BG Values Research Articles

Diagnostic performance of serum galactomannan and β-D-glucan for invasive aspergillosis in suspected patients: A meta-analysis.

Serum galactomannan (GM) and β-D-glucan (BG) are known markers of invasive aspergillosis (IA). The aim of this meta-analysis was to evaluate the efficiency of serum GM and BG as diagnostic markers of symptomatic IA infection and compare the performance of the combined tests with that of either test individually. A literature search was carried out using PubMed, Web of Science, and EMBASE databases to include relevant studies published in English up to May 2023. The quality assessment was performed using Review Manager 5.3 software. A bivariate model was applied to pool diagnostic parameters using Stata 14.0 software. We used Cochrane I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Paired t tests were used to compare the value of GM and BG for IA diagnosis when used in combination or alone. Sixteen studies were eligible for inclusion in the meta-analysis. For proven or probable IA, serum GM and BG yielded a pooled sensitivity of 0.53 (95% CI 0.40-0.66) vs 0.72 (95% CI 0.61-0.81) and a pooled specificity of 0.94 (95% CI 0.91-0.97) vs 0.82 (95% CI 0.73-0.88). The area under the curve (AUC) of ROC was 0.90 (95% CI 0.87-0.92) vs 0.83 (95% CI 0.80-0.86) for all studies. The pooled sensitivity and specificity for IA diagnosis by combined GM and BG assays (GM/BG) were 0.84 (95% CI 0.69-0.86) and 0.76 (95% CI 0.69-0.81), respectively. The sensitivity of the combined GM/BG test to diagnose IA was higher than of the GM or BG test alone. Serum GM and BG tests had a relatively high accuracy for IA diagnosis in suspected patients. The diagnostic accuracy of both assays is comparable, and the diagnostic sensitivity is further improved by the combined detection of the 2 markers.

Allograft bone vs. bioactive glass in rehabilitation of canal wall-down surgery

Canal wall-down (CWD) mastoidectomy creates a radical cavity that modifies the anatomy and physiology of the middle ear, thus preventing it from being self-cleaning and causing epidermal stagnation in the posterior cavities. Canal wall-down tympanomastoidectomy with reconstruction (CWDTwR) can obliterate such radical cavities. The main objective of this study was to compare postoperative results after CWDTwR by using either bone allografts or 45S5 bioactive glass as a filling tissue with an 18-month follow-up. This was a single-center observational trial including all patients undergoing CWDTwR. Patients were divided into two groups according to the filling material used: allograft bone (AB group) or 45S5 bioactive glass (BG group). Clinical monitoring was performed regularly, with control imaging performed at 18 months (CT scan and DW MRI). The two groups were compared with the t test for quantitative variables and the chi square test for qualitative variables (no revision surgery, audiometric results, complications, mastoid obliteration volume). Thirty-two patients underwent CWDTwR between October 2015 and 2018. The mean age was 48 years, and 71.9% (23/32) were men. A total of 46.9% (15/32) of the patients had undergone at least 3 middle-ear surgeries prior to CWDTwR. The most frequent preoperative symptom was otorrhea (100.0%, 32/32), and only 12.5% (4/32) experienced dizziness. Fifteen and 17 patients underwent surgery with bone allografts and 45S5 bioactive glass, respectively. At 18 months post-operation, 53.3% of the patients (8/15) in the AB group presented with recurrent otorrhea versus 5.9% (1/17) of patients in the BG group (p = 0.005). Seventy-eight percent (7/9) of symptomatic patients had undergone revision surgery at 18 months postoperation: 40.0% (6/15) in the AB group and 5.9% (1/17) in the BG group (p = 0.033). One patient’s surgery was cancelled due to the COVID-19 pandemic, and one patient refused surgery. The effects of CWDTwR with bone allografts are disappointing in early follow-up, with significant resorption leading to a 40.0% revision surgery rate. 45S5 BG is a simple solution, with preliminary results that are superior to those of AB. However, prospective controlled studies with longer follow-up times are needed to evaluate the value of BG versus other synthetic materials (such as hydroxyapatite) in surgical management of CWDTwR.Trial registration: retrospectively registered.

