Blood Glucose Strips Research Articles

Diabetes tipo 2 en Andalucía: uso de recursos y coste económico

Background and objectivesPrevious studies that quantify the cost of type 2 diabetes (DM2) show very different results. We set out to define the profile of the patient with DM2 in Andalusia, analyze the use of health resources and quantify their economic cost during 2022. Patients and methodsMulticenter, cross-sectional and descriptive study. Three hundred and eighty-five patients with DM2 from Andalusia (confidence level: 95%; error: 5%). Data analyzed: age, sex, attendance at primary care (PC), nursing, emergency and hospital specialty consultations; consumption of drugs in general and antidiabetics in particular, blood glucose strips, complementary tests and hospitalization days. ResultsMean age: 70.7 ± 12.44 years; 53.6% men. Care contacts: PC physician: 8.36 ± 4.69; nursing: 7.17 ± 12; hospital visits: 2.31 ± 2.38; emergencies: 1.71 ± 2.89; hospitalization days: 2.26 ± 6.46. Laboratory tests: 3.79 ± 5.45 and 2.17 ± 3.47 Rx. Drugs consumed: 9.20 ± 3.94 (1.76 ± 0.90 antidiabetics). Blood glucose strips: 184 ± 488. Annual cost: 5171.05 €/patient/year (2228.36 € for hospital admissions, 1702.87 € for drugs and 1239.82 € for assistance and complementary tests). ConclusionsThe DM2 Andalusian is 71 years old, consumes 10 different drugs and treats DM2 with double therapy. He has been 20 attendances/year (75% in PC), 4 analyses, 2 X-rays and requires 2 days of hospitalization. Direct healthcare costs goes over 5000 €/year. This represents 41.66% of the budget of the Andalusian Ministry of Health and triples the average cost per habitant.

The Impact of Functional Insulin Therapy on the Psychological Aspect of Type Diabetics

Functional insulin therapy is an educational method that is part of a strategy to intensify type 1 diabetes in order to optimize the balance of diabetes while improving the psychological aspect of the patient. The Aim: of this study is to assess the impact of functional insulin therapy on the psychological aspect of type 1 diabetics. Patients and Methods: This is a retrospective and analytical descriptive study, conducted from March 2019 to August 2019, we included 20 type 1 diabetic patients who benefited from a functional insulin therapy education program and an evaluation of the psychological impact made by a questionnaire and a psychological interview. Results: Out of a total number of 20 patients benefited from education between March 2019 to August 2019: 6 men, 14 women, average age of 20 years, average duration of diabetes of 8 years, 80% are students. Functional insulin therapy is used exclusively in all patients. The questionnaire shows an improvement in the perception of the impact of diabetes in (66%), there is a decrease in anxiety in (75%), With 16 patients or (80%) declaring satisfaction with the method, 12 patients either (60%) declared an acceptance of the treatment, 14 patients or (70%) reported more autonomy and self-management, 8 patients or (40%) reported an improvement in their socio-professional relations, The doctor-patient relationship is improved in (90%) of patients. According to the open questions, functional insulin therapy brings better control of diabetes and food freedom. The difficulties mainly felt are the calculation of the quantities of carbohydrates, the economic constraint: the cost of the insulin pens and capillary blood glucose strips and the multiple injections: more than four times a day and self- monitoring six times a day. Conclusion: The results suggest that learning functional insulin therapy improves the psychological aspect of type 1 diabetics through better control of the disease.

Impact on variables of severe hypoglycaemia and healthcare costs of the use of the FreeStyle system in paediatric population with type 1 diabetes mellitus

IntroductionAnalysis of the impact on severe hypoglycaemia and direct costs of the introduction of the FreeStyle Libre sensor in paediatric population with type 1 Diabetes Mellitus. Material and methodsAmbispective single-centre study to assess the impact on severe hypoglycaemia and direct costs, focusing on consumption of materials, in paediatric population with type 1 Diabetes Mellitus before and after introduction of the FreeStyle Libre 1 sensor. ResultsA significant decrease was found in episodes of severe hypoglycaemia, with 4.2 episodes of severe hypoglycaemia per 100 patients under follow-up versus 0.25 episodes per 100 patients a year after introduction of the system. This represents a cost difference for severe hypoglycaemia, estimated at €6559.52 before introduction and €409.97 after introduction of the FreeStyle Libre sensor. We found a decrease in the daily consumption of capillary blood glucose strips, which translates as a decrease in the cost of materials and helps mitigate the cost of the sensor. The cost in materials for the patient with FreeStyle Libre was €185.13 per patient and year higher than conventional control with capillary blood glucose strips.

