Capillary Blood Glucose Levels Research Articles

Evaluating the association between gingival crevicular blood glucose levels and finger capillary blood glucose levels according to periodontal status

ObjectivesThe aim of this study was to evaluate the association between gingival crevicular blood glucose levels (GCBG) and finger capillary blood glucose levels (FCBG) according to the periodontal status of patients.Materials and methodsIn this case–control study, 80 patients were divided into 4 groups according to their periodontal status. In these patients, an area of the maxillary gingiva with the highest probing depth was selected for blood sampling. Blood glucose obtained from this area and the right fingertip was measured with a glucometer. Data were analyzed using ANOVA and Pearson correlation coefficient with a significance threshold of 0.05.ResultsThe groups studied were matched in regard to their sex and age (P > 0.05). The average FCBG and GCBG were not significantly different according to periodontal status (P > 0.05). The correlation between the FCBG and the GCBG showed a significant positive correlation in the total number of participants (P < 0.05, r = 0.531).ConclusionThe study observed a positive association between GCBG and FCBG. However, the relationship with periodontal status appeared to be relatively weak. Further research may be needed to determine the potential efficacy of GCBG in diabetes screening during periodontal examinations. Clinical relevance: Most patients with diabetes do not have proper periodontal health, so it may be helpful to screen for diabetes during periodontal examinations.

Incidence and Risk factors of Intraoperative Hyperglycemia in Non-diabetic Patients: A Prospective Observational Study

Introduction: Intraoperative hyperglycemia is recognized as a significant concern, being associated with various complications such as surgical site infection, cardiovascular events, kidney injury, stroke, and even death. These complications can occur in both diabetic and non-diabetic patients. However, previous studies have not fully established the incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients.&#x0D; Objectives: The primary objective was to find the incidence of intraoperative hyperglycemia in non-diabetic patients. The independent risk factors for intraoperative hyperglycemia and the incidence of surgical site infection in patients with intraoperative hyperglycemia were the secondary outcome.&#x0D; Methodology: A quantitative prospective observational study was performed after IRC approval. Six hundred five non-diabetic patients above 18 years who underwent intermediate- to high-risk surgery were included in the study. For 18 months capillary blood glucose levels were measured in all patients during surgery. Risk factors and postoperative surgical site infection was noted to identify relation and risk factors of intraoperative hyperglycemia.&#x0D; Results: Seventy-eight (12.9%) patients developed hyperglycemia during surgery. The independent risk factors for intraoperative hyperglycemia were an ASA status ≥3, preoperative impaired fasting blood sugar (OR 20.27, 95%CI:10.19–37.63, p&lt;0.001, intraoperative hypotension (OR 4.6, 95%CI: 2.36–8.97, p &lt; 0.001), intraoperative blood transfusion (OR 4.45, 95%CI: 1.88–10.56, p &lt; 0.001) and steroid use (OR 2.81, 95%CI: 1.38–5.73, p = 0.003). Surgical site infection was higher in patients with intraoperative hyperglycemia compared with patients without intraoperative hyperglycemia (5 [6.8%] vs. 9 [1.7%], respectively, p = 0.010).&#x0D; Conclusion: Intraoperative hyperglycemia was observed among non-diabetic patients undergoing intermediate- to high-risk surgeries. Patients with risk factors for intraoperative hyperglycemia should undergo close monitoring of their blood glucose levels.