Fortification of carrot (Daucus carota L.) and snakehead fish (Channa striata) in bagea product for nutrition fulfillment patients of type II diabetes mellitus (DM)

Sago (Metroxylon sago) is generally found in central and eastern Indonesia. The nutritional content of sago flour per 100 grams is 94 g of carbohydrates, 0.2 g of protein, 0.2 g of fat, 14 g of water content, and 355 cal of calories. Sago flour also has a low glycemic index of <55. One of the sago product developments is Bagea, typical Sulawesi cookies made from sago that can be fortified with local natural resources such as carrots and snakehead fish flour. The purpose of this study was to obtain the best composition, to determine the chemical characteristics of the bagea products produced after fortification, and to analyze the glycemic index and glycemic load levels of the bagea so that it is safe for consumption by people with Type II Diabetes Mellitus (DM). The stages of this study were sample preparation, bagea making with two treatment factors in the form of variations in the concentration of snakehead fish flour (10%, 15%, 20%) and variations in physical treatment in the form of carrots (flour, puree, juice) of 15 grams each. The results obtained were the best formulation of 85% sago flour: 15% snakehead fish flour with fortification treatment of carrot flour, carrot juice, and carrot puree of 15 grams each. The conclusion obtained was that bagea (85% sago flour: 15% snakehead fish flour) with fortification treatment of carrot juice and carrot puree has a high IG category (>70). However, it is still safe to be consumed by DM Type II sufferers with a BG value of 9.44 each for bagea fortification of carrot juice and 9.60 for bagea fortification of carrot puree (low BG<10) if consumed as much as 20grams/serving dose.

Glucometer derived glycemic variability as an early spot prognosticator for insulin dependent critically ill patients

Background: Glycemic variability, as mathematically defined by higher fluctuation rate or higher gap between the maximum and minimum values. In critically ill patients, the blood glucose readings are highly susceptible to fluctuation owing to multi-dimensional confounders. Aim: In this study, we primarily aim to investigate the prognostic utility of the glucometer derived glycemic variability regarding the overall mortality. Also, we aim to explore the optimal operating cutoff point and the binary logistic regression correlation for the glycemic variability versus mortality. Methods: A retrospective study was conducted for tested critically ill patients who were admitted in the Intensive Care Unit at King Hussein Medical Center between 1 Jan 2018 and 31 Dec 2022. Patients who had primarily missed data&gt;20% was excluded from our study. Firstly, a receiver operating characteristic and sensitivity analysis was conducted to explore the area under curve and sensitivity indices of the tested mortality prognosticator. A binary logistic regression was also used to explore the association of the glycemic variability with the 28-day overall ICU mortality rate. All statistical analysis will be conducted with p-value &lt;0.05 as a level of significance via SPSS version 25. Results: Actually, 2528 and 3217 cases were processed as positive actual states (Positive OI, Non-Survivors) and as negative actual states (Negative OI, Survivors) respectively. The AUC±SEM (95 C) for the GLK_BG_Var (%) was significantly higher than that of the GLK_BG Avg 0.829±0.006 (95% CI; 0.817-0.841) versus 0.597±0.008 (95% CI; 0.582-0.612) The probabilities of our investigated admitted ICU patients’ mortality were binary logistically correlated to the GLK_BG_Var% and GLK_BG_Avg via the following constructed BLgR models [e (-5.152+10.8×GLK_BG_%Var) /1+ e (-5.152+10.8×GLK_BG_%Var) and e(-5.416+0.025×GLK_BG_Avg) /1+ e (-5.416+0.025×GLK_BG_Avg), respectively]. Also, the probabilities of the critically ill patients’ mortality at the explored 2 tested BG prognosticators; Var% and Avg, were identified at 48.1% and 43.96% at the optimal thresholds of 47% and 206.94 mg/dl, respectively. Indeed, the explained variations in the dependent variable based on the 2 aforementioned adopted independent investigated mortality’s predictors ranged significantly from 26.1%-35% and 3.4%-4.6% depending on whether you reference the Cox &amp; Snell R2 or Nagelkerke R2 methods, respectively, and they correctly classified approximately 80.1% and 48.4% of the cases, χ2(8) = 926.992 and1232.19, respectively. Conclusion: that the first investigated glucometer-based BG mortality’s prognosticator [GLK_BG_Var%] had higher AUROC, predictive utilities than its comparative average related prognosticator. Also, we revealed a strong correlation between the poor critically ill patients’ outcomes and the higher variability in BG values, notably when the variation exceeding 47%.

