Capillary Blood Glucose Values Research Articles

Comparison of Point Accuracy Between Two Widely Used Continuous Glucose Monitoring Systems.

Safe and effective self-management of glucose levels requires immediate access to accurate data. We assessed the point accuracy of the Dexcom G7 Continuous Glucose Monitoring System (Dexcom, Inc., San Diego, CA, USA) and FreeStyle Libre 3 (Abbott Diabetes Care, Alameda, CA, USA) sensors in a head-to-head comparison. Multicenter, single-arm, prospective, nonsignificant risk evaluation enrolled adults (≥ 18 years) with diagnosed type 1 diabetes (T1D) or type 2 diabetes (T2D). Accuracy was assessed by comparing sensor data to laboratory reference values Yellow Springs Instrument [YSI] and capillary blood glucose values. Outcome measures were differences in mean absolute relative difference (MARD), number and percentage of matched glucose pairs within ±20 mg/dL/±20 of reference values within glucose ranges: < 54, 54 to 69, 70 to 180, 181 to 250, > 250 mg/dL, and combined. Data from 55 adults were included in the analysis. Analysis showed significantly lower MARD with the FreeStyle Libre 3 sensor vs the Dexcom G7 sensor (8.9% vs 13.6%, respectively, P < .0001) with a higher percentage of glucose values within ±20 mg/dL/±20 of reference (91.4% vs 78.6%). The MARD values for both continuous glucose monitoring (CGM) sensors were similar during the first 12 hours; however, the FreeStyle Libre 3 MARD was notably lower than the Dexcom G7 MARD during the next 12 hours (10.0% vs 15.1%, respectively, P < .0001) and throughout the study period. The FreeStyle Libre 3 sensor was more accurate than the Dexcom G7 sensor in all metrics evaluated throughout the study period. This is the first head-to-head study to our knowledge that compares the flagship products currently in widespread use of the two largest CGM manufacturers.

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.

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)

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

Improving Intrapartum Glycemic Control Using a Software-Driven Insulin Infusion Protocol

Our research question asked whether a software-driven insulin program, GlucoStabilizer, provides better glycemic control during labor than a paper-driven protocol. For changes in infusion dosing based on patient response to insulin, we believe this software will provide less opportunity for human error, thus improving glycemic control. GlucoStabilizer is an FDA-approved software for managing insulin infusions in the hospital. This tool has been validated in critical care settings and has been shown in multiple studies to be superior to paper protocols. Literature on GlucoStabilizer use in women giving birth includes one study. GlucoStabilizer was superior in achieving lower mean capillary blood glucose values and glucose values in target range at delivery compared with standard insulin infusions. A study of this software in obstetric patients supports the mission of the Association of Women’s Health, Obstetric and Neonatal Nurses of using research to empower and support nurses who care for women.

Prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019.

Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02-1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49-5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24-5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29-6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75-3.59; p = 0.004) were statistically associated with hyperglycemia. The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

IDF21-0470 Neither plasma glucose at admission nor in-hospital hyperglycaemia predict poor clinical outcomes in COVID-19 patients

