Blood Glucose Monitoring Methods Research Articles

Sensor-augmented pump therapy in type 1 diabetes

Recent developments in technology have ushered in a new era of managing type 1 diabetes. Continuous glucose monitoring is rapidly becoming an accepted adjunct to traditional self-monitoring of plasma glucose, and the marriage of continuous glucose sensors to continuous subcutaneous insulin infusion is the first step towards the development of a true artificial pancreas. The purpose of this review is to familiarize the reader with the new glucose sensors and discuss the literature evaluating their accuracy and effectiveness. Current models of continuous glucose sensors are still less accurate than traditional methods of blood glucose monitoring but provide information regarding trends that cannot be obtained with blood testing. Short-term studies of continuous glucose sensors have demonstrated reduction in glycosylated hemoglobin levels and time spent in hypo- and hyperglycemic ranges. Patient acceptance and satisfaction with sensors has been shown to depend on the quality of the data, comfort of wear, and ease of use. Sensor-augmented pump therapy represents a landmark improvement in diabetes treatment and will likely become the standard of care. Future work should focus on improvements in sensor accuracy and development of user-friendly algorithms to assist patients with self-management.

Evaluation of the VIA® Blood Chemistry Monitor for Glucose in Healthy and Diabetic Volunteers

Manual methods of blood glucose monitoring are labor-intensive, costly, prone to error, and expose the caregiver to blood. The VIA(R) blood chemistry monitor for glucose can automatically measure plasma glucose (PG) every 5 minutes for 72 hours using blood sampled from a peripheral vein/artery or a central vein. VIA performance was evaluated in eight normal and five type 1 diabetic (T1DM) subjects in 15 separate experiments. The VIA device was connected to a peripheral vein and reported a PG value every 5 minutes during each 510-minute experiment. Blood samples were collected manually every 10 minutes and assayed using a HemoCue(R) beta-glucose analyzer (HC). Whole blood HC measurements were corrected to PG values. Paired HC/VIA measurements (n = 717) were analyzed. Mean PG was 90 +/- 14 and 96 +/- 12 mg/dl in normal subjects and 194 +/- 64 and 173 +/- 48 mg/dl in T1DM subject as measured by the HC and VIA, respectively. Clark error grid analysis revealed 86% points in zone A, 11% points in zone B, and 2% points in zone D. Linear regression analysis yielded the following equation: VIA = 0.732 x HC + 30.5 (r(2) = 0.954). Residual analysis revealed a glucose-dependent bias between the HC and the VIA. VIA data were transformed using the linear regression equation to correct for bias. After the correction, the mean absolute relative difference between the VIA and the HC was less than 10%, and 99.6% of data were in zones A and B. The VIA was able to sample blood automatically every 5 minutes for more than 8 hours in the laboratory setting. On average, the VIA reported glucose values for 94% of the samples it attempted to obtain. This study demonstrated that the VIA blood chemistry monitor for glucose can reliably sample blood frequently for a prolonged period of time safely and effectively in diabetic and nondiabetic volunteers. Agreement between the two devices was the closest at normal glucose concentrations. After correcting for a glucose-dependent bias between the devices, the MARD was consistently less than 10% for all glucose ranges.

Evaluation of a noninvasive blood glucose monitoring device for critically ill patients

Critically ill patients frequently experience abnormalities in carbohydrate metabolism and a severe insulin resistance state. Hyperglycemia is a negative predictor of outcome in these patients, as high blood glucose (BG) values are associated with an increased risk of morbidity and mortality. Currently, BG monitoring methods cannot fulfill the need for continuous glucose monitoring in order to safely implement tight glucose control protocols. The purpose of this study is to evaluate the feasibility of the NBM-100 device (OrSense Ltd) for non-invasive (NI) continuous glucose monitoring in critically ill patients.

Evaluation of a noninvasive blood glucose monitoring device for critically ill patients

Critically ill patients frequently experience abnormalities in carbohydrate metabolism and a severe insulin resistance state. Hyperglycemia is a negative predictor of outcome in these patients, as high blood glucose (BG) values are associated with an increased risk of morbidity and mortality. Currently, BG monitoring methods cannot fulfill the need for continuous glucose monitoring in order to safely implement tight glucose control protocols. The purpose of this study is to evaluate the feasibility of the NBM-100 device (OrSense Ltd) for non-invasive (NI) continuous glucose monitoring in critically ill patients.

Subcutaneous Insulin Therapy in the Hospital Setting: Issues, Concerns, and Implementation

To summarize issues and recommendations regarding subcutaneous insulin therapy in various clinical settings in the hospital. The inpatient insulin regimen must be tailored to the specific clinical circumstance of the individual patient. Because nutritional intake is not necessarily provided as discrete meals in the hospital, the insulin dose requirement can be subclassified into "basal" and "nutritional" needs. In addition, the insulin requirement is generally increased in the presence of acute illness and stress. Thus, components of the insulin requirement are divided into basal, nutritional, and correction insulin. When the physician writes insulin orders, the basal and nutritional components are written as programmed or scheduled insulin, and the correction-dose insulin is written as an algorithm to supplement the scheduled insulin. Total insulin requirements may vary widely. Practical guidelines and suggestions are presented for selection of appropriate insulins, the delivery route, and the logical apportionment to programmed and correction insulin doses for hospitalized patients who are eating or not eating. Moreover, the role of bedside blood glucose monitoring in the hospital setting is discussed. Strict glycemic management in hospitalized patients has been shown to improve outcomes. Development and implementation of specific strategies for insulin delivery and improved methods for blood glucose monitoring should help to achieve target blood glucose levels safely.

