Capillary Blood Glucose Testing Research Articles

Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study.

To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). Prospective cohort study. Antenatal clinics at King's College Hospital. Women screened for GDM between March and June 2020. The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.

Validation of the blood glucose testing method on the Accu-chek Inform II

Blood glucose testing, including capillary blood glucose, is the recommended test for the diagnosis and monitoring of diabetes treatment. Currently, capillary blood glucose testing is performed on point-of-care testing (POCT) with reasonable cost, fast time, convenience, supporting timely diagnosis and treatment. However, in order to select POCT devices that meet quality standards, it is necessary to strictly control the laboratory. Object and method: Confirmation of the capillary blood sugar testing method on the Accu-chek Inform II (Acc-II) machine including the following indicators: accuracy, precision, linear range, comparison of test results according to the recommendations of the Clinical &amp; Laboratory Standards Institute (CLSI) (EP15A3, EP06A, EP09A3). The authors compared results on the testing machine in the central laboratory (Cobas 8000) of blood glucose testing on the POCT machine with the results of whole capillary blood, whole venous blood, and plasma venous samples. Results: Precision, accuracy, and linearity were confirmed as published. The linear range of the method is from 1.6 to 31 mmol/l. The difference between capillary blood glucose pairs and plasma venous glucose, whole blood venous glucose on Accu-chek Inform II and plasma venous blood glucose on Cobas 8000 machine are 6.89, -8.62, and -10.97%, respectively.

1987 Capillary blood glucose testing on older inpatients at the Norfolk and Norwich University Hospital (NNUH)

Abstract Rationale Inpatient glycaemic management is a challenge in older people. Clinicians at the Norfolk and Norwich University Hospital noticed substantial numbers of finger-prick capillary blood glucose (CBG) tests being documented. This quality improvement project explored the frequency of CBG testing on older people’s medicine wards, to determine if improvements in service provision and patient safety could be made. Methods Setting: Electronic records of inpatients on geriatric medicine wards at NNUH (May-July 2023) Patient selection: Older people with recorded CBG testing Measures: Type of diabetes, medication regime and frequency of CBG testing. Staff survey of CBG monitoring knowledge. Analysis: Compliance with the Joint British Diabetes Societies for Inpatient Care guidelines for frail older adults with diabetes (February 2023). Staff knowledge. Results 240 inpatients included - 23% had type 2 diabetes. 32% had regular CBG monitoring (once daily or more). Of these patients, 70% had tests that were not compliant with guidance. In a single day, we calculated 120 CBG tests that were not clinically indicated. 43% of patients were on single-therapy treatment (not including sulphonylureas) or diet-controlled type 2 diabetes, all of whom underwent excessive testing during their inpatient stay. A staff survey of 15 ward sisters, nurses and healthcare assistants revealed no consensus on who determines frequency of CBG testing and target CBG ranges for frail, older inpatients. Conclusions Ad hoc CBG testing has resulted in potential harm to our inpatients and overuse of staff time and resources. Future work is underway to ‘Think Glucose’ and implement protocols for appropriate CBG monitoring frequencies and target CBG ranges for our inpatients.

Current Screening and Management Practices for Gestational Diabetes Mellitus in Public Hospitals of South India