Background: Diabetes mellitus and hyperglycaemia are associated with poor outcomes in COVID-19, however, the predictors of clinical outcomes are variable across all the available studies. Besides, data from the Indian subcontinent are limited in this regard. Aim: To compare clinical outcomes in COVID-19 patients with and without hyperglycaemia and delineate the clinical and biochemical predictors in a cohort of adults hospitalized at a tertiary care institution in India. Method: In this prospective single-center cohort study, consecutive adults (≥18 years) admitted with PCR-proven diagnosis of COVID-19 between December 2020 and March 2021 were recruited. Patients who had received glucocorticoids prior to present admission were excluded. Complete blood count, biochemical/coagulation panel, random plasma glucose (RPG), C-reactive protein (CRP), interleukin-6, ferritin, lactate dehydrogenase (LDH), creatine kinase, troponin I, pro-brain natriuretic peptide, procalcitonin, glycated hemoglobin (HbA1c), thyroid function test, cortisol and 25-hydroxyvitamin D were estimated within 24 h of admission. Patients with a prior history of type 2 diabetes (T2D) were categorized as pre-existing diabetes (preDM). In those without a prior history of diabetes, an admission HbA1c ≥6.5% was categorized as new-onset diabetes (newDM); a normal HbA1c with admission RPG > 140 mg/dl was classified as new-onset hyperglycaemia (newGly). Patients with normal HbA1c/RPG at admission were grouped as having normoglycaemia (normoGly). In-hospital hyperglycaemia was defined as any 2 consecutive random capillary blood glucose (CBG) values >180 mg/dl. The primary outcome was a composite of in-hospital death and/or need for invasive mechanical ventilation (death/IMV). Results: A total of 440 COVID-19 patients were included (mean age 51.1 ± 16.9 years; M:F=1.5:1). At admission, 36%, 13%, 13% and 38% of patients had preDM, newDM, newGly and normoGly, respectively. Overall, 62% had hyperglycaemia at admission (preDM+newDM+newGly). One hundred patients (22.7%) meet with death/IMV. Patients with hyperglycaemia at admission had a higher chance of death/IMV than those with normoGly (78% vs. 28%, p = 0.017). No significant difference in death/IMV was observed in those with and without in-hospital hyperglycaemia (62% vs. 38%, p = 0.063). On binomial logistic regression, the following clinical/biochemical parameters at admission were predictive of death/IMV: SpO2 (OR 0.92, 95% CI: 0.85–1.00, p = 0.050), requirement of non-rebreather mask as compared to non-requirement of oxygen (OR 4.59, 95% CI: 1.67-12.64, p = 0.003), total leukocyte count (OR 1.10, 95% CI: 1.02–1.19, p = 0.013), platelet count (OR 0.995, 95% CI: 0.991–0.998, p = 0.003), albumin (OR 0.30, 95% CI: 0.13-0.69, p = 0.005), thyroxine (T4) (OR 0.82, 95% CI: 0.68–0.99, p = 0.045) and cortisol (OR 1.002, 95% CI: 1.000–1.003, p = 0.008).Notably, RPG at admission, in-hospital hyperglycaemia, age, sex, use of steroids/remdesivir/tocilizumab in hospital and choice of in-hospital anti-diabetic drugs were not predictive of death/IMV on binomial logistic regression analyses. Discussion: Although COVID-19 patients with hyperglycaemia at admission tend to have poor clinical outcomes, neither plasma glucose at admission nor in-hospital glycemic status are reliable prognostic markers. Factors other than ambient plasma glucose might be operational in dictating poor clinical outcomes in COVID-19 patients with hyperglycaemia and diabetes mellitus.

A Case of Non-Islet Cell Tumor Hypoglycemia in Metastatic Solitary Fibrous Tumor

Abstract Introduction: Insulin like growth factor (IGF-2) mediated hypoglycemia secondary to solitary fibrous tumor (SFT), also known as Doege-Potter syndrome is a rare paraneoplastic syndrome. The tumor cells produce large amounts of high molecular weight IGF 2 precursor protein called “big IGF-2” which binds to insulin and IGF receptors in liver, muscle and other peripheral tissues. This causes reduced gluconeogenesis and increased uptake of glucose by the muscle and other tissues leading to hypoglycemia. Big IGF-2 also exerts central negative feedback of growth hormone causing reduction of IGF-I production. Most SFTs are benign and localized (approximately 78-88%). As a result, tumor excision alone would often lead to resolution of the hypoglycemia. We present a case of metastatic SFT with multiple metastasis managed with oral prednisone. Clinical Case: A 44-year-old man with metastatic SFT presented with bilateral humeral fractures. He has known metastatic disease to the brain, lung, liver, bony lytic lesions over a course of eleven years. It has progressed despite multiple chemotherapy and radiation therapies. Prior to admission, he had multiple syncopal episodes associated with fasting hypoglycemia. He reported capillary blood glucose values ranging between 30-50 mg/dl during these episodes which would improve after drinking juice or eating candy. There was no history of diabetes mellitus or use of oral hypoglycemic agents or insulin. On admission, he had a capillary blood glucose value of less than 20 mg/dl, which was confirmed by a serum glucose value of 18 mg/dl on basic metabolic panel. His renal, liver and thyroid function tests were normal. Significant labs include: serum glucose 17 mg/dl, C-peptide &amp;lt;0.10 ng/ml (n: 1-4 ng/ml), serum insulin &amp;lt;1.6 Uu/ml (n: &amp;lt;20 Uu/ml), beta-hydroxybutyrate &amp;lt;0.2 mmol/L (n: &amp;lt;0.3), cortisol 10.8 ug/dl(n: 5-15 ug/dl) glucagon 6 pg/ml(ref 8-57 pg/ml), insulin-like growth factor-1 (IGF 1) 20 ng/ml (n: 52-328), and IGF-2 level 380 ng/ml (267-616 ng/ml), improvement in blood glucose from 46 to 111 mg/dl after 1-gram glucagon administration. The IGF-2/IGF-1 ratio of 19 confirmed our clinical suspicion of non-islet cell tumor hypoglycemia (NICTH). He was started on prednisone 20 mg twice daily with marked improvement in hypoglycemia. Conclusion: NICTH is a rare cause of hypoglycemia and should be considered in the differential while evaluating hypoglycemia in malignancy. For diagnosing NICTH, assays for big IGF-II are not commercially available. However, the IGF-II:IGF-I ratio is considered to be a surrogate marker of big IGFII concentration. The normal ratio is 3 and ratio &amp;gt;10 is diagnostic of NICTH. In cases like ours where tumor resection is not possible, glucocorticoids are most effective in management of hypoglycemia by inhibiting big IGF2 production and stimulating gluconeogenesis.