The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes

PurposeThis study investigated: (1) the type of corticosteroid associated with the greatest degree of hyperglycemia, assessed using bedside capillary blood glucose monitoring, in hospitalized patients; and (2) the pattern of hyperglycemia throughout the day with the use of each type of corticosteroid. MethodsThis single-center, retrospective study used data from 964 adult inpatients receiving oral or IV corticosteroids. Data on capillary blood glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to investigate changes in glucose concentration over time with the use of four different corticosteroids. An autoregressive covariance structure was used to model correlations between repeated measurements. FindingsAcross all 7 days, the mean blood glucose concentration was greater with dexamethasone compared to that with hydrocortisone (mean difference, 16.6 mg/dL [95% CI, 8.1–24.8] [0.92 mmol/L (95% CI, 0.45–1.38)]) or prednisolone (mean difference, 20.0 mg/dL [95% CI, 14.2–25.7] [1.11 mmol/L (95% CI, 0.79–1.43)]). The mean blood glucose concentration was greater with methylprednisolone compared to that with hydrocortisone (mean difference, 23.9 mg/dL [95% CI, 11.3–36.4] [1.33 mmol/L (95% CI, 0.63–2.02)]), and with methylprednisolone versus prednisolone (mean difference, 27.4 mg/dL [95% CI, 16.4–38.3] [1.52 mmol/L (95% CI, 0.91–2.13)]). There were no significant differences in the patterns of hyperglycemia at six time points of the day with each type of corticosteroid. ImplicationsTreatment with oral or IV dexamethasone or methylprednisolone was associated with greater hyperglycemia in comparison to prednisolone and hydrocortisone. More vigorous monitoring and intervention, when necessary, are suggested in adult inpatients receiving corticosteroids, in particular dexamethasone and methylprednisolone.

Factors Influencing Glucose Response to Exercise Following Oral Glucose Load

PURPOSE: Exercise can reduce postprandial hyperglycemia by increasing contraction-mediated glucose uptake in skeletal muscles. However, postprandial exercise does not always have similar effects in all patients. This study aimed to analyze the factors influencing glucose response to exercise following oral glucose load.METHODS: We enrolled 169 adults with impaired glucose tolerance (IGT, n = 64) and type 2 diabetes (T2D, n = 105). We measured fingertip capillary blood glucose level at 30-minute intervals over 2-hour after the 75-g oral glucose ingestion. In addition, a single bout of moderate-intensity aerobic exercise was conducted at 30 minutes after 75-g oral glucose ingestion. We also measured glycated hemoglobin (HbA1c), insulin, insulin resistance (HOMA-IR), β-cell function (HOMA-β), physical activity level questionnaire and anthropometrics.RESULTS: There was a significant difference in glucose concentration between the IGT and T2D groups (&lt;i&gt;p&lt;/i&gt; &lt;.001). Additionally, we found that patients with short diabetes duration (≤1 year) had significantly more decrease in glucose concentration than long diabetes duration (≥10 years) (&lt;i&gt;p&lt;/i&gt; &lt;.001). A regression analysis showed that waist circumference, visceral fat area, fasting glucose, HbA1c, and HOMA-IR affected glucose response to exercise following oral glucose load in patients with T2D.CONCLUSIONS: Higher volumes of exercise following an oral glucose load may be necessary for individuals with Type 2 Diabetes (T2D) who have a longer disease duration, larger waist circumference, increased visceral fat area, higher HbA1c levels, and elevated HOMA-IR values in order to prevent hyperglycemia.

Randomized Controlled Trial Comparing the Effects of Preoperative Carbohydrate and Non-carbohydrate Loading on Gastric Emptying in Diabetic and Non-diabetic Patients Posted for Elective Surgery.

Background Preoperative fasting for six hours and accepting clear fluids till two hours of surgery is followed as a regular practice. Carbohydrate-rich fluids antagonize catabolism and are claimed to be tolerated better. This study aims to compare the effect of carbohydrate-rich drinks on gastric volume and blood sugar control in diabetic and non-diabetic patients undergoing elective surgery with plain water. Methods Two hundred forty patients aged 40 to 65 undergoing elective surgery under regional anesthesia were randomized into diabetic control, diabetic study, non-diabetic control, and non-diabetic study. Control groups were given 400 ml of plain water, while the study group received 50 grams of dextrose dissolved in 400 ml of water two hours prior to surgery. Gastric volume was evaluated using USG, and thirst and discomfort were assessed using the Likert scale. Perioperatively, blood sugar values were monitored and kept under control using insulin. Results Mean gastric volume (ml) in diabetic control (35.3±12.95 ml), diabetic study (31.2±11.75 ml), non-diabetic control (29±11.42 ml), and non-diabetic study (30.4±9.12 ml) showed no statistically significant difference (p>0.05). Capillary blood glucose (CBG) values two hours post fluid intake showed a significant increase in CBG levels in the diabetic study (183.2±28.67 mg/dl) compared to the diabetic control group (138.66±15.81 mg/dl). The values returned to baseline within six hours. Thirst and discomfort were significantly lower in the study group of diabetic and non-diabetic populations. Conclusion We conclude that carbohydrate loading does not affect gastric volume in diabetics and non-diabetics. However, the sugar values do increase which may warrant hourly checking and administration ofinsulin in diabetics.

Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty

AimThis work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. MethodsThis cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. ResultsA total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12–1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. ConclusionsPatients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.

1137 Perioperative Glycaemic Control in Patients Undergoing Major Lower Limb Amputation – How Can We Improve?

Abstract Aim Patients with diabetes undergoing major lower limb amputation (MLLA) have higher rates of unfavourable postoperative outcomes compared to those without diabetes. Inadequate glycaemic management can lead to an increase in wound healing problems, infections, increased length of hospital stay and higher mortality rates. Guidelines from the Vascular Society for Great Britain and Ireland recommend that all MLLA patients should have early input from the Diabetes team. Our study aimed to evaluate local practice in perioperative glycaemic control in MLLA patients at our unit. Method All patients who underwent MLLA between November 2021 and April 2022 were identified by reviewing theatre records. Patient records were reviewed to collect data on diagnosis of diabetes, diabetic medications, capillary blood glucose (CBG) levels on admission, preoperative HbA1c levels, and perioperative and post-operative glycaemic control. Results 33 MLLA were performed (17 AKA, 16 BKA), age range 41 to 85 (mean age 66), 20 male and 13 female patients. 25 patients (76%) were diabetic, 19 patients (58%) had a preoperative HbA1c recorded and all 33 patients had a CBG recorded on admission. 10 diabetic patients (40%) were found to have inappropriate management of their diabetic medication. 18 patients (55%) were identified as having poor glycaemic control on admission (HbA1c &amp;gt;48 or CBG &amp;gt;11.1). Of these, 12 (67%) were reviewed by the Diabetes team. Conclusions Surgical teams must be actively involved in the management of diabetes of their MLLA patients. Patients undergoing MLLA should have HbA1c checked on admission to help identify those who need review by the Diabetes team.

Effects of Melatonin on Glycemic Variability in Type 2 Diabetes Mellitus: Protocol for a Crossover, Double-Blind, Placebo-Controlled Trial.

Glycemic variability is recognized as a significant factor contributing to the development of micro- and macrovascular complications in individuals with type 2 diabetes mellitus (T2DM). Numerous studies have shown that melatonin, a hormone involved in regulating various biological rhythms, including those related to glucose regulation, such as hunger, satiety, sleep, and circadian hormone secretion (ie, cortisol, growth hormone, catecholamines, and insulin), is deficient in individuals with T2DM. This raises an important question: Could melatonin replacement potentially reduce glycemic variability in these patients? This warrants investigation as a novel approach to improving glycemic control and reducing the risk of complications associated with T2DM. We aimed to investigate whether melatonin replacement in individuals with T2DM who supposedly have melatonin deficiency can positively impact the regulation of insulin secretion rhythms and improve insulin sensitivity, ultimately resulting in a reduction in glycemic variability. This study will use a crossover, randomized, double-blind, placebo-controlled trial design. Patients with T2DM in group 1 will receive 3 mg of melatonin at 9:00 PM in the first week, undergo a washout period in the second week, and receive a placebo in the third week (melatonin-washout-placebo). Group 2 will be randomized to receive a placebo-washout-melatonin sequence (3 mg). Capillary blood glucose levels will be measured at 6 different times before and after meals during the last 3 days of the first and third weeks. The study aims to compare the mean differences in blood glucose levels and the coefficient of glycemic variability in patients receiving melatonin and placebo during the first and third weeks. After analyzing the initial results, the number of needed patients will be recalculated. If the recalculated number is higher than 30, new participants will be recruited. Thirty patients with T2DM will be randomized into the 2 groups: melatonin-washout-placebo or placebo-washout-melatonin. Participant recruitment took place between March 2023 to April 2023. In all, 30 participants were eligible and completed the study. We expect that patients will show different glycemic variability on the days they receive placebo or melatonin. Studies on melatonin and glycemic control have shown both positive and negative results. We hope that there will be a positive outcome regarding glycemic variability (ie, a reduction in glycemic variability), as melatonin has a well-described chronobiotic effect in the literature. This study aims to determine whether melatonin supplementation can effectively reduce glycemic variability in patients with T2DM. The crossover design is necessary due to the multiple variables involved in the circadian variations of glucose, including diet, physical activity, sleep parameters, and pharmacological treatments. The relatively low cost of melatonin and its potential role in reducing the severe complications associated with T2DM have motivated this research effort. Furthermore, the indiscriminate use of melatonin in current times makes conducting this study essential to evaluate the effect of this substance in patients with T2DM. Brazilian Registry of Clinical Trials RBR-6wg54rb; https://ensaiosclinicos.gov.br/rg/RBR-6wg54rb. DERR1-10.2196/47887.