Background Gestational Diabetes Mellitus GDM leads to adverse maternal and foetal health outcomes. There are several benefits of screening pregnant women for GDM including reducing the impact and timing of GDM-associated complications. However there is limited evidence regarding GDM screening and management in public hospitals in low- and middle-income countries. Therefore we aimed to understand the current GDM screening and management practice in public hospitals in South India through the study of pregnant women in Bangalore.Methods We conducted a cross-sectional study in all the six tertiary-level public hospitals of Bengaluru which were providing antenatal services during September 2017. We compared the results of GDM screening in five of these hospitals with a tertiary public hospital wherein a cohort of women were studied during the same time wherein voluntarily consented women were subjected to GDM screening and were followed up through their pregnancy and post-partum.Results Among the 186 pregnant women included in the cross-sectional study 41.4 n77186 had undergone random blood sugar test and 22 n39186 underwent a confirmatory test in the form of either a Glucose Challenge Test GCT or Oral Glucose Tolerance Test OGTT for diagnosis. Similarly pregnant women underwent capillary blood glucose testing 5.1 n9186 fasting blood sugar 1.7 n3186 urine glucose and albumin level 1.7 n3186 testing. The prevalence of GDM in this cross-sectional study obtained via routine screening in public hospitals was 4.3 n8186 while in comparison the prevalence of GDM was 15.4 n1571019 in the ongoing cohort. Furthermore only 22.9 of cohort women diagnosed with GDM received any follow-up treatment in public hospitals. We also found that 12.1 and 7 of women achieved glucose control in the antenatal and postnatal period respectively.Conclusion Our results suggest that most women with GDM attending public hospitals may be ldquomissedrdquo from GDM diagnosis and treatment even in the major public hospitals in Bangalore. Therefore strengthening the GDM screening and management in public hospitals is imperative to avert the adverse risks of GDM among women and their children in urban areas.

Participant and GP perspectives and experiences of screening for undiagnosed type 2 diabetes in community pharmacy during the Pharmacy Diabetes Screening Trial

BackgroundThe Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs).MethodsAll referred participants (n = 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis.ResultsResponse rates 16% (n = 369) and 17% (n = 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (n = 784/853) and would recommend it to a family member or friend (n = 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46–3.06). GPs (15.8% response rate, n = 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate.ConclusionOpportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.

The relationship between diabetes self-care management and blood glucose level among type 2 diabetes mellitus patients

There are still many patients with diabetes mellitus (DM) with uncontrolled blood sugar levels. Self-care was needed to control blood glucose levels. The aim of this study was to analyze the relationship between diabetes self-care management and blood sugar levels in type 2 DM (T2DM) patients. This study was used a correlational design. Data was collected from the Internal Medicine Polyclinic of William Booth Hospital Surabaya. The dependent variable was blood glucose and the independent variable was diabetes self-care management. The 99 respondents were selected using the purposive sampling technique. The inclusion criteria were patients with T2DM, the ages between 45-and 64 age years old. We used the summary of diabetes self-care activities to assess self-care management and blood sugar level was measured using a capillary blood glucose test. Chi-square was used to calculate the relationship between diabetes self-care management and blood glucose level. This study showed that most of the respondents with good diabetes self-care management had good blood sugar levels and there was a significant relationship between diabetes self-care management and blood sugar levels among T2DM patients (p&amp;lt;0.05). Increasing diabetes self-care management among T2DM patients was required to control blood glucose levels.

The accuracy of capillary blood glucose testing versus real time and intermittently scanned continuous glucose monitoring

The accuracy of capillary blood glucose testing versus real time and intermittently scanned continuous glucose monitoring

952-P: The Accuracy and Feasibility of Continuous Glucose Monitoring in COVID-19 Non-Critically Ill Hospitalized Patients—A Pilot Study

