diabetes was 4.9 (2.7, 7.5) years, and median baseline HbA1c was 8.6% (7.9, 9.8). The sample was 49% male and 86% white. Youths with T1D synchronized glucometer data with the mobile app an average of 0.22 times per week (range 0-2.25). The glucometer sync rate did not have a statistically significant association with HbA1c or mean BG; in contrast, data sync frequency was associated with the frequency of self-monitoring of blood glucose (SMBG) such that each additional sync was associated with a 2.3-fold increase in SMBG frequency ( P < .01).

CONCLUSION

A glucometer-connected mobile app may increase an individual's engagement with other aspects of care (eg, SMBG frequency). Whether diabetes device-connected mobile apps can improve glycemic control remains to be determined.

Obtaining accurate glucose measurements from wild animals under field conditions: comparing a hand held glucometer with a standard laboratory technique in grey seals

Glucose is an important metabolic fuel and circulating levels are tightly regulated in most mammals, but can drop when body fuel reserves become critically low. Glucose is mobilized rapidly from liver and muscle during stress in response to increased circulating cortisol. Blood glucose levels can thus be of value in conservation as an indicator of nutritional status and may be a useful, rapid assessment marker for acute or chronic stress. However, seals show unusual glucose regulation: circulating levels are high and insulin sensitivity is limited. Accurate blood glucose measurement is therefore vital to enable meaningful health and physiological assessments in captive, wild or rehabilitated seals and to explore its utility as a marker of conservation relevance in these animals. Point-of-care devices are simple, portable, relatively cheap and use less blood compared with traditional sampling approaches, making them useful in conservation-related monitoring. We investigated the accuracy of a hand-held glucometer for 'instant' field measurement of blood glucose, compared with blood drawing followed by laboratory testing, in wild grey seals (Halichoerus grypus), a species used as an indicator for Good Environmental Status in European waters. The glucometer showed high precision, but low accuracy, relative to laboratory measurements, and was least accurate at extreme values. It did not provide a reliable alternative to plasma analysis. Poor correlation between methods may be due to suboptimal field conditions, greater and more variable haematocrit, faster erythrocyte settling rate and/or lipaemia in seals. Glucometers must therefore be rigorously tested before use in new species and demographic groups. Sampling, processing and glucose determination methods have major implications for conclusions regarding glucose regulation, and health assessment in seals generally, which is important in species of conservation concern and in development of circulating glucose as a marker of stress or nutritional state for use in management and monitoring.

Test results for the evaluation of a glucometer for use under hyperbaric conditions: Technical report

This study aimed to evaluate a recently developed equipment test method by assessing the safe and accurate functioning of the Abbott Optium FreeStyle H portable blood glucose monitor for use in the Alfred Hospital's hyperbaric chamber. The results of this study indicate that the test method can be used successfully to evaluate instruments and/or devices for use in the hyperbaric environment. The evaluation initially found that this particular glucose monitor contained a lithium battery which can be hazardous when used in the hyperbaric environment. However, upon further inspection it was determined the battery posed minimal risk for fire and explosion due to its small capacity and design application. The results indicate that the Abbott Optium FreeStyle H blood glucose monitor operated normally when used in the hyperbaric chamber. This glucometer was found to perform within the calibration specification requirements for accuracy at all stages of a typical hyperbaric treatment and as such the Abbott Optium FreeStyle H blood glucose monitor was deemed safe for use in the hyperbaric chamber at the Alfred Hospital.

Dental students' glucometer experience and attitudes toward diabetes counseling, monitoring, and screening: a comparative study

The objectives of this study were to compare glucometer experience and attitudes toward counseling, monitoring, and screening for diabetes between two classes of graduating students at one dental school to determine if there were differences by experience and year of graduation. Dental students graduating in 2010 and 2013 completed a survey about their experience with use of a glucometer as well as their attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling. Response rates for the two classes were 100 percent and 95.7 percent, respectively. Students in the two classes were in general agreement that activities related to glucose monitoring and counseling of patients with diabetes are within the scope and responsibility of the dental profession. Examination of their attitudes toward diabetes monitoring and counseling activities by level of glucometer experience indicated that students with more experience using a glucometer were more likely to consider these activities to be within the scope of dental practice and less likely to perceive barriers to such activities compared to those with little or no experience. In addition, regardless of experience, there was significantly higher endorsement for monitoring of patients who had already been diagnosed than for screening of patients who had not been diagnosed. This study suggests that any strategy to encourage dental students' and dentists' involvement in nontraditional health promotion activities should include ample direct clinical experience with these activities.