Impacto en hipoglucemia grave y costes sanitarios del uso del sistema FreeStyle en población pediátrica con diabetes mellitus tipo 1

IntroductionAnalysis of the impact on severe hypoglycaemia and direct costs of the introduction of the FreeStyle Libre sensor in paediatric population with type1 diabetes mellitus. Material and methodsAmbispective single-centre study to assess the impact on severe hypoglycaemia and direct costs, focusing on consumption of materials, in paediatric population with type1 diabetes mellitus before and after introduction of the FreeStyle Libre1 sensor. ResultsA significant decrease was found in episodes of severe hypoglycaemia, with 4.2 episodes of severe hypoglycaemia per 100 patients under follow-up versus 0.25 episodes per 100 patients a year after introduction of the system. This represents a cost difference for severe hypoglycaemia, estimated at €6,559.52 before introduction and €409.97 after introduction of the FreeStyle Libre sensor. We found a decrease in the daily consumption of capillary blood glucose strips, which translates as a decrease in the cost of materials and helps mitigate the cost of the sensor. The cost in materials for the patient with FreeStyle Libre was €185.13 per patient and year higher than conventional control with capillary blood glucose strips.

Important Drop in Rate of Acute Diabetes Complications in People With Type 1 or Type 2 Diabetes After Initiation of Flash Glucose Monitoring in France: The RELIEF Study.

The RELIEF study assessed rates of hospitalization for acute diabetes complications in France before and after initiation of the FreeStyle Libre system. A total of 74,011 patients with type 1 diabetes or type 2 diabetes who initiated the FreeStyle Libre system were identified from the French national claims database with use of ICD-10 codes, from hospitalizations with diabetes as a contributing diagnosis, or the prescription of insulin. Patients were subclassified based on self-monitoring of blood glucose (SMBG) strip acquisition prior to starting FreeStyle Libre. Hospitalizations for diabetic ketoacidosis (DKA), severe hypoglycemia, diabetes-related coma, and hyperglycemia were recorded for the 12 months before and after initiation. Hospitalizations for acute diabetes complications fell in type 1 diabetes (-49.0%) and in type 2 diabetes (-39.4%) following FreeStyle Libre initiation. DKA fell in type 1 diabetes (-56.2%) and in type 2 diabetes (-52.1%), as did diabetes-related comas in type 1 diabetes (-39.6%) and in type 2 diabetes (-31.9%). Hospitalizations for hypoglycemia and hyperglycemia decreased in type 2 diabetes (-10.8% and -26.5%, respectively). Before initiation, hospitalizations were most marked for people noncompliant with SMBG and for those with highest acquisition of SMBG, which fell by 54.0% and 51.2%, respectively, following FreeStyle Libre initiation. Persistence with FreeStyle Libre at 12 months was at 98.1%. This large retrospective study on hospitalizations for acute diabetes complications shows that a significantly lower incidence of admissions for DKA and for diabetes-related coma is associated with use of flash glucose monitoring. This study has significant implications for patient-centered diabetes care and potentially for long-term health economic outcomes.

PDB37 Cost-Effectiveness of Insulin Degludec/Insulin Aspart Twice Daily Versus BASAL-Bolus Full Regimen in Patients with Type 2 Diabetes Mellitus in Algeria