Background: Optimal glycemic control is associated with favorable outcomes in COVID-19 hospitalized patients. Frequent capillary blood glucose (CBG) monitoring is difficult to perform. Using continuous glucose monitoring (CGM) system to assist glycemic care can reduce the exposure of healthcare personnel and PPE usage. However, data on the accuracy of CGM in this setting are limited. Objective: To evaluate the accuracy and feasibility of real-time CGM (rt-CGM) in non-ICU hospitalized adult COVID-19 patients. Methods: This is a single-center prospective study of non-ICU hospitalized adult patients with COVID-19 infection who had hyperglycemia requiring insulin therapy during admission. Medtronic Guardian Connect rt-CGM sensor and transmitter were placed on the patient’s abdomen. Paired CBG and sensor glucose values were analyzed for accuracy of CGM using mean absolute relative difference (MARD) and Clarke Error Grid Analysis (CEGA). Results: Fifteen patients were enrolled. Mean age was 48.6 ± 17.9 years. Thirteen patients (86.7%) had pre-existing diabetes. Mean HbA1c was 10.6± 3.6%. Mean duration of CGM use was 6 ± 1.2 days and mean calibration was 2.6 ± 0.7 times/day. There were 253 paired CBG and CGM measurements. The overall MARD was 9.9 ± 9.3%. The lowest MARD was observed in the CBG range of 70-180 mg/dl (9.6 ± 9.0%). The percentages of glucose readings within ±15%/15 mg/dL, ±20%/20 mg/dL, and ±30%/30 mg/dL were 80.2%, 89.7%, and 95.3%, respectively. A total of 99.2% of the data points were in zone A and B of CEGA, and none were in zone E. Percent time in range on day 1 was 57.9 ± 22.9 and improved to 64.9 ± 18.1 in the last 72 hours of sensor wear. No adverse events from the CGM were observed. CGM reduced POC testing by 30%. Conclusions: Rt-CGM use in hospitalized patients with COVID-19 infection demonstrates high accuracy and potentially improves glucose control, reduces the frequency of CBG testing, and preserves medical resources. Disclosure C.Sakjirapapong: None. S.Sirinvaravong: None. L.Preechasuk: None. N.Thongtang: None. Funding Specific League Funds (R016421005)

Accuracy of Continuous Glucose Monitoring in an Insulin-Treated Population Requiring Haemodialysis.

Continuous glucose monitoring (CGM) is revolutionizing diabetes care by giving both patients and the healthcare professionals unprecedented insights into glucose variability and patterns. It is established in National Institute for Health and Care Excellence (NICE) guidance as a standard of care for type 1 diabetes and diabetes in pregnancy under certain conditions. Diabetes mellitus (DM) is recognized as an important risk factor for chronic kidney disease (CKD). Around a third of patients receiving in-center haemodialysis as renal replacement therapy (RRT) have diabetes, either as a direct cause of renal failure or as an additional co-morbidity. Evidence of poor compliance with the current standard of care (self-monitoring of blood glucose [SMBG]) and overall greater morbidity and mortality, suggests this patient population as an ideal target group for CGM. However, there exists no strong published evidence showing the validity of CGM devices in insulin-treated diabetes patients requiring haemodialysis. We applied a Freestyle Libre Pro sensor to 69 insulin-treated diabetes haemodialysis (HD) patients on a dialysis day. Interstitial glucose levels were obtained, and time matched within 7 minutes to capillary blood glucose testing and any plasma blood glucose levels sent. Data cleansing techniques were applied to account for rapidly correcting hypoglycaemia and poor SMBG technique. Clarke-error grid analysis showed 97.9% of glucose values in an acceptable range of agreement (97.3% on dialysis days and 99.1% on non-dialysis days). We conclude that the Freestyle Libre sensor is accurate in measuring glucose levels when compared to glucose as measured by capillary SMBG testing and laboratory obtained serum glucose in patients on HD.

Performance of Different Glucose Testing Methods Amongst Patients of Gestational Diabetes Mellitus in St. Francis Hospital Nsambya, Kampala, Uganda: A CrossSectional and Descriptive Study