Dental students' attitudes toward diabetes counseling, monitoring, and screening

The main objective of this study was to examine attitudes of dental students toward chairside counseling and monitoring of and screening for diabetes. A secondary objective was to examine the psychometric properties of the survey instrument. First- and fourth-year students at one dental school completed a survey examining attitudes toward and perceived barriers to performing glucose monitoring, screening, and counseling in a dental setting. Surveys were completed by seventy-one of ninety first-year dental students (79 percent) and eighty-six fourth-year students (100 percent) for a total of 157 responses. Factor analysis of the survey instrument resulted in a three-factor solution: scope and responsibility, barriers, and glucometer use. In analyses to determine whether there were differences in attitudes by gender, level of education, or family history of diabetes, no statistically significant effects were seen. The dental students were in general agreement that glucose monitoring of patients diagnosed with diabetes is within the scope and responsibility of the dental profession; however, only a minority endorsed screening of patients who have not been diagnosed with diabetes. Psychometric analysis revealed internal reliability of the survey instrument.

[Buccal glucose measurements in dogs using safety lancets for blood sampling]

OBJECTIVE

Glucose measurements at the pinna or paws are an important part of the management of diabetic dogs. Despite extensive rubbing or warming of the testing site, an adequate blood sample cannot always be obtained. Therefore, the objective of this study was to evaluate the lip as an alternative sampling site with respect to practicability and tolerance by the dogs and reliability of the measured values.

MATERIAL AND METHODS

Nine clinic-owned male-castrated healthy beagles were included in this prospective study. Glucose measurements were performed using a glucometer developed for veterinary use, before and 15 minutes after oral application of glucose syrup. Capillary blood was collected using two commercially available safety lancets (Wellion Safety lancet [23 gauge] and Wellion Safety lancet special [blade 0.8 mm]) at the buccal mucosa of the upper lip and at the pinna. Measured values were compared with those obtained from venous plasma (reference method).

RESULTS

Buccal glucose measurements were easy to perform and were well tolerated by the dogs without obvious pain reactions. There was no difference between the glucose concentrations from the lip samples and those determined using the reference method (p = 0.793, F < 1). The glucose application had no effect on the observed differences (reference value minus glucometer value; p = 0.63, F < 1). However, in one dog, a clinically problematic discrepancy of 3.6 mmol/l was observed. The special lancet caused noticeable secondary bleeding in two dogs.

CONCLUSION AND CLINICAL RELEVANCE

The results of this study indicate that the buccal mucosa is a convenient and reliable alternative sampling site for glucose measurements in dogs. Problematic deviations from reference values are possible after oral glucose application and the use of blade-like needles is not encouraged.

Fasting capillary glucose as a screening test for ruling out gestational diabetes mellitus

OBJECTIVE

A common approach to screening for gestational diabetes mellitus (GDM) is the testing of all pregnant women with a one-hour, 50 g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) when the GCT is positive (≥ 7.8 mmol/L). As only a small subset of those with a positive GCT will have GDM, many more women undergo the OGTT than may be necessary. In this context, we hypothesized that measurement of fasting capillary glucose (FCG) could provide a strategy for reducing the number of unnecessary OGTTs. Thus, we sought to identify a threshold level of FCG below which GDM could be ruled out following a positive GCT, without need for the OGTT.

METHODS

Following a positive GCT, 888 women underwent measurement of FCG prior to their OGTT. We evaluated the test characteristics of FCG for identifying the 209 women diagnosed with GDM on the OGTT.

RESULTS

Fasting capillary glucose was positively associated with each glucose measurement on the OGTT (all P < 0.001) and inversely related to insulin sensitivity and pancreatic beta-cell function (both P < 0.001). As FCG increased, the prevalence of GDM progressively rose (P < 0.001). However, the area under the curve of the receiver-operating characteristic curve for FCG in predicting GDM was modest (0.67). Although using an FCG threshold of 4.8 mmol/L could reduce the number of OGTTs by 28.4%, this approach would miss 18.2% of cases of GDM.

CONCLUSION

Fasting capillary glucose is associated with glycemia, insulin sensitivity, and pancreatic beta-cell function. However, a single FCG measurement is insufficient for reliably ruling out GDM after an abnormal GCT.

Glucose transport into everted sacs of the small intestine of mice

The Na(+)-glucose cotransporter is a key transport protein that is responsible for absorbing Na(+) and glucose from the luminal contents of the small intestine and reabsorption by the proximal straight tubule of the nephron. Robert K. Crane originally described the cellular model of absorption of Na(+) and glucose by a "cotransport process" in 1960. Over the past 50+ yr, numerous groups have tested and verified Crane's hypothesis. Eventually, Wright and colleagues cloned the Na(+)-glucose cotransporter (SGLT1; the product of the SLC5A1 gene) in 1987. This article provides a "hands-on" laboratory exercise using the everted mouse jejunal preparation (everted sac) that allows students to investigate various components of the Na(+)-glucose cotransport absorptive cell model (e.g., Na(+) dependence of SGLT1, inhibition of SGLT1, and inhibition of Na(+)-K(+)-ATPase). Additionally, the laboratory exercise includes a case-based study of glucose-galactose malabsorption in which the students conduct an internet search and participate in a small-group discussion during the laboratory period to better understand the basic principles and functions of the Na(+)-glucose absorptive process of the small intestine. This laboratory exercise was introduced into the second-year undergraduate physiology curriculum in 2008, and >850 physiology students have participated in this laboratory exercise. The students have produced very robust and reproducible data that clearly illustrate the theory of the cellular model for Na(+)-glucose absorption by the jejunum.