Nocturnal Hypoglycaemia in Patients with Diabetes Mellitus: Database Analysis of a Cohort Using Telemedicine Support for Self-Monitoring of Blood Glucose over a 10-Year-Long Period.

Background and Objectives: In patients with diabetes mellitus, hypoglycaemic episodes, especially during night hours, carry a significant risk. Data about the occurrence of nocturnal hypoglycaemia in real-world settings are of clinical importance. The aim of our study was to evaluate the occurrence of nocturnal hypoglycaemia among patients with diabetes using self-monitoring of blood glucose (SMBG) with telemedicine support. Materials and Methods: We retrospectively analysed the central database of an internet-based supportive system between 2010 and 2020 when 8190 SMBG users uploaded nearly 10 million capillary blood glucose values. Nocturnal hypoglycaemia was defined as capillary blood glucose < 3.0 mmol/L measured between 00:00 and 05:59 h. Results: The database contained 914,146 nocturnal blood glucose values from 7298 users; 24,623 (2.7%) glucose values were below the hypoglycaemic threshold and 2363 patients (32.4%) had at least one hypoglycaemic glucose value. Nocturnal hypoglycaemia was more often found in patients with type 1 vs. type 2 diabetes (n = 1890 (80.0%) vs. n = 387 (16.4%), respectively). Hypoglycaemic blood glucose values were most frequently observed in the age group of 10.0–19.9 years (n = 481 (20.4%)). Patients with nocturnal hypoglycaemia were mostly on insulin treatment (1854 (78.5%) patients with 20,727 (84.1%) hypoglycaemic glucose values). Only 356 patients (15.1%) with nocturnal hypoglycaemia performed a retest within 120 min. Within a one-day-long (1440 min) timeframe, the elapsed median time until a retest, yielding a safe blood glucose value (>3.9 mml/L), was 273 min (interquartile range: 157–300 min). Conclusions: Nocturnal hypoglycaemia should be considered as a persisting challenge to antihyperglycaemic treatment in patients living with diabetes. Continuous efforts are needed to improve both antihyperglycaemic treatment and patient education for preventing nocturnal hypoglycaemia, and to act adequately if hypoglycaemic values are detected.

820 The GuMDROP study: current practices in gestational diabetes mellitus treatment in the United States

To survey MFMs who manage patients with gestational diabetes mellitus (GDM) in order to quantify the ‘provider’s discretion’ for the transition from diet and exercise alone to pharmacotherapy. A survey of 29 questions was designed and validated with 7 cognitive interviews of GDM providers (General OB, MFM, Endocrinology). The survey was disseminated in partnership with SMFM in Special Delivery newsletter to SMFM members. 466 SMFM members completed the survey, representing 51/53 states/territories and treating an average of 15-20 patients with GDM per month. 94% regularly diagnose GDM based on two-step criteria while only 9% regularly diagnose based on one-step (2-hour 75g OGTT). 99.8% regularly initiated GDM treatment with diet, with 34% allowing 1 week, 31% allowing >1 to <2 weeks and 33% allowing 2 weeks, for it to take effect before adding pharmacotherapy. 97% considered both fasting & post-prandial values in their decision to initiate pharmacotherapy, with 44% considering fasting values more important and 55% weighing both equally (Table 1). In a typical patient with GDM, 28.8% of MFMs initiate pharmacotherapy at 20% elevated capillary blood glucose (CBG) values, and 46.5% initiate pharmacotherapy at 25% elevated CBG values. Majority initiate pharmacotherapy at 30% elevated CBG values (Figure 1). When selecting the choice of pharmacotherapy, 65.4% of MFMs would initiate therapy with insulin and 26.7% with oral antidiabetic medication. The remainder perform shared decision-making on the type of pharmacotherapy with the patient. Among MFMs that select oral antidiabetic as first line pharmacotherapy, 81.8% prescribe Metformin. 79.4% of respondents endorsed an official statement providing evidence-based recommendations for pharmacotherapy initiation for GDM would be very or moderately useful to their practice. The survey showed marked heterogeneity in the threshold of elevated CBG values prior to initiating GDM pharmacotherapy with an inflection point for the majority of MFMs adding pharmacotherapy between 25-30% elevated CBG values.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalencia de hiperglicemia y su relación con el tiempo de estadía en un hospital terciario