Background: Medical examination detects illness or disease risk factors in individuals otherwise well to treat early on and minimize morbidity and death. In spite of recommended GDM screening during prenatal care worldwide and local standards, it has been shown that the procedure has not been properly implemented. A further difficulty might be the lack of consensus worldwide and on local consistence on GDM screening and diagnosis guidelines. Methods: The study was a hospital based cross-sectional and descriptive study that employed both quantitative and qualitative methods of data collection. A descriptive study was concerned with describing the characteristics of a particular individual, or of a group in a given situation. The study was guided by the primary objective of assessing the extent of GDM monitoring among women receiving antenatal care at St. Francis Hospital Nsambya in Kampala, Uganda. Both Capillary and venous blood samples in which plasma/serum was taken from pregnant mothers and their glucose levels estimated using a One touch (Roche Diagnostics) code 298 and plasma calibrated glucometer and Roche Cobas C311fully automated Chemistry Analyser respectively. Both whole blood glucose and plasma/serum glucose was determined as per the principle of enzyme hexokinase (HK) catalyzes the reaction between glucose and adenosine triphosphate (ATP) to form glucose-6-phosphate (G-6-P) and adenosine diphosphate (ADP). In the presence of nicotinamide adenine dinucleotide (NAD), G-6-P is oxidized by the enzyme glucose-6-phosphate Dehydrogenase (G-6-PD) to 6-phosphogluconate and reduced nicotinamide adenine dinucleotide (NADH). The increase in NADH concentration was directly proportional to the glucose concentration and was measured spectrophotometrically at 340 nm. The data was analysed using the McNemar's test to determine the sensitivity, specificity and the direct cost for performing capillary glucose. Receiver operator characteristic and Area under curve analyses to analyze the predictive power of the constructed equation Sensitivity, specificity, false positive rate and false negative rate was computed to validate the capillary method in testing/detecting Gestational Diabetes Mellitus. Data analysis was performed using the SPSS package Results: The results presented below for both capillary and Venous Blood Glucose were based on the principle of glucose oxidase test. Cutoff for the different blood sugar level were as follows; Normal A1C test being &lt; 5.4% and Diabetes being &gt;5.4%. Based on the Venous Blood Glucose tests method, 89.0% (154/173) respondents tested normal, while 11.0% (19/173) had diabetes. However, capillary blood glucose testing method identified 78.6% (136/173)5 respondents as being normal compared 21.4% (37/173) having diabetes. Results obtained from the process indicate capillary glucose blood test for gestation diabetes having very low sensitivity i.e. 30% for gestation diabetes. The findings of the study will help to create public awareness on disease burden, improved diagnosis, classification, management and health policies by the Ministry of Health about Gestational diabetes among Ugandan mothers. Conclusion: Most of the procedures employed to detect and trace for GDM was found to be painful and stressful. The healthcare providers and managers some lacked required skills and knowledge concerning GDM among women and procedural handling was found to be wanting in one case or another. The GDM prevalence was discovered to be slowly increasing even though it was detected to be at low levels at Nsambya hospital but the situation elsewhere might be different. Most of the GDM risk factors were majorly originating from family background, maternal ages discrepancies, and abuse of alcohol. Most GDM challenges were found to be fueled by lack of proper counseling and screening since it wasn’t routine among health care professionals hence lack of expertise and inconsistencies in handling GDM women. Preparing women for GDM screening and diagnosis would have reduced the risks and health challenges faced by pregnant women if they are well prepared and trained before subjecting them to the GDM testing.

Elicitation of domain knowledge for a machine learning model for paediatric critical illness in South Africa.

Delays in identification, resuscitation and referral have been identified as a preventable cause of avoidable severity of illness and mortality in South African children. To address this problem, a machine learning model to predict a compound outcome of death prior to discharge from hospital and/or admission to the PICU was developed. A key aspect of developing machine learning models is the integration of human knowledge in their development. The objective of this study is to describe how this domain knowledge was elicited, including the use of a documented literature search and Delphi procedure. A prospective mixed methodology development study was conducted that included qualitative aspects in the elicitation of domain knowledge, together with descriptive and analytical quantitative and machine learning methodologies. A single centre tertiary hospital providing acute paediatric services. Three paediatric intensivists, six specialist paediatricians and three specialist anaesthesiologists. None. The literature search identified 154 full-text articles reporting risk factors for mortality in hospitalised children. These factors were most commonly features of specific organ dysfunction. 89 of these publications studied children in lower- and middle-income countries. The Delphi procedure included 12 expert participants and was conducted over 3 rounds. Respondents identified a need to achieve a compromise between model performance, comprehensiveness and veracity and practicality of use. Participants achieved consensus on a range of clinical features associated with severe illness in children. No special investigations were considered for inclusion in the model except point-of-care capillary blood glucose testing. The results were integrated by the researcher and a final list of features was compiled. The elicitation of domain knowledge is important in effective machine learning applications. The documentation of this process enhances rigour in such models and should be reported in publications. A documented literature search, Delphi procedure and the integration of the domain knowledge of the researchers contributed to problem specification and selection of features prior to feature engineering, pre-processing and model development.