Control hospitalario de la diabetes y de la hiperglucemia: una auditoría en hospitales españoles

ObjectivesEvaluation of the quality of care for patients with diabetes mellitus admitted to hospitals in Spain. MethodsCross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycemia out of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycemic monitoring, treatment administered during admission, and recommended therapy at discharge. ResultsThe median age of the patients was 80 years (74-87), of which 561 (47%) were women, with a Charlson index of 4 points (2-6), and 742 (65%) were fragile. Median blood glucose on admission was 155mg/dL (119-213). On the third day, the number of capillary blood glucose levels in target (80-180mg/dL) was pre-breakfast 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%) and night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogs in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At the time of discharge, the use of iSGLT2 increased significantly (30.1% vs. 21.6%; p<0.001), as well as the use of basal insulin (25.3% vs. 10.1%; p<0.001). ConclusionsThere is an excessive use of insulin on a sliding scale as well as deficient information on HbA1c values and an even deficient prescription at the discharge of treatments with cardiovascular benefit.

#3873 UTILITY OF BLOOD KETONE MONITORING IN HAEMODIALYSIS PATIENTS UNDER INPATIENT NEPHROLOGY CARE

Abstract Background and Aims There is a lack of evidence regarding the relationship between capillary blood glucose (CBG) &amp;gt;15 mmol/L and blood ketones in maintenance haemodialysis dialysis patients meaning the utility of ketone measurement in this group is uncertain. Despite this, guidance published by the Joint British Diabetes Society for Inpatient Care (JBDS-IP) in 2022 states that blood ketones should be measured in patients on maintenance haemodialysis with diabetes mellitus (DM) who have pre- or post-dialysis CBG &amp;gt;15mmol/L and symptoms consistent with diabetic ketoacidosis (DKA), acknowledging that these can be non-specific [1]. We sought to identify if there is a relationship between elevated CBG and blood ketone levels in haemodialysis patients, and if haemodialysis affects blood ketone levels. Method Maintenance haemodialysis patients with DM admitted to a single ward over 2 separate 2 month periods were included. Nursing staff recorded CBG and blood ketone levels pre- and post-dialysis using a FreeStyle PrecisionPro ketone meter. For each patient, further demographic data were collected from the electronic patient record. Results 79 measures were collected from 30 patients, with between 1 and 7 measures for each patient. 57% patients (n = 17) were male, 37% (n = 11) had T1DM, and 80% (n = 24) were on insulin therapy. The median pre-HD CBG for all measures was 10.5mmol/L (IQR 8.15-15.05), median post-HD CBG was 9.1mmol/L (IQR 6.8-12.95), median pre-HD ketones were 0.1mmol/L (IQR 0.1-0.2) and median post-HD ketones were 0.1mmol/L (IQR 0.1-0.3). There was no significant difference in blood ketones pre-and post-HD for all measures (p = 0.09) (Figure 1). For measures where pre-HD CBG was &amp;gt;15mmol/L (n = 21) median pre-HD and post-HD ketones were 0.1 (IQR 0.1-0.2) and 0.2mmol/L (IQR 0.1-0.2) respectively (p = 0.45). For measures where pre-HD CBG was &amp;gt;20mmol/L (n = 6) median pre-HD and post-HD ketones were 0.1 mmol/L (IQR 0.1-0.13) and 0.2 mmol/L (IQR 0.1-0.2) respectively (p = 0.13). For measures where pre-HD CBG was &amp;lt;15mmol/L, median pre-HD ketones were 0.1 (IQR 0.1-0.2). There was no significant difference in blood ketones pre-HD between those with a pre-HD CBG &amp;gt;15mmol/L and those with a pre-HD CBG &amp;lt;15mmol/L (p = 0.69). Conclusion These results demonstrate no significant relationship between elevated CBG measures (&amp;gt;15mmol/L) and blood ketone levels in haemodialysis patients, nor do they demonstrate a significant change in blood ketone levels post haemodialysis. Unwell haemodialysis patients with elevated CBG clearly warrant medical assessment, but there is a lack of evidence that blood ketones are useful to aid assessment and guide management of these patients.