BACKGROUND Hyperglycemia during hospital stay is associated with adverse outcomes. AIM To characterize the frequency of hyperglycemia in a tertiary hospital and to correlate it with length of hospital stay (LOS). MATERIAL AND METHODS Review of medical records of hospitalized patients. Demographic data and laboratory data, previous diabetes mellitus (DM) history, current main diagnosis, unit of hospitalization and the two highest capillary blood glucose values from the analyzed period were recorded for each patient. LOS was obtained from electronic clinical records. RESULTS 210 subjects, aged 60 ± 19 years (104 women) were included. 113 patients (54%) developed hyperglycemia ≥ 140 mg/L. Thirty one percent of these had a previous history of diabetes and 29% had stress hyperglycemia (SHG). Patients with a history of DM had a higher average blood glucose than those with SHG (238.9 and 178.2 mg/dL, respectively, p < 0.01) and a greater percentage of cases with a blood glucose above 180 mg/dL (72 and 40.0%, respectively, p < 0.01). Hospital LOS was significantly longer in patients with hyperglycemia ≥ 140 mg/dL as compared with those with normoglycemia (29.3 and 12.8 days, respectively, p < 0.01). This association remained significant when introduced in a linear regression analysis including diagnosis, decreased glomerular filtration rate (GFR) and hospitalization unit (p < 0.01). CONCLUSIONS Hyperglycemia during hospitalization affects more than half of hospitalized patients and is associated with a longer length of stay.

Utility of an Internet-based short message service in the care of children and adolescents with type 1 diabetes mellitus

Objective: To evaluate the impact of an internet-based intervention system and a short message service (SMS) using cellular phones on the diabetes care and glycemic control in children and adolescents with type 1 diabetes mellitus (DM). Materials and Methods: Observational study in children with type 1 DM on basal bolus regimen. After administering diabetes care education children were divided in 2 groups, group I received timely SMS on diabetes care and group II did not. At the end of 3 months detailed data of diabetes care was recorded. Analysis was done using Statistical Package for the Social Sciences. Results: In a total of 42 children, group I (21) who received the SMS and group II (21), completed the follow-up period of 3 months were included in the study. There was marginal improvement in glycosylated hemoglobin in group I (from 9.2 ± 1.7 to 8.8 ± 1.2); and a minimal increase observed in group II (from 8.8 ± 1.8 to 9.4 ± 1.9) (P > 0.05). The percentage of capillary blood glucose (CBG) values below and above the target range, mean CBG, frequency of self-monitoring blood glucose, significantly improved compared to the control group (P < 0.05). Conclusion: SMS-based education program lead to a significant improvement in self-monitoring blood glucose frequency, diabetes self-care and marginal increase in glycemic control.