Pharmacy diabetes screening trial (PDST): Outcomes of a national clustered RCT comparing three screening methods for undiagnosed type 2 diabetes (T2DM) in community pharmacy

AimsTo compare the effectiveness of three pharmacy-based screening methods for type 2 diabetes (T2DM): (1) risk assessment (AUSDRISK) alone (Group A); AUSDRISK followed by a point of care test if AUSDRISK ≥12; either (2) HbA1c (Group B); or (3) small capillary blood glucose test (Group C). MethodsA cluster RCT with a nationally representative sample of Australian pharmacies was implemented with random allocation of eligible pharmacies to Groups A, B or C. GP referral was based on prespecified cut offs. Diagnoses were considered positive if confirmed by a GP, pathology laboratory, or national diabetes register. ResultsOf the 14,093 people screened in 339 pharmacies, 3059 participants met group-specific referral criteria: 1775 (45%) (Group A); 893 (17%) (Group B); and 391 (8%) (Group C). For the total screened population rates of T2DM diagnoses were significantly higher in Group B (1.5%), compared with Groups A (< 0.8%) and C (< 0.6%) with the odds of detection in Group B compared with Group A (1.8 [1.0;3.0]), and no difference between Groups A and C. ConclusionsIn community pharmacy, the most effective method to uncover undiagnosed T2DM was a stepwise approach; initial risk assessment; and if appropriate an HbA1C POC test and referral.

Application of the New "Points in Range" Metrics in the Assessment of In-Hospital Glycemic Control.

Introduction Capillary blood glucose (CBG) monitoring remains the most used testing form in hospitals and allows for"points in range (PIR)" metric calculation. This study was conceived to evaluate the metabolic control in patients with diabetes mellitus (DM) at a hospital through PIR metrics. Methods This was an observational cross-sectional study conducted on October 9, 2020, that included non-critical adults admitted to Centro Hospitalar Universitário do Porto (except pregnant/postpartum women) with DM under CBG monitoring and a minimum of 24 hours of hospitalization. Glycemic control was evaluated by previous day CBG monitoring. Results The study sample consisted of 110 patients with DM (93.6% type 2) with a median number of CBG tests of 4.00 (1.00) and a median CBG of 166.20 (69.41) mg/dL, SD 41.93 ± 27.20 mg/dL, and variation coefficient of 22.56 ± 12.51%. Points below range were 0.5%, with 0% below 54 mg/dL. The points in ranges 70-140 mg/dL and 140-180 mg/dL were32.8% and 22.0%, respectively, and the total number of patients with all points in range 70-180 mg/dL was 19 (17.3%), with only 3 (2.7%) having all points in range 140-180 mg/dL and 10 (9.1%)in range70-140 mg/dL. Regarding points above range (PAR), 29.9% and 14.8%pointswere at levels 1 and 2 hyperglycemia, respectively, and 15 (13.6%) patients had all points above 180 mg/dL. Correlations were identified between PAR and the total number of CBG assessments (ρ = 0.689, p < 0.001). Conclusion We conclude that in-hospital glycemic control remains suboptimal: only few have adequate control according to the PIR metrics despite low glycemic variability. PIR metrics are a new, valuable, simple and valid way to take better advantage of CBG monitoring at no added cost.

Diagnostic Accuracy of Capillary Blood Glucometer Testing for Gestational Diabetes.