While due to the progressive nature of Type 2 Diabetes Mellitus (T2DM), patients usually require treatment intensification, fixed combinations of short and long acting insulin can offer a convenient alternative to Basal-Bolus insulin regimen. The aim of this study was to evaluate the cost-effectiveness of 70% Insulin Degludec / 30% Insulin Aspart co-formulation administered twice daily (IDegAsp BID) versus Basal-Bolus full regimen (IGlar+ IAsp, four injections per day) in Algerian patients treated for T2DM. Data derived from a treat-to-target noninferiority trial, and the BAROMETER real-world nationwide study, were used to populate a simple and transparent short-term cost-effectiveness model (DACE Excel-based model). Costs covered insulin, needles, Self-Monitoring Blood Glucose (SMBG) strips and lancets, healthcare resources utilization and indirect costs associated with hypoglycemia. Effects included disutilities of hypoglycemia, SMBG testing, and BMI gain, as well as mortality risk after severe hypoglycemic event. Costs and effects of IDegAsp BID versus Basal-Bolus full regimen were discounted at 3.5% rate, and compared over a 5-year period. Probabilistic Sensitivity Analysis (PSA) was conducted to assess the degree of uncertainty and robustness of the results obtained. Over a 5-year time horizon, the base-case incremental cost of IDegAsp BID versus Basal-Bolus full regimen was estimated to DZD -53,253.13 (all costs), and DZD -6,866.06 (without indirect costs). Savings were mainly driven by SMBG, needles and hypoglycemia. The incremental effectiveness was 0.289 gained Quality-Adjusted Life Years (QALYs) and 0.020 gained Life Years (LYs). The PSA demonstrated that the probability of IDegAsp BID being cost-effective relative to Basal-Bolus full regimen is 93.9% (all costs), and 93.4% (without indirect costs), assuming a willingness-to-pay threshold of 1,401,649 DZD per QALY (3 times GDP per capita). This study has shown that IDegAsp BID is a cost-effective alternative for treatment of T2DM in Algeria compared with Basal-Bolus full regimen, from both payer and societal perspectives.

PDB17 COST BURDEN OF TYPE 2 DIABETES IN A TERTIARY HOSPITAL IN SOUTH WEST NIGERIA: A COST OF ILLNESS ANALYSIS

Globally, diabetes and its complications exerts enormous economic burden on patients and health care systems, through direct medical and non-medical costs and in-direct costs due to loss of work and wages as a result of hospitalization. Quantifying cost burden guides healthcare resource allocation and rational prescribing. This study quantified the direct medical and non-medical cost of managing type 2 diabetes annually and identified major drivers of cost. The study was a prevalence-based cost of illness study that utilized the bottom-up approach. 118 patients who attended the out-patient diabetes clinic of the hospital from January 2016 to December 2016 filled the questionnaires and their medical records reviewed subsequently. Direct medical (cost of all medications, laboratory tests, blood glucose strips, consultation cost) and non-medical costs (transportation and feeding) were computed using hospital price of basic services. Both costs were used to estimate the average annual cost of treating patients with type 2 diabetes with and without complications. Descriptive statistics like frequencies, percentages and mean± standard deviation were used to summarize the data. Most patients were between 61-70 years (36.4%) with a mean age of 61.63 ±10.943 years and are retired (26.3%). The mean annual direct medical cost of treating a type 2 diabetes patient was ₦232,176.03 ($641.64), the mean annual direct medical cost for patient without complications was ₦163,220 ($447.17) and with complications was ₦244,588.11 ($670.10). The major drivers of medical cost were medications (87.3%), laboratory tests (33.1%) and glucose strips (23.7%). The cost associated with management of type 2 diabetes was quite substantial. Anti-diabetes medications were major drivers of cost. Generic substitution/prescribing can serve as a strategy geared towards cost reduction in a developing nation.

Estrutura das unidades básicas de saúde para atenção às pessoas com diabetes: Ciclos I e II do Programa Nacional de Melhoria do Acesso e da Qualidade

The objective was to describe the necessary structure for treating diabetes patients in the primary healthcare system, as evaluated in Cycles I and II of the Brazilian National Program for the Improvement of Access and Quality (PMAQ) in 2012 and 2014, according to the municipalities' characteristics. A descriptive study was used to assess primary care units whose teams participated in Cycles I and II of the PMAQ in 2012 and 2014. The study used variables from Module I of the external evaluation of the PMAQ that addresses the primary care units' structure. Materials (150kg scale, sphygmomanometer, adult stethoscope, tape measure, blood glucose monitor, monofilament packs, ophthalmoscope, and capillary blood glucose strips); medicines (NPH and regular insulin, glyburide, and metformin); and physical space (clinical consultation room, pharmacy, reception/waiting room, and meeting room). All the medicines and the reception/waiting room increased by more than 10p.p. from 2012 to 2014. The prevalence rates for adequate structure of materials, medicines, and physical space in the primary care units were higher in 2014. Adequate structure increased as follows: for materials, from 3.9% to 7.8%, for medicines, from 31.3% to 49.9%, for physical space, from 15.3% to 23.3%. Municipalities with more than 300,000 inhabitants, higher Human Development Index (HDI), and lower coverage of the Family Health Strategy (FHS) showed higher prevalence rates for adequate primary care units. Units that adhered to Cycles I and II of the PMAQ showed improvement in their structures. However, there was a low prevalence of primary care units with adequate structures, besides differences in the services' structure according to population size, HDI, and FHS coverage.