Inpatient management of diabetes and hyperglycaemia: an audit of Spanish hospitals

ObjectivesEvaluation of quality of care for patients with diabetes mellitus admitted to hospitals in Spain. MethodsCross-sectional study in one day that included 1193 (26.7%) patients with type 2 diabetes or hyperglycaemia out of a total of 4468 patients admitted to the internal medicine departments of 53 hospitals in Spain. We collected demographic data, adequacy of capillary glycaemic monitoring, treatment administered during admission, and recommended therapy at discharge. ResultsThe median age of the patients was 80 years [74–87], of which 561 (47%) were women, with a Charlson index of 4 points [2–6], and 742 (65%) were fragile. Median blood glucose on admission was 155 mg/dl [119–213]. On the third day, the number of capillary blood glucose levels in target (80−180 mg/dl) at pre-breakfast was 792/1126 (70.3%), pre-lunch 601/1083 (55.4%), pre-dinner 591/1073 (55.0%), and at night 317/529 (59.9%). A total of 35 patients (0.9%) were suffering from hypoglycemia. Treatment during hospitalization was performed with sliding scale insulin in 352 (40.5%) patients, with basal insulin and rapid insulin analogues in 434 (50%), or with diet exclusively in 101 (9.1%). A total of 735 (61.6%) patients had a recent HbA1c value. At discharge, the use of SGLT2i increased significantly (30.1% vs. 21.6%; p< 0.001), as did the use of basal insulin (25.3% vs. 10.1%; p < 0.001). ConclusionsThere is an excessive use of sliding scale insulin as well as insufficient information on HbA1c values and prescription upon discharge of treatments with cardiovascular benefit.

Role of Pharmacist in Prevention and Management of Diabetics

In the last three decades role of pharmacist has changed dramatically. Presently, the pharmacists are becoming more patient oriented than product oriented. Patient counseling by pharmacist deals with providing information to the patients regarding the diseases, medications and lifestyle modifications. In diabetes, self management and patient adherence to the prescribed medication and lifestyle modifications is very essential and pharmacist can play an important role in counseling. A study was carried out to assess the influence of pharmacist provided patient counseling on patients' perception about quality of life in type 2 diabetes. 70 type-2 diabetes mellitus patients (48 males and 22 female) were enrolled and randomized into test and control groups. Mean capillary blood glucose levels were decreased in test group where as non-significant increase of capillary blood glucose levels was observed in the control group patients. Pharmacist provided patient counseling might be considered as an important element in implementing the disease management program.

Predictability of the Development of Insulin Resistance Based on the Risk Factors Among Female Medical Students at a Private College in Saudi Arabia.

Insulin resistance (IR) is currently an underlying phenomenon in the etiology of mostnon-communicable diseases. IR has been proposed as the key linking factor for the metabolic syndrome disease cluster of glucose intolerance. This study's target was to assess the predictability of risk factors for IR among female medical students Methods: A cross-sectional study involving female medical students was carried out. The sample size was 272, and a suitable non-probability sampling method was employed. A correlation test was done, and a P value less than 0.05 is considered statistically significant.Each participant underwent assessment of anthropometric measurements and biochemical testing. For assessing lifestyle, validated questionnaires on physical activity, sleep pattern, dietary pattern, and stress were adopted. The anthropometric data such as height, weight, and waist circumference were collected. Biochemical testing involved estimation of the postprandial capillary blood glucose level on campus. Additionally, systolicblood pressure and diastolic blood pressurewere measured. The association of lifestyle risk factors with waist circumference as an indicator of IR was done wherethe majority of those with high waist circumference were physically inactive and more prone to stress which was statistically significant when compared to those with normal waist circumference. However, poor sleep and unhealthy diet were high among those with high waist circumference, but they were not statistically significant. The correlation of waist circumference as an indicator of IR was highly significant with body mass index, postprandial blood sugar, systolic blood pressure, and diastolic blood pressure. A series of unhealthy lifestyle habits was contributable to developing obesity and therefore IR among medical students in Saudi Arabia.