Few pregnant women in low-resource settings are screened for gestational diabetes mellitus (GDM) using the gold standard oral glucose tolerance test (OGTT). This study compared capillary blood glucose testing with 2-h plasma glucose measurements obtained using the 75-g OGTT to screen for GDM at primary healthcare clinics in Mexico. Pregnant women who participated in a previous prospective multicenter longitudinal cohort study and who had not been previously diagnosed with diabetes were included. Participants were evaluated using the plasmatic 2-h 75-g OGTT with simultaneous capillary blood glucose measurements using a glucometer. The study endpoint was the comparability of the glucometer results to the gold standard OGTT when collected simultaneously. Sensitivity, specificity, and area under the curve of the glucose measurements obtained for capillary blood compared with venous plasma (gold standard) were calculated to determine diagnostic accuracy. The study included 947 pregnant women who had simultaneous glucose measurements available (blood capillary [glucometer] and venous blood OGTT). Overall, capillary blood glucose testing was very sensitive (89.47%); the specificity was 66.58% and the area under the curve (95% confidence interval) was 0.78 (0.74-0.81). The sensitivity, specificity and area under the curve of each capillary measurement were: 89.47%, 66.58% and 0.78 (0.74-0.82) for the fasting measurement, 91.53%, 93.24% and 0.92 (0.88-0.96) for the one-hour measurement, and 89.80%, 93.32%, 0.91 (0.87-0.95) for the second-hour measurement, respectively. No adverse events were reported. Capillary OGTT is a valid alternative to the gold standard OGTT for screening of GDM in low-resource situations or in situations where there are other limitations to performing the OGTT as part of primary healthcare services.

Risk of obstructive sleep apnea and quality of sleep among adults with type 2 diabetes mellitus in a sub-Saharan Africa city.

Introductiondiabetes mellitus (DM) and Obstructive Sleep Apnea (OSA) are two major and interconnected non-communicable diseases. Both negatively impact on sleep quality. This study aimed to determine among persons with type 2 DM, the proportions at high risk of OSA and of self-reported poor sleep quality along with their associated-factors in Parakou city, Benin.Methodsthis was a cross-sectional prospective study of 100% (n=383) outpatient adults with type 2 DM, conducted between April and August 2019 in the three top centres managing diabetic persons in Parakou city. They were interviewed, examined and investigated using capillary fasting blood glucose tests. The STOP-Bang Questionnaire (SBQ) was used to determine the risk of OSA.Resultsoverall, their mean age was 57.37 (11.45) years. They were 61.62% (n=236) females and 38.38% (n=147) males. Sleep duration was insufficient in 26.89% (n=103). Nocturia was reported in 49.35% (n=189). The risk of OSA was high in 14.10% (n=54), intermediate in 24.80% (n=95) and low in 61.10% (n=234). Friedman Position Tongue Grade 3 (Adjusted Odds Ratio, aOR=2.48; 95%CI=1.11 - 5.55; p=0.025) and 4 (aOR=4.65; 95%CI=1.26 - 15.90; p=0.015) were independently associated with a high risk of OSA. The prevalence of reported poor sleep quality was 27.42% (n=105). Female gender (aOR=2.08; 95%CI=1.18-3.83; p=0.014), diabetic foot (aOR=5.07; 95%CI=1.15-23.63; p=0.031), nocturia (aOR=1.96; 95%CI=1.18-3.29; p=0.010), tiredness (aOR=2.77; 95%CI=1.26-6.23; p=0.012) and a high risk of OSA (aOR=3.31; 95%CI=1.28-8.93; p=0.015) were independently associated with a greater risk of reported poor sleep quality.Conclusionin Parakou, the proportions of patients with type 2 DM at increased risk of OSA and with poor quality of sleep are relatively high. There is need for better systematic screening of OSA in persons with DM.

Good Metabolic Control in Children with Type 1 Diabetes Mellitus: Does Glycated Hemoglobin Correlate with Interstitial Glucose Monitoring Using FreeStyle Libre?

Background: Good metabolic control of Type 1 diabetes (T1D) leads to a reduction in complications. The only validated parameter for establishing the degree of control is glycated hemoglobin (HbA1c). We examined the relationship between HbA1c and a continuous glucose monitoring (CGM) system. Materials and methods: A cohort prospective study with 191 pediatric patients with T1D was conducted. Time in range (TIR), time below range (TBR), coefficient of variation (CV), number of capillary blood glucose tests, and HbA1c before sensor insertion and at one year of use were collected. Results: Patients were classified into five groups according to HbA1c at one year of using CGM. They performed fewer capillary blood glucose test at one year using CGM (−6 +/− 2, p < 0.0001). We found statistically significant differences in TIR between categories. Although groups with HbA1c < 6.5% and HbA1c 6.5–7% had the highest TIR (62.214 and 50.462%), their values were highly below optimal control according to CGM consensus. Groups with TBR < 5% were those with HbA1c between 6.5% and 8%. Conclusions: In our study, groups classified as well-controlled by guidelines were not consistent with good control according to the CGM consensus criteria. HbA1c should not be considered as the only parameter for metabolic control. CGM parameters allow individualized targets.