Diagnosis and Management of Neonatal Hypoglycemia: A Comprehensive Review of Guidelines.

Hypoglycemia represents one of the most frequent metabolic disturbances of the neonate, associated with increased morbidity and mortality, especially if left untreated or diagnosed after the establishment of brain damage. The aim of this study was to review and compare the recommendations from the most recently published influential guidelines on the diagnosis, screening, prevention and management of this common neonatal complication. Therefore, a descriptive review of the guidelines from the American Academy of Pediatrics (AAP), the British Association of Perinatal Medicine (BAPM), the European Foundation for the Care of the Newborn Infants (EFCNI), the Queensland Clinical Guidelines-Australia (AUS), the Canadian Pediatric Society (CPS) and the Pediatric Endocrine Society (PES) on neonatal hypoglycemia was carried out. There is a consensus among the reviewed guidelines on the risk factors, the clinical signs and symptoms of NH, and the main preventive strategies. Additionally, the importance of early recognition of at-risk infants, timely identification of NH and prompt initiation of treatment in optimizing the outcomes of hypoglycemic neonates are universally highlighted. All medical societies, except PES, recommend screening for NH in asymptomatic high-risk and symptomatic newborn infants, but they do not provide consistent screening approaches. Moreover, the reviewed guidelines point out that the diagnosis of NH should be confirmed by laboratory methods of BGL measurement, although treatment should not be delayed until the results become available. The definition of NH lacks uniformity and it is generally agreed that a single BG value cannot accurately define this clinical entity. Therefore, all medical societies support the use of operational thresholds for the management of NH, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Over the past several decades, ΝH has remained an issue of keen debate as it is a preventable cause of brain injury and neurodevelopmental impairment; however, there is no clear definition or consistent treatment policies. Thus, the establishment of specific diagnostic criteria and uniform protocols for the management of this common biochemical disorder is of paramount importance as it will hopefully allow for the early identification of infants at risk, the establishment of efficient preventive measures, the optimal treatment in the first hours of a neonate's life and, subsequently, the improvement of neonatal outcomes.

A prospective cohort study on glucose variability and clinical outcomes in comatose children due to acute central nervous system infections admitted in the pediatric intensive care unit

Background: Pediatric acute central nervous system (CNS) infections are associated with severe neuromorbidity. This study aimed to study the effect of glucose variability on clinical outcomes in comatose children due to acute CNS infections admitted in pediatric intensive care unit (PICU). Subjects and Methods: A prospective cohort study enrolled comatose children aged 1 month to 12 years due to acute CNS infection. Within 6 h, continuous glucose monitoring was started (Freestyle Libre Pro, Abbott). The unit practice was targeting blood glucose (BG, mg/dL) of &lt;140–145. The hyperglycemic index was calculated to estimate the relative time spent above BG of &gt;126, &gt;140, &gt;180, &gt;200, and &lt;60. Glucose variability was defined as BG fluctuation, with both hypoglycemia (&lt;60) and hyperglycemia (&gt;126). The primary outcome was new-onset organ dysfunction. The secondary outcomes were organ support, length of mechanical ventilation, hospital (including PICU) stay, and 90-day composite poor outcome (mortality or severe neurodisability). Results: Total BG values measured were 27,792 from 66 patients (mean [standard deviation (SD)] 421.1 [212.6] values per patient). The mean (SD) BG was 103.2 (37.7) (minimum: 42.1; maximum: 228.8). The new-onset organ dysfunction has occurred in 83.3% (n = 55/66), and no difference was noted among normoglycemic and abnormal glycemic groups (84.4% vs. 80.9%; relative risk = 1.09, 95% confidence interval: 0.67–1.76). The median (interquartile range) PICU stay (days) was higher in the normoglycemic group (7, 5–14 vs. 4, 3.5–8.5; P = 0.014). No difference was noted in other outcomes. Conclusions: Glucose variability was not significantly associated with new-onset organ dysfunction and poor outcome in comatose children due to acute CNS infections.