Modifying Type of Insulin to Manage Steroid-Induced Hyperglycemia: A Case Report.

Steroid-induced hyperglycemia was diagnosed in an older hospitalized patient after he was treated with the intermediate-acting glucocorticoid methylprednisolone. Before hospital admission, the patient did not have a diagnosis of diabetes. His elevated admission glucose level of 167 mg/dL along with his significant hyperglycemia after glucocorticoid initiation prompted the medical team to obtain a hemoglobin A1c result, 8.4%, which confirmed the diagnosis of type 2 diabetes. The capillary blood glucose level was elevated into the 200 to 399 mg/dL range for most of the patient's hospital stay while he was receiving subcutaneous insulin therapy of glargine and aspart correction and prandial bolus dosing. When the patient's subcutaneous insulin therapy was changed from glargine to neutral protamine Hagedorn insulin, the target glucose level range of 140 to 180 mg/dL was attained. From this case report, we determined that it is important to consider modifying subcutaneous insulin therapy by using another type of insulin when target glucose values are not achieved during the treatment of steroid-induced hyperglycemia.

Effects of Acute Exergame on Glucose Control After Glucose Ingestion in Individuals with Pre- and Type 2 Diabetes

OBJECTIVES The purpose of present study was to analyze the acute effects of exergame on glucose control after glucose ingestion in individuals with pre- and type 2 diabetes.METHODS We enrolled 60 adults with pre-diabetes (Pre-DM, 58.1±9.2 years, n=20) and type 2 diabetes (T2DM, 61.7±9.9 years, n=40). We measured fingertip capillary blood glucose level at 10 min before, 30 min after, 60 min after and 120 min after the 75-g oral glucose tolerance test (OGTT). For the non-exergame control days, participants pursued normal daily activities but refrained from unusual strenuous physical activity. On the exercise days, participants conducted on exergame at 30 min after 75-g OGTT for 30 min.RESULTS Acute exergame reduced the glucose level 60 min, ∆BG30-60 and ∆BG60-120 after glucose ingestion compared to the control trials (&lt;i&gt;p&lt;/i&gt;&lt;0.01, &lt;i&gt;p&lt;/i&gt;&lt;0.01 and &lt;i&gt;p&lt;/i&gt;&lt;0.001 respectively). The cumulative glucose total area under the curve was lower with exergame than under the control condition (&lt;i&gt;p&lt;/i&gt;&lt;0.05).CONCLUSION Acute exergame after glucose ingestion can improve hyperglycemia and glycemic excursion.

Glycemic Index of a Diabetes-Specific Nutritional Powder: An Open-Label Study in Healthy Indian Adults

Background: A balanced diet with a low glycemic index (GI) plays an important role in controlling and managing type 2 diabetes mellitus (T2DM). Here, we compared the GI of 2 flavors (vanilla and chocolate) of diabetes-specific nutritional (DSN) supplements to its comparator in healthy Indian adults under fasting conditions. Methods: This study was a 39-day open-label, non-comparative, single-center trial involving healthy adults aged between 18 to 45 years. The subjects received equal doses of 2 DSN powder (Treatments A and B), the comparator product (Treatment C), and dextrose monohydrate as a reference (Treatment R). Doses were administered as per the dosing schedule, after an overnight fast for 10 hours, with 2 intervening non-dosing days. Blood samples were collected on the dosing days to assess changes in capillary blood glucose levels. The primary endpoint of the study was the mean GI of Treatments A, B, and C (Defined as low: GI ≤ 55; medium: 55 GI ≤ 70; High: GI > 70), generated using the incremental area under the curve (AUCi) methodology. Safety was assessed throughout the study. Values of all study parameters were represented in ±SD or standard deviation. Results: Fourteen adult male subjects with a mean age of 29.42 ± 4.46 years, and a body mass index of 22.0 ± 1.95 Kg/m2, were enrolled in the study. The mean AUCi for treatments A, B, and C were 104 ± 10, 111 ± 12, and 87 ± 12 mmol min/L, respectively and for Treatment R it was 276 ± 16, 319 ± 28 and 338 ± 25 mmol min/L for Days 1, 6 and 8, respectively. The mean GI of Treatment A was 33 ± 3, Treatment B was 35 ± 3 and Treatment C was 29 ± 5; all GI means were ≤55. Mild adverse events were reported in 2 (14.3%) subjects. No serious adverse events or deaths were reported in the study. All treatments were well tolerated by the subjects. Conclusion: The glycemic index of both test products and comparator was low (i.e., GI 55) as per ISO 26642:2010 standard.