Safe threshold of capillary blood glucose for predicting early future neonatal hypoglycaemia in babies born to mothers with gestational diabetes mellitus, an observational, retrospective cohort study

BackgroundThere is increasing pressure to get women and babies home rapidly after birth. Babies born to mothers with gestational diabetes mellitus (GDM) currently get 24-h inpatient monitoring. We investigated whether a low-risk group of babies born to mothers with GDM could be defined for shorter inpatient hypoglycaemia monitoring.MethodsObservational, retrospective cohort study conducted in a tertiary maternity hospital in 2018. Singleton, term babies born to women with GDM and no other risk factors for hypoglycaemia, were included. Capillary blood glucose (BG) testing and clinical observations for signs of hypoglycaemia during the first 24-h after birth. BG was checked in all babies before the second feed. Subsequent testing occurred if the first result was < 2.0 mmol/L, or clinical suspicion developed for hypoglycaemia. Neonatal hypoglycaemia, defined as either capillary or venous glucose ≤ 2.0 mmol/L and/or clinical signs of neonatal hypoglycaemia requiring oral or intravenous dextrose (lethargy, abnormal feeding behaviour or seizures).ResultsFifteen of 106 babies developed hypoglycaemia within the first 24-h. Maternal and neonatal characteristics were not predictive. All babies with hypoglycaemia had an initial capillary BG ≤ 2.6 mmol/L (Area under the ROC curve (AUC) 0.96, 95% Confidence Interval (CI) 0.91–1.0). This result was validated on a further 65 babies, of whom 10 developed hypoglycaemia, in the first 24-h of life.ConclusionUsing the 2.6 mmol/L threshold, extended monitoring as an inpatient could have been avoided for 60% of babies in this study. Whilst prospective validation is needed, this approach could help tailor postnatal care plans for babies born to mothers with GDM.

Reliability of continuous glucose monitoring system in the inpatient setting

Aims/HypothesisHyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the inpatient setting. Standard point of care capillary glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. The goal of this study was to examine the relationships between the glucose readings obtained by a continuous glucose monitoring system (CGMS) (Freestyle Libre) and the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) as well as between CGMS readings and the serum glucose values obtained by the hospital laboratory. Study participants had either primary or secondary diagnosis of diabetes mellitus and were admitted to non-critical units. We hypothesized that there exists an acceptable agreement between the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) and the readings obtained by the CGMS (Freestyle Libre); and that there exists an acceptable agreement between the serum glucose levels and the glucose values obtained by the CGMS. MethodsThis was an Institutional Review Board approved prospective cohort study for the non– critical inpatient setting. Fifty-two hospitalized patients with diabetes were recruited. After informed consent was obtained, patients were instructed on the application and use of the CGMS. The data were assessed using a standard regression analysis and modified Bland Altman analysis. All analyses were conducted using SAS, release 3.8 Enterprise Edition (SAS Institute Inc., Cary, NC). ResultsFifty-two subjects recruited into the study represented a sample of convenience. There were a total of 467 AccuChek-Libre pairs, The regression analysis showed a negative bias between.Libre and AccuChek, R2 = 0.83, with Libre glucose readings on average being lower than those of AccuChek. Using Bland-Altman analysis, 42% of the 467 Libre-AccuChek pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and AccuChek was 15.6%; mean relative difference (MRD) between Libre and AccuChek was −11.4%.The regression analysis showed a negative bias between Libre and serum glucose, R2 = 0.89. Using Bland Altman analysis, 36% of the 44 Libre-serum pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and serum glucose was 13.2%; mean relative difference (MRD) between Libre and serum glucose was −12.5%.A review of the data pairs showed that 71/467 Accuchek-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl (combined American Diabetes Association-ADA-, American College of Physicians-ACP- and American College of Endocrinology-AACE- goals). Thus 85%, of these pairs would have yielded results that engendered the same intervention (e.g. treatment for hypoglycemia or hyperglycemia). Likewise 5/45 Serum-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl; thus 89% of these pairs would have yielded results requiring the same intervention. Conclusion/InterpretationThese findings confirm the existent literature and indicate acceptable agreement between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS over capillary blood glucose testing (reduced patient discomfort and reduced staff exposure to patients in isolation) CGMS use may be preferable to the current bedside capillary blood glucose testing in hospitalized patients with diabetes mellitus. As with other laboratory measures, clinical judgement needs to be exercised when the laboratory values are used to guide patient care.