To characterize the sociodemographic, clinical, therapeutic and quality of life of users of the Unified Health System with Diabetes mellitus

Introduction: Descriptive study with a quantitative approach carried out between October 2015 and October 2016. Sampling was about 100 people with diabetes. Objective: To characterize the sociodemographic, clinical, therapeutic and quality of life of users of the Unified Health System with Diabetes mellitus in a Basic Health Unit (BHU) of the Rural Zone of the city of Vitoria de Santo Antao. Methods: Two questionnaires, sociodemographic, clinical and therapeutic, and DQUOL-BRASIL, both validated, were used. Results and discussion: Higher prevalence of female people (75%). Of the investigators (51%) were not able to report their type of diabetes, the medication was obtained in the BHU (44%) as well as the follow-up (78%). (44%) did not receive the blood glucose strips, and (92%) did not participate in educational programs. Regarding the quality of life or impact domain, the highest mean was obtained (32.05) and the lowest for the sale of diabetes problems (6.66). Conclusion: It is concluded that the results obtained contribute to increase the knowledge about the factors studied, since knowing a population makes possible the development of effective health actions, considering the local specificities.

Factors associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes: A prospective cohort study.

Aims/IntroductionWe aimed to identify factors independently associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes, in terms of glycemic control and the rate of severe hypoglycemia.Materials and MethodsThis was a prospective cohort study of 466 adult patients with type 1 diabetes from five tertiary referral hospitals who registered for a national reimbursement program for blood glucose strips and were then followed‐up for 12 months. Factors associated with a > 5% reduction in glycated hemoglobin (HbA1c) and decreased rate of severe hypoglycemia (SH) at 12 months from baseline were evaluated.ResultsAt the end of the 12 months of follow up, 158 of 466 patients (33.9%) achieved >5% reduction in HbA1c, and 47 of 111 patients (42.3%) had a decreased rate of SH relative to baseline. Higher HbA1c (P < 0.001), lower total daily insulin dose at baseline (P = 0.048) and an increase in self‐monitoring of blood glucose (SMBG) frequency during follow up (P = 0.001) were independently associated with >5% reduction in HbA1c. A higher SMBG frequency (P < 0.001), higher rate of SH at baseline (P = 0.029) and lack of hypoglycemic unawareness (P = 0.044) were independently associated with an increase in the frequency of SMBG during follow up. Higher SMBG frequency at baseline (P < 0.001) was independently associated with a decreased rate of SH.ConclusionsSeveral factors, including higher SMBG frequency at baseline, were independently associated with reduced HbA1c and a decreased rate of severe hypoglycemia, showing that patients with these characteristics derive the most benefit from reimbursement of blood glucose test strips.

Lowering Cost Share May Improve Rates of Home Glucose Monitoring Among Patients with Diabetes Using Insulin.

Not much is known about the extent to which lower cost share for blood glucose strips is associated with persistent filling. To evaluate the relationship between cost sharing for blood glucose testing strips and continued use of testing strips. This is a retrospective observational study using medical and pharmacy claims data integrated with laboratory hemoglobin A1c (A1c) values for patients using insulin and blood glucose testing strips. Diabetic patients using insulin who had at least 1 fill of blood glucose testing strips between 2010 and 2012 were included. Patients were divided into a low cost-share group (out-of-pocket cost percentage of total testing strip costs over a 1-year period from the initial fill < 20%; n = 3,575) and a high cost-share group (out-of-pocket cost percentage ≥ 20%; n = 3,580). We compared the likelihood of continued testing strip fills after the initial fill between the 2 groups by using modified Poisson regression models. Patients with low cost share had higher rates of continued testing strip fills compared with those with high cost share (89% vs. 82%, P < 0.001). Lower cost share was associated with greater probability of continued fills (adjusted risk ratio [aRR] = 1.05, 95% CI = 1.03-1.07, P < 0.001). Other patient characteristics associated with continued fills included type 1 diabetes diagnosis, types of insulin regimens, and health insurance plan type. In a subset analysis of patients whose A1c values at baseline were above the target level (8%) set by the National Committee for Quality Assurance guidelines, we saw a slight increase in magnitude of relationship between cost share and continued fills (RR = 1.06, 95% CI = 1.03-1.10, P < 0.01). There was a statistically significant association between cost share for testing strips and continued blood glucose self-monitoring. Among patients not achieving A1c control at baseline, there was an increase in the magnitude of relationship. Lowering cost share for testing strips can remove a barrier to persistence in diabetes self-management. Funding for this study was provided by Anthem, which had no role in the study design, data interpretation, or preparation or review of the manuscript. The decision to publish was strictly that of the authors. Xie, Agiro, and DeVries are employees of HealthCore, a wholly owned subsidiary of Anthem. Bowman is an employee of Anthem. Study concept and design were contributed by all the authors. Xie took the lead in data collection, along with Agiro, and data interpretation was performed by all the authors. The manuscript was written by Xie and Agiro, along with DeVries, and revised by Xie, Agiro, and Devries, along with Bowman.