The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus

BackgroundThe decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes.MethodsThis was a retrospective cohort study of women with GDM delivering in a single tertiary care center. Pregnancy outcomes were compared using bivariable and multivariable analyses between women who started pharmacotherapy (insulin or oral hypoglycemic agent) after a failed trial of dietary modifications at two different ranges of elevated capillary blood glucose (CBG) values: Group 1 when 20–39% CBG values were above goal; Group 2 when ≥40% CBG values were above goal. The primary outcome was a composite GDM-associated neonatal adverse outcome that included: macrosomia, large for gestational age (LGA), shoulder dystocia, hypoglycemia, hyperbilirubinemia requiring phototherapy, respiratory distress syndrome, stillbirth, and neonatal demise. Secondary outcomes included cesarean delivery, preterm birth (< 37 weeks), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA).ResultsA total of 417 women were included in the study. In univariable analysis, the composite neonatal outcome was statistically significantly higher in Group 2 compared to Group 1 (47.9% vs. 31.4%, p = 0.001). In addition, rates of preterm birth (15.7% vs 7.4%, p = 0.011), NICU admission (11.7% vs 4.0%, p = 0.006), and LGA (21.2% vs 9.1% p = 0.001) were higher in Group 2. In contrast, higher rates of SGA were noted in Group 1 (8.0% vs. 2.9%, p = 0.019). There was no difference in cesarean section rates. These findings persisted in multivariable analysis after adjusting for confounding factors (composite neonatal outcome aOR = 0.50, 95%CI [0.31–0.78]).ConclusionsInitiation of pharmacotherapy for GDM when 20–39% of CBG values are above goal, compared to ≥40%, was associated with decreased rates of adverse neonatal outcomes attributable to GDM. This was accompanied by higher rates of SGA among women receiving pharmacotherapy at the lower threshold. Additional studies are required to identify the optimal threshold of abnormal CBG values to initiate pharmacotherapy for GDM.

Gingival Crevicular Blood Glucose Evaluation in Patients with Periodontitis: Evolution of A New Screening Technique

OBJECTIVE: The aim and objective of this study was to assess if gingival crevicular blood could be utilized for blood glucose evaluation in patients with periodontitis and to check the reliability of this screening method. METHODOLOGY: The study was conducted at the department of Oral Medicine, Ziauddin Dental Hospital, Karachi. The sample size involved 348 participants with chronic periodontitis. The gingival crevicular blood produced during periodontal probing was collected on a glucometer strip to assess random glucose levels. Glycemic levels were also checked by finger capillary blood via a glucometer. Intravenous blood glycated hemoglobin A1c test was performed in patients found with blood glucose levels in pre-diabetic or diabetic range. RESULTS: The results of this study demonstrate a strong correlation (0.987, p&lt; 0.001) between gingival crevicular blood and finger capillary blood glucose values and good correlation (0.709, p&lt;0.001) between gingival crevicular bloodglucose and glycated Hemoglobin A1c levels. Receiver operating characteristic curve showed 94.1% sensitivity and 100% specificity of GCB glucose screening at the cut-off value of 168mg/dl. Gingival crevicular blood glucose showed significant regression with Finger capillary bloodglucose (R=0.987, R2=0.974, p&lt;0.001) andglycated hemoglobin A1clevels (R=0.709, R2=0.502, p&lt;0.001). CONCLUSIONS: From this study we conclude that gingival crevicular blood can be relied upon for screening of blood glucose levels in periodontitis patients presenting with bleeding on probing. KEYWORDS: Blood glucose, Diabetes Mellitus, Gingival Crevicular blood,Inflammation, Periodontitis. HOW TO CITE: Saeed Q, Memon S, Hosein M. Gingival crevicular blood glucose evoluation in patients with periodontitis: Evolution of a new screening technique. J Pak Dent Assoc 2020;29(4):193-198.

Risk factors for systemic arterial hypertension: Evaluation of the effectiveness of health education actions

Systemic Arterial Hypertension is the most frequent of cardiovascular diseases and responds as the main risk factor for the most common complications, such as stroke and acute myocardial infarction, in addition to end-stage chronic kidney disease. Health education is the main tool for changes in habits and lifestyle, fundamental in the preventive process for this pathology. The aim of this research was to analyze the influence of educational actions in health on systemic arterial hypertension in the change of lifestyle of the servants of the Court of Justice of the State of Amapá. The study had the participation of 255 servers and a questionnaire was used for data collection, which were analyzed through SPSS version 22 (IBM SPSS, USA). It was observed that 54.1% were female, 66.3% brown, 33.7% aged between 40 and 49 years, 47.8% had higher education and 59.6% were married or lived in a stable union. The Body Mass Index showed that 48.2% were overweight, 64.7% had increased abdominal circumference and 10.6% had capillary blood glucose values ≥ 99 mg/dL. Regarding blood pressure, 33.3% of men and 21.7% of women had PA ≥ and 140 and/or 90 mmHg. Regarding participation in some preventive or educational activity, 76.1% stated that yes, of which 60.4% considered them satisfactory and 44.7% considered that there was no influence on lifestyle change. It was concluded that health education actions are partially impacting on the change in the habits of employees, because the indexes of risk factors still raise concern.