Comparative Study of Current Approaches for Minimally Invasive and Non-invasive Blood Glucose Monitoring

Monitoring of blood glucose for people with diabetes is an important element of managing the disease. Frequent monitoring can help to prevent both hypoglycemia and hyperglycemia and thereby would contribute to reduce adverse complications associated with the disease. As the current methods of blood glucose monitoring are invasive, many people do not adhere to it as painful finger pricks and other complications are associated with it. Noninvasive methods for the same are long sought goals. A noninvasive self monitoring of blood glucose (SMBG) device would allow the people with diabetes to test their blood glucose as often as necessary and perhaps in real time and will improve adherence. Although glucose in other body fluids (for example urine, sweat, tears and saliva) can be measured non-invasively, blood glucose levels do not register quickly in these fluids, which is problematic for diabetics. Hence it is mandatory to measure blood glucose instead of measuring it in any other body fluid. In this paper we have done a detailed study of the current approaches which are under various stages of research and development, for noninvasive self-monitoring of blood glucose. A comparative study has been presented based on the various aspects associated with each approach. Again the feasibility of these approaches to develop as a stand alone, portable, real time, noninvasive and accurate glucose monitor has been investigated. Finally, based on the study, a method has been suggested which has potential to cater the performance aspects of the so-called noninvasive SMBG device.

Does strict metabolic control prevent long‐term diabetic complications?

AbstractAlthough insulin has been in use for 65 years, it is still not kn„n whether strict metabolic control can prevent long‐term diabetic complications. There are two major reasons for this: conventional insulin treatment is unable to normalise or near‐normalise blood glucose levels; and until recently there were no methods for long‐term monitoring of blood glucose. During the last decade infusion pumps and pens have been marketed which enable us to simulate the endogenous insulin secretion and thereby normalise or near‐normalise blood glucose levels and home blood glucose monitoring methods are widely available. Therefore, it should n„ be possible to test the hypothesis that strict metabolic control prevents long‐term diabetic complications. This paper reviews the results of six prospective, controlled, randomised, clinical trials which have been published. The consensus is that near‐normalisation of blood glucose levels is able to retard or arrest the progression of long‐term diabetic complications.

Accuracy of four methods of home blood glucose monitoring in hemodialysis patients

The accuracy of four techniques of home blood glucose monitoring in hemodialysis patients was compared. Arterial-venous blood samples were collected from 23 patients undergoing hemodialysis and analyzed for serum glucose concentrations using an automated laboratory method. Capillary-blood glucose concentrations were also determined in each patient by visual readings of the Chemstrip bG and Dextrostix reagent strips and by reflectometer readings of the StatTek Glucose and Dextrostix reagent strips. Readings of glucose concentration obtained by each of the four techniques were compared with laboratory-determined values, and the true and absolute deviations in these values for each technique were recorded. The effect of patient hematocrit on deviations in glucose concentration readings was evaluated by analysis of variance. The mean glucose concentration readings obtained using the visual and reflectometer (Dextrometer) readings of Dextrostix were substantially less accurate than the other two techniques when compared with serum glucose concentrations determined by the laboratory. The StatTek technique gave the smallest mean absolute deviation from laboratory-determined values. No correlation was found between the patient's hematocrit and either the true or absolute deviations in glucose concentrations. The Chemstrip bG and StatTek techniques are reasonably accurate methods for home monitoring of blood glucose concentrations in diabetic patients undergoing hemodialysis.

Evaluation of a New Reflectance Photometer For Use in Home Blood Glucose Monitoring

A new reflectance photometer (Glucometer, Ames Division, Miles Laboratories, Elkhart, Indiana) has been developed for use with the Dextrostix reagent strip. The device measures 8 X 17 cm, weighs 330 g, uses AA batteries, and requires no warm-up. High (330 mg/dl) and low (50 mg/dl) calibrations are stored in memory and need be repeated only when: (1) a control solution (100 mg/dl) reading is in error, (2) ambient temperature changes by more than 5 degrees C, (3) a new bottle of Dextrostix is used, and (4) batteries are changed. A 60-s timer with alarm helps make timing of the procedure consistent. Nineteen insulin-dependent and one non-insulin-dependent diabetic subjects each performed a minimum of 20 blood glucose determinations over a 3-mo period in the investigators' laboratories. Simultaneous capillary blood samples were obtained for plasma glucose analysis by a comparative method. A total of 602 patient-determined glucose values ranging from 30 to 400 mg/dl were compared with simultaneous laboratory values. These values correlated significantly (r = 0.96, P less than 0.0001, y = 2.6 + 0.92x). The Glucometer-Dextrostix System is an accurate and convenient method for home blood glucose monitoring by diabetic patients.