The Role of Admission Hyperglycaemia as a Risk Factor for Surgical Site Infection in Orthopaedic Trauma Patients

Introduction: Acute hyperglycemia following traumatic injury is common. Studies have shown that 20– 30% of trauma patients present following injury with blood glucose values ≥ 200 mg/dL, and that a majority of patients demonstrate values ≥ 150 mg/dL. The relationship between hyperglycemia and adverse outcomes, such as infectious complications, has been well described in the surgical literature. Post-traumatic hyperglycemia is less well-documented in orthopaedic trauma patients. Aim of the Study: The aim of this study was to evaluate the role of admission hyperglycaemia as a risk factor for surgical site infection in orthopaedic trauma patients. Methods: This was a retrospective observational study and was conducted in the Department of Orthopaedics Surgery of Brahmanbaria medical college Hospital, Brahmanbaria, Bangladesh during the period from October, 2020 to October, 2022. We included 130 patients who were admitted to orthopaedics surgery department. Result: Majority of our patients (41.54%) were aged 41-50 years and 65% patients were male compared to female (35%). The mean age was 45.69 ± 22.83 years. Majority (41.54%) of our patients had a preoperative American Society of Anesthesiologists (ASA) classification of II. Majority of patients 36.15% had type 1 open fracture. We found 45 patients with surgical site infection. Admission glucose more than 200 mg/dL was found higher (26.67%) in infected group. Among the hyperglycemic patients 36.36% were classified as ASA III &amp; the surgical site infection for 30 days was found 54.55%. Conclusion: We found that orthopaedic trauma patients without a history of diabetes showed a significant independent correlation between an admission BG value of ≥200 mg/dL and 30-day surgical site infection (SSI). Because of this, admission glucose readings in orthopaedic trauma patients may be a key indicator of the risk of infection.

Prognostic Significance of Baseline Blood Glucose Levels and Glucose Variability in Severe Acute Kidney Injury: A Secondary Analysis from the RENAL Study.

Aim: To study the associations between baseline blood glucose levels (BGL), glycemic variability and clinical outcomes in patients with severe acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). Methods: We performed a secondary analysis of the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. A multivariate Cox regression model was used to assess the association between baseline BGL, glycemic variability and clinical outcomes. The primary outcome was all-cause mortality, and secondary outcomes were duration of hospital and intensive care unit (ICU) stay. Results: Baseline BGL data were available in 1404 out of 1508 patients from the RENAL study. Among them, 627 patients died within 90 days of randomization. Compared to patients in the second quartile (BGL 5.8−7.2 mmol/L), patients in the first quartile (BGL < 5.8 mmol/L) had increased mortality rate (90-day HR 1.48; p = 0.001; 28-day HR 1.47; p = 0.042). However, there were no significant differences in ICU and hospital length of stay (LOS) (p = 0.82 and p = 0.33, respectively). Glycemic variability data were from 1345 out of 1404 patients who had data for BG values within 28 days. Higher coefficient of variation (CV) (HR 1.02; P trend = 0.002) and standard deviation value (SD) (HR 1.29; P trend = 0.027) were associated with higher risk of death at day 90. Conclusions: We identified a low BGL within the normal physiological range at baseline and greater CV and SD values as significant modifiable risk factors for mortality in severe AKI patients in ICU, which may be a target for intervention.

Rotational remanent magnetization as a magnetic mineral diagnostic tool at low rotation rates

SUMMARY Prior work on rotational remanent magnetization (RRM) and rotational anhysteretic remanent magnetization (ARMROT) has demonstrated promise for magnetic mineral identification in earth materials. One challenge has been to calibrate the measurements to magnetic mineral types and microstructural controls, since previous studies have used differing spin rates, alternating field (AF) intensities and decay times, which hinders a comparison of data sets. Using a RAPID magnetometer we show that the range of usable practical rotation rates is 0.25–3 Hz [rps] which allows a wide range of RRM and ARMROT characteristics to be utilized (at 100 mT AF field, 100 μT bias field). Sets of magnetic mineral extracts from sediments, and well characterized rock samples that contain the key magnetic minerals magnetite, pyrrhotite and greigite are used for a calibration of the RRM-ARMROT behaviour. Detrital pyrrhotite and pyrrhotite-bearing phyllites have largely small positive effective field (Bg) values (up to 6 μT), with differences in Bg and ARMROT ratios at 0.5 and 2.5 Hz [rps] allowing grain size discrimination. The positive Bg values, and changes in RRM and ARMROT with rotation rates allow distinction of pyrrhotite from magnetite and diagenetic greigite. Diagenetic greigite has Bg values of –83 to –109 μT (at 0.5 Hz [rps]) and unusual RRM variation at low rotation rates caused by anisotropy affects. In contrast to previous work, based on crushed and sized natural magnetite at high spin rates, Bg for single domain magnetite from intact bacterial magnetofossils from Upper Cretaceous Chalk has some of the lowest Bg (0–1 μT) and displays a steep decline in ARMROT with increasing rotation rates. A simple tool for particle size characterization of magnetite may be the ratio of ARMROT at spin rates 2.5 and 0.5 Hz [rps]. Stability of RRM is better studied using RRM acquisition with increasing AF field intensity, since static demagnetization imparts a nuisance gyroremanence along the field axis. Mineral microstructure, dislocations and particle interactions are likely additional effects on RRM behaviour that need more investigation.