Association between Admission Blood Glucose Levels and Clinical Outcomes among Diabetic Adults Admitted to a Tertiary Care Hospital in Chennai, India: A Retrospective Study

Introduction: Admission blood glucose levels have an impact on hospitalisation and Length Of Stay (LOS). Uncontrolled blood glucose levels have been found to affect patients’ outcomes. Elevation of the initial blood glucose level during critical diagnosis was identified as an independent risk factor for in-hospital mortality in critical cases. Aim: To examine the association between admission blood glucose levels and clinical outcomes in adult diabetic patients. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India. Data were collected between July 1, 2021, and August 31, 2021, using non-probability convenience sampling from 522 records of adult diabetic patients admitted between January 2019 and March 2020. Capillary random blood glucose levels at the time of admission and their effects on LOS, both in the hospital and Intensive Care Unit (ICU), readmission, and mortality data were collected. Statistical analysis was performed using the Chi-square test. Results: Analysis of the records of 522 adult diabetic patients revealed that the mean and standard deviation (SD) of admission Capillary Blood Glucose (CBG) level were 177.46±49.42 mg/ dL, and the mean LOS in the hospital was 4.54±3.89 days. It was found that 340 (65.1%) patients had an admission duration of ≤4 days. There was a statistically significant association between admission blood glucose levels and LOS in the hospital (p-value=0.01), LOS in the ICU (p-value=0.008), readmission to the hospital (p-value=0.001), and mortality rate (p-value=0.0001). Conclusion: The study demonstrates that admission blood glucose levels are associated with the clinical outcomes of patients. These findings substantiate the need for maintaining normal glycemic levels through patient education and a proactive team approach to improve patient outcomes.

Comparative Evaluation of the Efficacy of Gingival Crevicular Blood with Finger Capillary Blood and Venous Capillary Blood to Assess Blood Glucose Levels for Screening of Diabetes Mellitus in Chronic Periodontits Patients: A Cross-sectional Study

Introduction: Diabetes mellitus is defined as a clinically and genetically diverse cluster of illnesses involving conflict in carbohydrate and protein metabolism. Periodontitis is a complex condition with several causes. The interaction between these two conditions appears to be cyclical as well as bidirectional. Gingival crevicular blood obtained through routine periodontal oral assessment could be utilised for blood glucose estimation. Aim: To examine the efficacy of gingival crevicular blood elicited during routine periodontal probing as a reliable source for screening of diabetes mellitus, and to compare it with finger capillary blood and venous capillary blood in chronic periodontitis patients. Materials and Methods: This cross-sectional, in-vivo, clinical study was conducted in the Department of Periodontology at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from January 2021 to January 2022. The study included 50 patients, who were diagnosed with chronic periodontitis in the age range ≥30 years, and met the inclusion and exclusion criteria. A prior detailed history was compiled. The clinical parameters recorded were sulcus bleeding index, plaque index, gingival index, probing pocket depth, and clinical attachment level. Each patient’s blood samples were collected from three different sites, Gingival Crevicular Blood (GCB) collected from gingival crevice, Finger Capillary Blood (FCB) collected from finger bed and and Venous Capillary Blood (VCB) collected from forearm for determining the blood glucose levels. Glucose levels were compared by oneway Analysis of Variance (ANOVA). Karl Pearson’s correlation was used for the comparison. Statistical Package for Social Sciences (SPSS) version 26.0 was used for statistical analysis and p-value ≤0.05 was considered as statistically significant. Results: The mean Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL) was 5.5±0.61 mm and 6.76±0.82 mm, respectively. The mean Plaque Index (PI) and Gingival Index (GI) score was 1.41±0.25 and 1.45±0.21, respectively. The mean GCB, FCB, and VCB glucose level of the subjects were 171.58±85.63 mg/dL, 179.14 ±80.31 mg/dL and 186.96±87.57 mg/dL, respectively. There was no statistical difference seen among the three methods thus, either of the methods can be used for measuring blood glucose levels for screening of diabetes mellitus in chronic periodontitis patients (p-value= 0.66). Posistive correlation between FCB and VCB (r-value=0.976, p-value&lt;0.001). VCB and GCB when correlated showed strong positive and highly statistically significant results (r-value= 0.934, p-value&lt;0.001). Similarly, GCB and FCB showed a positive correlation (r-value=0.920, p-value&lt;0.001) which was statistically highly significant. Conclusion: The results suggested that the efficacy of gingival crevicular blood when compared with finger capillary blood and venous capillary blood glucose levels showed positive correlation, suggesting either can be used in dental clinics for diabetic screening purpose without any extra invasive procedures.