Prevalence of diabetes mellitus in persons with tuberculosis in a tertiary health centre in Lagos, Nigeria

CONTEXT

In Nigeria, much has been reported on the unacceptably high disease burden of Tuberculosis (TB) and Diabetes Mellitus (DM) but not the possible co-existence of these diseases.

AIM

This study was conducted to document the co-existence of DM and TB in persons with established TB.

SETTINGS AND DESIGN

This was a cross-sectional study conducted at a Tertiary hospital's Directly Observed Therapy short course clinic in Lagos, South west, Nigeria.

MATERIALS AND METHODS

Three hundred and fifty one consecutive patients with TB who consented to the study participated after a written consent. Ethical approval was given by the Ethics committee of the institution. Clinical examination for documentation of anthropometric indices and biochemical evaluation for blood glucose levels were carried out.

RESULTS

The prevalence of DM among the patients with TB was 5.7%. About half of the diabetics were diagnosed (2.8%) at the screening. The mean age of the participants was 34.9 ± 13.21 years; the mean duration of symptoms of TB was 9.65 ± 9.49 months. Weight (kg) loss was the most predominant symptom occurring in 94% of the patients. There was no significant difference in the sputum positivity and duration of cough among patients with TB-DM and those with TB alone.

CONCLUSION

Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB.

Food and Drug Administration regulation of diabetes-related mHealth technologies

mHealth smartphone applications (apps) offer great promise for managing people with diabetes, as well as those with prediabetes. But to realize that potential, industry needs to get clarity from the U.S. Food and Drug Administration (FDA) regarding the scope of its regulatory oversight. Certain smartphone apps, when properly understood, simply help people live healthier lives, assisting with dietary choices, monitoring exercise, and recording other factors important to overall health. The manufacturers of such apps, in an effort to promote their products but also to educate customers, might wish to explain how using the app can help reduce the risk of developing diabetes. Right now, though, the mere mention of the disease "diabetes" would cause the app to be regulated by the FDA. Such regulation, we submit, discourages the kind of education and motivational messages that our country needs to stem the tide of this disease. Further, should the app simply receive data from a blood glucose meter and graph that data for easier comprehension by the patient, the app would become a class II medical device that requires FDA clearance. Again, we submit that such simple software functionality should not be so discouraged. In this article, we identify the issues that we believe need to be clarified by the FDA in order to unleash the potential of mHealth technology in the diabetes space.

Monitoring methods for dogs and cats with diabetes mellitus

Effective monitoring is essential for the management of dogs and cats with diabetes mellitus. However, methods for evaluating glycemic control must be tailored to meet both the needs of the patient and the expectations of the owner. This article discusses the philosophies that drive blood glucose monitoring in veterinary diabetics and review common practices. The advantages and limitations of the various options are presented.

Correlation of glucose level among venous, gingival and finger-prick blood samples in diabetic patients

It is essential for a dental surgeon or a periodontist to detect blood glucose level for patients whose signs and symptoms are suggestive of diabetes. Seventy patients in the age group of 40 to 80 years of either sex were selected for the study. The study population included patients with type 1 or type 2 diabetes mellitus. Venous blood was used as a control group, whereas gingival blood and finger-prick blood constituted the study groups I and II, respectively. The percentage deviations of gingival blood glucose level measurements and finger-prick blood glucose level measurements from the standard venous blood glucose level measurements were recorded, which showed that 72.86% of gingival and 68.57% of finger-prick blood glucose level measurements were found to be within ±15% of the standard venous blood glucose level measurements. All values exhibited significant correlations among each other, but correlations between glucose values obtained using venous and gingival blood samples were higher than the correlations between glucose values obtained using venous and finger-prick blood samples.

Disinfected so it is safe and works

There has been an upsurge in interest in monitoring the cleanliness of the health care environment as it relates to disease transmission. Cleaning and disinfecting practices are nothing new in health care facilities. However, continued development of analytical medical products such as point-of-care devices or, as in this review, glucose meters, has created potential risks to patients on a number of levels. Examples are (1) inappropriate disinfection of glucose meters so that the risk of disease transmission is increased and (2) cleaning agents potentially affecting glucose reading accuracy. Cleaning and disinfection recommendations have become available to address these issues. In this issue of Journal of Diabetes Science and Technology, Sarmaga and colleagues discuss the impact of a disinfecting agent on results generated from a particular device, which suggests that not all equipment are created equal and not all practices/products used to clean and disinfect are the same. It appears that more interaction must take place between vendors of these technologies as well as vendors of cleaning/disinfecting agents and the end users who will be performing all the requisite tasks to ensure a high quality product as well as care.