655-P: Evaluation of Accuracy and Longevity of an Implantable CGM System through 365 Days

Background: The PROMISE Clinical Trial, conducted to assess safety and accuracy of a 180-day implantable CGM System, had 43 subjects implanted with a modified sensor containing sacrificial boronic acid (SBA) to reduce the degradation of the boronic acid glucose-binding moieties. In-home use to 365 days was monitored in a 30 subject SBA sub-study. Methods: Accuracy of sensor glucose (SG) measurements produced by an algorithm emulator was compared to YSI model 2300 glucose obtained during in-clinic visits to 180 days. The sub-study compared SG to fingerstick blood glucose (BG, CONTOUR Next One BG meter) 4-7 times/day, from days 1-365 or until sensor retirement. SG values were paired within 5 mins after a BG values in the 30 sensors. MARD for 1-180 days was assessed with both YSI and BG reference methods. MARD by glucose ranges were compared for 1-180 days, 181-365 days and 1-365 days using BG as reference. Results: The MARD for SBA sensors for days 1-180 from in-clinic visits was 8.1% with YSI and 9.5% with BG as reference. The Table shows a comparison of MARD values by glucose ranges for the 3 time periods. Conclusions: There was ∼1.4 percentage point increase in overall MARD obtained when BG measurements were used as the reference value rather than YSI. The extension of the PROMISE Clinical Trial in a subset of subjects implanted with SBA sensors suggests accuracy can be maintained and extended to 365 days and across 40-400 mg/dl glucose ranges. Disclosure A.E.Jacquin: Employee; Senseonics, Other Relationship; BrainScope Company, Inc. L.Al-khawi: None. P.Sanchez: Employee; Senseonics. S.Mohanty: Employee; Senseonics. K.S.Tweden: Employee; Senseonics. F.R.Kaufman: Consultant; Twin Health, Employee; Senseonics.

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.

PurposePoor 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.MethodsThis 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.ResultsOf 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.ConclusionDigitally 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.

Acute Metabolic Responses to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial.

The aim of this study was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru) and sucralose on blood glucose response in healthy individuals. Fifteen healthy individuals (five females, age of 25.4 ± 2.5 years, BMI of 23.7 ± 1.7 kg/m2 with a body mass (BM) of 76.3 ± 12.3 kg) participated in this double-blind randomized crossover placebo-controlled trial. Participants received a mixture of 300 mL of water with 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose as a placebo. Peak BG values Glu were reached after 40 ± 13 min (peak BG: 141 ± 20 mg/dL), for Fru after 36 ± 22 min (peak BG: 98 ± 7 mg/dL), for GluFru after 29 ± 8 min (BG 128 ± 18 mg/dL), and sucralose after 34 ± 27 min (peak BG: 83 ± 5 mg/dL). Significant differences regarding the time until peak BG were found only between Glu and GluFru supplementation (p = 0.02). Peak blood glucose levels were significantly lower following the ingestion of Fru compared to the supplementation of Glu and GluFru (p < 0.0001) while Glu and GluFru supplementation showed no difference in peak values (p = 0.23). All conditions led to a significantly higher peak BG value compared to sucralose (p < 0.0001). Blood lactate increased in Glu (p = 0.002), Fru and GluFru (both p < 0.0001), whereas sucralose did not increase compared to the baseline (p = 0.051). Insulin levels were significantly higher in all conditions at peak compared to sucralose (p < 0.0001). The findings of this study prove the feasibility of combined carbohydrate supplementations for many applications in diabetic or healthy exercise cohorts.