Dual-basal-insulin regimen for the management of dawn phenomenon in children with type 1 diabetes: a retrospective cohort study.

Handling of the dawn phenomenon (DP) with multiple daily insulin injection (MDII) regimen is a real challenge. We aimed to demonstrate the effectiveness of a dual-basal-insulin (a long-acting glargine and an intermediate-acting neutral protamine Hagedorn (NPH)) regimen for the management of DP in children with type 1 diabetes mellitus (T1DM). The primary efficacy outcome was to overcome morning hyperglycemia without causing hypoglycemia during the non-DP period of the night. Retrospective cohort study. Charts of 28 children with T1DM (12 female; 42.8%, mean age 13.7 ± 2.1 years) treated with MDII were retrospectively reviewed. The median duration of diabetes was 4.5 years (range 2-13.5 years). DP was diagnosed using a threshold difference of 20 mg/dL (0.1 mmol/L) between fasting capillary blood glucose at 3 a.m. and prebreakfast. NPH was administered at midnight in addition to daily bedtime (08.00-09.00 p.m.) glargine (dual-basal-insulin regimen). Midnight, 03:00 a.m., prebreakfast and postprandial capillary blood glucose readings, insulin-carbohydrate ratios, and basal-bolus insulin doses were recorded the day before the dual-basal-insulin regimen was started and the day after the titration of the insulin doses was complete. Body mass index standard deviation scores (BMI SDS) at the onset-3rd-12th month of treatment were noted. Before using dual basal insulin, prebreakfast capillary blood glucose levels were greater than those at midnight and at 03:00 a.m. (F = 64.985, p < 0.01). After titration of the dual-basal-insulin doses, there were significant improvements such that there were no statistically significant differences in the capillary blood glucose measurements at the three crucial time points (midnight, 03.00 a.m., and prebreakfast; F = 1.827, p = 0.172). No instances of hypoglycemia were reported, and the total daily insulin per kilogram of body weight did not change. The BMI SDS remained steady over the course of the 1-year follow-up. In this retrospective cohort study, the dual-basal-insulin regimen, using a long-acting glargine and an intermediate-acting NPH, was effective in overcoming early morning hyperglycemia due to insulin resistance in the DP. However, the effectiveness of the dual-basal-insulin regimen needs to be verified by prospective controlled studies using continuous glucose monitoring metrics or frequent blood glucose monitoring.

Abstract #1320430: Effect of Hand Hygiene Practice on Capillary Blood Glucose Among the Family Medicine Residents in Jeddah, Saudi Arabia

Good glycemic control significantly reduces the incidence of diabetes-related complications; however, it depends greatly on the frequent and accurate monitoring of blood glucose levels. Hand hygiene may determine the accuracy of capillary blood glucose measurements, which may vary due to differences in hand hygiene practices. This study evaluated the impact of different hand hygiene practices on capillary blood glucose levels in Jeddah, Saudi Arabia.