An Economic Evaluation of Continuous Glucose Monitoring for People with Type 1 Diabetes and Impaired Awareness of Hypoglycaemia within North West London Clinical Commissioning Groups in England.

To assess the economic impact of providing real time continuous glucose monitoring (CGM) for people with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) within North West (NW) London clinical commissioning groups (CCGs). Methods: The eligible population for CGM and inputs for the economic budget impact model developed were derived from published data. The model includes cost of CGM; cost savings associated with lower hypoglycaemia related hospital admissions, accidents and emergency visits; self-monitoring of blood glucose (SMBG) strip usage; and glycated haemoglobin (HbA1c) reduction-related avoided complications and insulin pump use. Results: The cost of CGM for T1D-IAH (n=3,036) in the first year is £10,770,671 and in the fourth year is £11,329,095. The combined cost off-sets related to reduced hypoglycaemia admissions, SMBG strip usage and complications are £8,116,912 and £8,741,026 in years one and four, respectively. The net budget impact within the NW London CCGs is £2,653,760; £2,588,068 in years one and four respectively. Conclusions: Introduction of CGM for T1D-IAH patients will have a minimal budget impact on NW London CCGs, driven by cost of CGM and offsets from lower hypoglycaemia-related costs, reduced SMBG strip usage, avoided HbA1c-related complications and lower insulin pump use.

Self-monitoring of blood glucose: Is it justified?

Despite the availability of robust evidence demonstrating that lowering glycaemic levels reduces the risks of diabetes-related complications, there has been little improvement in recent years in glycaemic control among individuals with diabetes in Europe and the US. Although widely used, there has been considerable controversy surrounding the role of self-monitoring of blood glucose (SMBG) as a means of achieving glycaemic control. This has resulted in a re-consideration of the prescription of blood glucose strips especially in the current climate of health care cost-containment. Existing clinical recommendations lack specific guidance to patients and health professionals regarding SMBG practice intensity and frequency, particularly for those not treated with insulin. Previous studies of the association between SMBG and glycaemic control found often weak, and sometimes conflicting, evidence. More rigorous longitudinal studies are needed to examine the role of SMBG with special attention to the unique needs of patients using different diabetes treatments, within special clinical sub-populations, and during initiation of SMBG versus its ongoing use. Further understanding of the intensity and frequency of SMBG are also needed to capture variability in glycaemic patterns in order to facilitate more specific guideline development.

Evaluation of Commercial Glucometer Test Strips for Potential Measurement of Glucose in Tears

Tear glucose measurements have been suggested as a potential alternative to blood glucose monitoring for diabetic patients. While previous work has reported that there is a correlation between blood and tear glucose levels in humans, this link has not been thoroughly established and additional clinical studies are needed. Herein, we evaluate the potential of using commercial blood glucose test strips to measure glucose in tears. Of several blood glucose strips evaluated, only one brand exhibits the low detection limit required for quantitating glucose in tears. Calibration of these strips in the range of 0-100 μM glucose with an applied potential of 150 mV to the working electrode yields a sensitivity of 0.127 nA/μM and a limit of quantitation (LOQ) of 9 μM. The strips also exhibit ≤13% error (n = 3) for 25, 50, and 75 μM glucose in the presence of 10 μM acetaminophen, 100 μM ascorbic acid, and 100 μM uric acid. Measurements of glucose in tears from nine normal (nondiabetic) fasting human subjects using strips yielded glucose values within the range of 5-148 μM (mean = 47 μM, median = 43 μM), similar to those for human tears reported by others with more complex LC-MS methods. The glucometer strip method could facilitate more clinical studies to determine whether tear glucose and blood glucose levels sufficiently correlate for application to routine measurements in tears to supplement blood glucose testing. This would be especially helpful for children, adolescents, other Type 1 diabetics, and also for Type 2 diabetics who require treatment with insulin and cannot tolerate multiple finger sticks per day.