Ecological Momentary Assessment of Positive and Negative Affect and Associations with Blood Glucose in Teens with Type 1 Diabetes.

Affect (i.e., emotions) can be associated with diabetes self-care and ambient glucose in teens with type 1 diabetes (T1D). We used momentary sampling to examine associations of daily affectwithblood glucose (BG) monitoring,BG levels,and BG variability in teens with T1D. Over 2 weeks, 32 teens reported positive and negative affect (Positive and Negative Affect Scale) and BG levels on handheld computers 4x/day, coordinated with planned daily BG checks. BG values were classified as: in-range (70-180 mg/dL); low (<70 mg/dL); severe low (<54 mg/dL); high (>180 mg/dL); severe high (>250 mg/dL). Daily BG variability was derived from BG coefficient of variation (BGCV). To determine associations of positive and negative affect with BG checks, BG levels, and BGCV, separate generalized estimating equations were performed, adjusting for demographic and diabetes-related variables, for the overall sample and stratified by HbA1c (≤8%, >8%). Teens (44% male, ages 14-18, 63% pump-treated, HbA1c 8.8 ± 1.4%) reported 51% in-range, 6% low (2% severe low), and 44% high (19% severe high) BG. In teens with HbA1c ≤8%, positive affect was associated with in-range BG (OR = 1.08, 95% CI = 1.04-1.13, P = .0002), reduced odds of very low glucose (OR = 0.35, 95% CI = 0.16-0.74, P = .006), and less daily BGCV (β = -0.9; 95% CI = -1.6, -0.2; P = .01). In teens with HbA1c >8%, negative affect was associated with less likelihood of checking BG (OR = 0.75, 95% CI = 0.64-0.87, P = .0003). Our findings shed light on individual differences in metabolic reactivity based on glycemic levels and the importance of incorporating affect into automated insulin delivery systems.

Measures of Risk for Sepsis and Mortality in Severe Burned Patients with Stress Induced Hyperglycemia.

Background; Hyperglycemia as a medical condition due to diabetes or other underlying conditions like Stress-Induced Hyperglycemia and sepsis as a life-threatening medical condition are two of the challenges faced during burn treatment.&#x0D; The purpose of this study was to evaluate the risk for sepsis and mortality for the patients with critical hyperglycemic values during the disease.&#x0D; Material and Methods; This is an observational retrospective cohort study conducted in the Service of Burns of the University Hospital Centre “Mother Teresa” in Tirana (UHCT), Albania from 1st January 2010 to 31st December 2014. Patients were categorized as having euglycemia (mean BG values ranging from 80-120 mg/dl), moderate hyper Sepsis was defined according to the ABA Consensus Panel Publication for Infection and Sepsis glycemia (mean BG values &lt;180 mg/dl) or critical hyperglycemia (mean BG values ≥180 mg/dl). to evaluate the impact of the presence of critical hyperglycemia during the disease in sepsis and mortality, we performed Relative risk, Odds ratio&#x0D; Results; Those who had overall hyperglycemia (Moderate and Critical) had 2.6 times the risk for sepsis compared to those who were in the euglycemia group. Analyzing the risk of mortality in patients with overall hyperglycemia during the disease, we observed that the chance of a bad outcome was 2.7 times more likely to occur if the patient had hyperglycemia (RR=2.7).&#x0D; Conclusions: Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycemia during burn disease and have a close relationship with other outcomes (sepsis and mortality).

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes.