631-P: Reliability of the Freestyle Libre Continuous Monitoring System in the Inpatient Setting: Implications for the COVID-19 Surge

Introduction: Standard point of care capillary blood glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. This technique is associated with increased staff/patient contact and patient discomfort. We examined the correlation of the capillary blood glucose results obtained by the POCT device (Accuchek Inform II) with the serum glucose values obtained by the hospital laboratory and with the glucose readings obtained by the FDA-waived for in-patient use (because of COVID-19 pandemic) Freestyle Libre continuous glucose monitoring system (CGMS). Methods: For this prospective cohort study fifty-two adult participants who were diagnosed with diabetes mellitus and admitted to non-critical units were recruited. Among them, 41 (79%) were male, 50 (96%) had type 2 diabetes mellitus. CGMS sensors were placed on patients’ arms, POCT and serum glucose measurements were taken as ordered. Descriptive statistics were calculated and linear mixed models were used to determine correlation. Results: There were a total of 467 Accuchek-Libre pairs with a highly statistically significant association between pairs, p&amp;lt;0.0001. There were also 44 serum glucose -Libre pairs, with a highly statistically significant association, p&amp;lt;0.0001. On average, for each unit increase in Libre glucose level, there was a 0.92 unit increase in Accuchek glucose level as well as a 1.05 unit increase in serum glucose level. Conclusion: These findings indicate excellent correlation between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS glucose readings over blood capillary glucose testing (reduced patient discomfort and reduced staff exposure to patients during the pandemic) hospitals should consider replacing capillary blood glucose testing with CGMS. Disclosure R. Murray-bachmann: None. K. Ziskovich: None. M. Sarbanes: None. T. Leung: None. A. Myers: None. S. Murthi: None. L. Poretsky: None.

613-P: Performance Evaluation of Dexcom G6 Continuous Glucose Monitoring and Capillary Blood Glucose after Hospital Discharge in Patients with Diabetes

The efficacy of continuous glucose monitoring (CGM) after hospital discharge in patients with diabetes (DM) has not been established. This prospective pilot study compared glycemic outcomes between capillary blood glucose (CBG) and CGM after hospital discharge. At discharge, a blinded Dexcom G6 CGM was inserted in 82 patients with DM. Patients were asked to perform CBG testing (3-4/d) and to return the CBG logs and CGM device after 10 days of discharge. Patients were treated with insulin ± oral antidiabetic agents and followed by their primary care team. A total of 65 patients (73.3%) returned their CGM and were included (age 58.3±11 years, 56% Males, HbA1c 8.7±2%, 98% DM2). Only 42 patients (51.2%) returned CBG logs (mean 3.01±0.9 CBG/d). CGM detection of hypoglycemia Disclosure R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. M. C. Perez-guzman: None. S. Cardona: None. F. J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Research Support; Self; Dexcom, Inc., Merck & Co., Inc. L. Peng: None. G. E. Umpierrez: Research Support; Self; AstraZeneca, Dexcom, Inc., Novo Nordisk. G. Davis: None. T. Idrees: None. M. A. Urrutia: None. K. W. Zamudio: None. B. S. Albury: None. A. Migdal: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Fayfman: None. Funding Dexcom, Inc.