Costes directos de la diabetes mellitus y de sus complicaciones en España (Estudio SECCAID: Spain estimated cost Ciberdem-Cabimer in Diabetes)

ObjectiveThe aim of the study was to estimate the direct costs associated with type1 and 2 diabetes mellitus in Spain taking into account a National Health Service perspective. MethodA costs of illness study was conducted using the prevalence approach and data from existing databases and bibliographic references related to the use of resources in the treatment of diabetes mellitus. The costs categories analysed were: hospital costs (including outpatient care), primary care costs (including additional tests cost and self monitoring blood glucose strips cost) and drug costs. In calculating the non-related cost, only the extra cost was taken into account. Additionally, we analysed the complications cost independently of where costs were originated. Costs were updated to 2012 euros. ResultsThe total direct annual cost of diabetes mellitus was 5,809 million euros, representing 8.2% of the total Spanish health expenditure. Drug costs was the major component of total cost (38%), followed by hospital costs (33%). Drug costs accounted for 2,232 million euros, with antidiabetic drugs costs being 861 million euros (15%). Self monitoring blood glucose strips only contributed 118 million euros (2%) to the total cost. The cost of complications cost was 2,143 million euros, around 37% of the total. ConclusionsTotal direct costs associated with diabetes mellitus represent a high proportion of total Spanish health expenditure. It is crucial to introduce measures and strategies to improve efficiency in the control and treatment of diabetes mellitus, with the final purpose of reducing its complications and the considerable economic impact generated.

Use of antidepressants in diabetes patients not using drugs, but only monitoring blood glucose

Objective: Patients with diabetes have an increased Odds Ratio （OR） for depressive disor- der. We wanted to investigate if patients with metabolic syndrome and/or diabetes type 2 not treated with antidiabetic agents, have an OR for concurrent antidepressant use comparable to other types of diabetes. Methods: Drug delivery data from 25 pharmacies were analysed with respect to sale of antidepressants, oral antidiabetic agents, insulin and blood glucose test strips. Results: Total population of the area was 337,019, whereas 254,083 were 18 or older. Of these 20,139 were patients receiving insulin, oral antidiabetics, glucose test strips and/or antidepressants. Those receiving antidepressants were 5.8% of those 18 or older whereas 2.4% received any antidiabetic medication (including test strips for HBGM). For patients receiving no medications but test strips alone, the adjusted OR for use concurrent use of antidepressants was 1.62 (95% confidence interval: 1.19 - 2.23), p = 0.002. For insulin-only receiving patients, the adjusted OR was 1.65 (1.41 - 1.93), p = 0.000, whereas for patients receiving only oral antidiabetics, it was 1.53 (1.38 - 1.71), p = 0.000. Patients receiving both insulin and oral antidiabetics: 2.23 (1.75 - 2.85), p = 0.000. Conclusion: Patients receiving only blood glucose strips have an OR of concurrently receiving antidepressants, not different from those receiving insulin only or oral antidiabetics only.

Hepatic Deficiency of Low Density Lipoprotein Receptor-related Protein-1 Reduces High Density Lipoprotein Secretion and Plasma Levels in Mice