IntroductionHyperglycemia and hypoglycemia have been found to increase morbidity and mortality among hospitalized patients with diabetes. In July of 2018, our academic medical center experienced a 48-hour nursing strike, during which time 600 replacement nurses were employed. This cohort study evaluated the impact of the nursing strike on glycemic control among hospitalized patients with diabetes.MethodsPoint-of-care fingerstick blood glucose (POC BG) values among hospitalized patients with diabetes were compared between the 48-hour nursing strike period and two 48-hour periods when the nursing strike did not occur. We evaluated the percentage of POC BG values that were hyperglycemic (POC BG 181-250 mg/dL), severely hyperglycemic (POC BG >250 mg/dL), and hypoglycemic (POC BG <70 mg/dL). Additionally, we assessed the proportion of patients who experienced one or more days of hypoglycemia, hyperglycemia, or severe hyperglycemia.ResultsWe found a significant association between the distributions of POC BG test results during the nursing strike; test results more frequently showed hyperglycemia, severe hyperglycemia, or hypoglycemia during the nursing strike than during the control period (p=0.006). There was a significant difference in the days of hypoglycemia, with 7.7% of patients experiencing one or more days of hypoglycemia during the strike period compared with 1.4% of patients during the control period (p=0.03).ConclusionNursing strikes have been employed as a last resort in contract negotiations with hospitals, but they have the potential to significantly affect patient care and safety. Further studies are needed to evaluate these impacts to prepare for future workforce disruptions.

594-P: Use of Connected Glucometer with Real-Time Feedback and Counseling for Glycemic Control in Patients with Diabetes in India: BeatO's Connected Diabetes Care Program

Background: BeatO® offers connected diabetes care program including smartphone connected glucometer and mobile app with real time feedback and counselling support. This study aims to evaluate the effectiveness of BeatO's connected diabetes care program with real time contextualized feedback loop and certified diabetes educator (CDE) counselling on glycemic control of patients with diabetes in India. Method: A retrospective data-based evaluation study was conducted on BeatO® cloud database. Medical records of patients with diabetes, digitally engaged between September 2019 to July 2020 and received at least one CDE counselling were evaluated. Intervention included SMBG using smartphone connected glucometer, real-time feedback, and contextualized counselling by CDE based on SMBG findings. Pre-counselling (BG values recorded for 30 days period before first counselling) and post counselling (BG values recorded between 15th to 45th day after last counselling) impact on glycemic control and in range BG values were assessed. Results: Out of total 7514 diabetes patients, majority of them were aged &amp;gt;40 years (76%). Most of the patients had T2D (95%) followed by T1D (4.5%), GDM (0.3%), LADA (0.1%) and MODY (0.1%). A total of 10,667 counselling sessions were conducted out of which majority had one session (74%) followed by 2 (17%), 3 (5%), 4 (2%) and ≥5 (1%) sessions. Intervention was effective in significantly reducing mean BG values across fasting (by 9.5%), pre-prandial (9.3%), post prandial (8.9%) and random (6%) BG readings (p value &amp;lt;.05). Proportion of patients with in-range BG values post intervention increased by 9.6% (post prandial &amp;lt;180 mg/dL), 9.1% (random &amp;lt;200 mg/dL), 5.8% (fasting 80-130 mg/dL) and 3.3% (pre-prandial 80-130 mg/dL). Conclusion: BeatO's smartphone connected SMBG with real time feedback, nudges, alerts and CDE counselling is effective in glycemic control in real world patients with diabetes. Disclosure M. Sabharwal: Employee; Self; Health Arx Technologies Pvt. Ltd. M. Mohit: Consultant; Self; Health Arx Technologies Pvt. Ltd. V. K. Kolukula: None. R. Jangid: None. G. Chopra: Employee; Spouse/Partner; Health Arx Technologies Private Limited, Other Relationship; Self; Health Arx Technologies Private Limited.

Comparative study of the effect of the Hubbard coefficient U on the properties of TiO2 and ZnO

First-principles calculations combined with Hubbard U correction based on Density Functional Theory has been used to investigate the effect of its inclusion on electronic, structural, and optical properties and to reproduce correct band gap for TiO2 (anatase and rutile) and ZnO (wurtzite) structures. The effect of the implementation of U for only metal (Ti or Zn) d state (Ud) or for both 3d (Ud) and Op (Up) states was investigated to exploring changes in valence and conduction bands and their origin. Bader’s charge analysis has been used to revealing the nature of chemical bonding. We can conclude that for both TiO2 polymorphs as the Ud factor increases, both the BG and the lattice parameter increase. On the contrary, for ZnO, as Ud increases the value of BG increases but the cell parameter decreases. The optimal values correspond to Ud =8 eV (TiO2) and Ud =13 eV (ZnO). The corresponding optical properties using Ud, such as real and imaginary parts of dielectric function, reflectivity R(ω), refractive index n(ω), extinction coefficient k(ω), absorption coefficient α(ω) and electron energy loss function L(ω) has been calculated. It is important to highlight that the curves obtained considering the inclusion of the Ud show an excellent agreement with those reported experimentally.