The low density lipoprotein receptor-related protein-1 (LRP1) is known to serve as a chylomicron remnant receptor in the liver responsible for the binding and plasma clearance of apolipoprotein E-containing lipoproteins. Previous in vitro studies have provided evidence to suggest that LRP1 expression may also influence high density lipoprotein (HDL) metabolism. The current study showed that liver-specific LRP1 knock-out (hLrp1(-/-)) mice displayed lower fasting plasma HDL cholesterol levels when compared with hLrp1(+/+) mice. Lecithin:cholesterol acyl transferase and hepatic lipase activities in plasma of hLrp1(-/-) mice were comparable with those observed in hLrp1(+/+) mice, indicating that hepatic LRP1 inactivation does not influence plasma HDL remodeling. Plasma clearance of HDL particles and HDL-associated cholesteryl esters was also similar between hLrp1(+/+) and hLrp1(-/-) mice. In contrast, HDL secretion from primary hepatocytes isolated from hLrp1(-/-) mice was significantly reduced when compared with that observed with hLrp1(+/+) hepatocytes. Biotinylation of cell surface proteins revealed decreased surface localization of the ATP-binding cassette, subfamily A, member 1 (ABCA1) protein, but total cellular ABCA1 level was not changed in hLrp1(-/-) hepatocytes. Finally, hLrp1(-/-) hepatocytes displayed reduced binding capacity for extracellular cathepsin D, resulting in lower intracellular cathepsin D content and impairment of prosaposin activation, a process that is required for membrane translocation of ABCA1 to facilitate cholesterol efflux and HDL secretion. Taken together, these results documented that hepatic LRP1 participates in cellular activation of lysosomal enzymes and through this mechanism, indirectly modulates the production and plasma levels of HDL.

A longitudinal study into the new and long-term use of self-monitoring blood glucose strips in the UK

AimsTo determine the impact of self-monitoring blood glucose (SMBG) strip use in patients with type 2 diabetes in the UK.MethodsThe study period was April 1, 2004 to July 31, 2005. Data from primary care was extracted from The Health Improvement Network database. Patients identified with diabetes and matching the inclusion criteria were defined as new users of SMBG, prevalent users, or non-users. Patients were also defined as treated with insulin, with oral agents (OA), or not pharmacologically treated. Change in glycosylated hemoglobin (HbA1c) at baseline and after 12 months was compared.Results2559 patients met the inclusion criteria. For new users, HbA1c fell by 0.59% (P=0.399) for those treated with insulin, 1.52% (P<0.001) for those treated with OA, and 0.51% (P<0.001) for no treatment. In prevalent users, changes were 0.31% (P<0.001), 0.34% (P<0.001), and 0.09% (P=0.456), respectively. In non-users, changes were 0.28% (P=0.618), 0.42% (P<0.001), and an increase of 0.05% (P=0.043), respectively. A significant decrease in mean HbA1c was associated with increasing strip use in OA patients newly initiated on strips.ConclusionThis observational study showed a significant decrease in HbA1c for new users of SMBG treated either non-pharmacologically or with OA, and for prevalent users treated with insulin or OA. Reduced HbA1c with increasing strip use was observed but was only significant for OA-treated new users. This suggests that SMBG use has a role in the treatment of non-insulin treated patients with type 2 diabetes.

Missing the boat

I must disagree with the conclusion drawn by Cameron and colleagues. [1][1] Technology is not static, and can never be assumed to be final. One should not focus on such a variable as the cost of a blood glucose strip, as it is a technology that will eventually become obsolete. Therefore, to suggest

Superior long-term stability of a glucose biosensor based on inserted barrel plating gold electrodes

Disposable one shot usage blood glucose strips are routinely used in the diagnosis and management of diabetes mellitus and their performance can vary greatly. In this paper we critically evaluated the long-term stability of glucose strips made of barrel plating gold electrodes. Compared to other glucose biosensing platforms of vapor deposited palladium and screen printed carbon electrodes, the proposed glucose biosensor was found to show the best stability among the three biosensing platforms in thermal acceleration experiments at 40°C for 6 months with an average bias of 3.4% at glucose concentrations of 5–20mM. The precision test of this barrel plating gold glucose biosensor also showed the best performance (coefficients of variation in the range of 1.4–2.4%) in thermal acceleration experiments at 40°C, 50°C and 70°C for 27 days. Error grid analysis revealed that all measurements fell in zone A and zone B. Regression analysis showed no significant difference between the proposed biosensor and the reference method at 99% confidence level. The amperometric glucose biosensor fabricated by inserting two barrel plating gold electrodes onto an injection-molding plastic base followed by immobilizing with a bio-reagent layer and membrane was very impressive with a long-term stability up to 2.5 years at 25°C. Overall, these results indicated that the glucose oxidase/barrel plating gold biosensing platform is ideal for long-term accurate glycemic control.