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements\u2014the STRONG observational study

AimsTo assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD).MethodsObservational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk.ResultsFrom a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk.ConclusionsIncreasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.

Fasting Glucose Identification Using Machine Learning: A Fundamental Step in Automated Diabetes Phenotyping in Electronic Medical Records

Background: The fasting blood glucose (FBG) values extracted from electronic medical records (EMR) are typically assumed to be valid in existing research, which may cause diagnostic bias. We proposed a machine learning (ML) algorithm to predict the fasting status of blood samples. Methods: We evaluated the distribution of BG values in the China Medical University Hospital Clinical Research Data Repository and established the theoretical fasting status when the ontologically labeled FBG was lower than the estimated average glucose calculated from HbA1c. In addition to logistic regression, we extracted 67 features to predict the fasting status by eXtreme Gradient Boosting (XGBoost). The discrimination and calibration of the prediction models were also assessed. Findings: Of the 784340 ontologically labeled fasting samples, 77·1% were considered theoretical FBGs. The median (IQR) glucose and HbA1c level of ontological and theoretical fasting samples in patients without diabetes mellitus (DM) were 110 mg/dL and 5·6%, and 92 mg/dL and 5·6%, respectively. In multiple logistic regression, 14 selected variables were significantly associated with the fasting status, but the area under the receiver operating characteristic curve (AUROC) was only 0·868. XGBoost showed better calibration and achieved an AUROC of 0·892 with the top five contributing predictors of glucose level, distance from home to hospital, age, height, and concomitantly prescribed serum creatinine. Interpretation: Our results demonstrated an innovative approach to clean EMR data and detect true FBG, which could aid more accurate estimation of the global and local epidemiology of DM. Funding: This study was supported by the Ministry of Science and Technology of Taiwan (grant number: 108-2314-B-039-038-MY3 and 109-2321-B-468-001) Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Research Ethical Committee/Institutional Review Board of China Medical University Hospital (CMUH105-REC3-068).

The informative value of assessment of direct serum biomarkers for diagnosis of various stages of liver&#x0D; fibrosis in children

Introduction. Serum concentrations of collagens I, III, IV types (K-I, K-III, K-IV) and hyaluronic acid (HA) are reported to be informative in terms of noninvasive diagnosis liver fibrosis stages. In pediatrics, there is not enough data on this. Purpose was to assess the diagnostic value of direct biomarkers in predicting the stage of fibrosis in children with chronic liver diseases (CLD). Materials and methods. A prospective single-center study included 80 children with CLD . All patients underwent marginal resection of liver tissue under laparoscopic control. The serum K-I, K-IV, and HA concentration were measured by enzyme immunoassay. The authors applied ROC curve analysis to assess quantitative signs’ diagnostic significance in predicting a specific outcome. Results.The optimal KI value for the diagnosis of cirrhosis was 144.24 ng/ml, with AUROC: 0.758 ± 0.101 with 95% CI: 0.560-0.957, sensitivity and specificity 65.2% and 77.8%, respectively. The optimal K-IV values for the diagnosis of moderate fibrosis and cirrhosis were 11.29 ng/ml and 27.40 ng/ml, respectively, with AUROC 0.807 ± 0.092 with 95% CI: 0.627-0.987, 0.685 ± 0.062 with 95% CI: 0.567-0.810, sensitivity 82.4% and 61.15%, specificity 66.7%, and 64.7%, respectively. The optimal BG values for the diagnosis of weak and moderate fibrosis were 34.9 ng/ml and 36.5 ng/ml, for cirrhosis 38.3 ng/ml, with AUROC 0.912 ± 0.050 with 95% CI: 0.815-1.00; 0.849 ± 0.064 with 95% CI: 0.723-0.974, and 0.825 ± 0.048 with 95% CI: 0.730-0.920, respectively. Sensitivity was 84.6% at all stages, specificity - 77.8%, 61.5% and 70.6%, respectively. Conclusions. LF biomarkers have diagnostic significance in the detection of the stages of liver fibrosis. LF biomarkers are informative, reproducible noninvasive indices in the diagnosis of liver fibrosis in children.