Experience with Real-Time Continuous Glucose Monitoring in Newborns with Congenital Hyperinsulinemic Hypoglycemia

Effective treatment and close monitoring of hypoglycemia in children with congenital hyperinsulinemic hypoglycemia (CHH) is vital to prevent brain damage. The current use of capillary sampling schedules does not provide a comprehensive assessment of glycemic status and fails to detect asymptomatic hypoglycemia episodes. To investigate the efficacy and accuracy of a real-time continuous glucose monitoring system (RT-CGMS) in neonates with CHH. A sensor connected to RT-CGMS was inserted into the newborn patients and maintained for at least 6 days during their stay in the hospital. We compared the readings of CGMS with capillary blood glucose values using Bland-Altman analysis. A total of 110 blood glucose values were compared to readings from the CGMS. All results were calculated and plotted for CGMS values at 0-4, 5-9, 10-14, 15-19, 20-24, and 25-29 min after capillary blood glucose sampling. CGMS readings were highly correlated with blood glucose values, especially during normoglycemia. In case of hypoglycemia, the mean difference between the CGMS and capillary glucose values was higher. Although the false positive rate for hypoglycemia was relatively high in CGMS, RT-CGMS may show some episodes of hypoglycemia earlier than blood measurement. RT-CGMS is accurate during normoglycemia, and it can reduce the number of capillary blood samples in children with CHH.

A comparative study of Venous and Capillary blood glucose in a Tertiary Care Hospital

Introduction: The cornerstone of providing optimum diabetic care in a tertiary care hospital is monitoring of glycemic status of the patient by the health care provider. Bed-side monitoring helps in achieving the glycemic goals in admitted patients. But it is important that the glucometer being used is accurate, calibrated and the values obtained from glucometer are as near as to the plasma glucose values obtained in the laboratory. Above factors can lead to unnecessary change in treatment which might result in hyper or hypoglycemia, which is a life-threatening situation and most common complication of diabetes. Therefore correlation in capillary and venous blood glucose will definitely help in better management of patients, especially in Intensive Care Units (ICUs). Aims and Objectives:The present study was done to determine the mean difference and correlation between capillary and laboratory venous plasma glucose estimation. Material and Methods: The study was carried out in a tertiary care hospital in Meerut. Total 373 subjects (176 males and 197 females) including 149 cases with altered glucose levels and 224 control subjects were studied. After overnight fasting, capillary blood glucose by glucometer and venous plasma glucose by Siemens autoanalyzer were estimated from all subjects, aged above 18 years. Both samples were taken at the same time. Mean difference and correlation coefficient were determined. Results:It was observed that there was a significant difference between capillary and venous blood glucose values. The capillary blood glucose value on an average was 10.19% higher than venous blood glucose values. Conclusion: According to the results obtained, it was concluded that glucometer, as a sole measuring device in a hospital setup, is not satisfactory. The venous blood glucose is a better indicator and is of utmost importance for confirmatory results. This is also of utmost importance in deciding the dose of insulin in diabetic patients who are on insulin infusion.

Evaluation of the Abbot FreeStyle Optium Neo H blood glucose meter in the hyperbaric oxygen environment.

This study investigated the effects of hyperbaric oxygen treatment (HBOT) on the accuracy and reliability of point-of-care fingertip capillary blood glucose values in euglycaemic non-diabetic participants compared against venous serum blood glucose samples processed in an accredited pathology laboratory. Ten non-diabetic hyperbaric staff members (age 35-55 years) underwent a standard 243 kPa HBOT exposure for 95 minutes. Blood glucose levels were measured via (i) finger-prick capillary test using the FreeStyle Optium™ Neo H glucometer and (ii) venous serum test using the Cobas 6000 laboratory analyser. Samples were taken at (T1) 0 minutes (pre-HBOT), (T2) 25 minutes, and (T3) 55 minutes into HBOT. All participants were euglycaemic at T1 (BGL 3.8-5.4 mmol·L⁻¹). The highest venous serum value was 5.90 mmol·L⁻¹ at T3 and the highest capillary value was 6.30 mmol·L⁻¹ at T1. Post hoc tests showed a statistically significant difference between the mean capillary result pre-dive (T1) and readings at T2 (P = 0.001) and T3 (P < 0.001) while differences between T2 and T3 capillary results were not statistically significant, illustrating the effect of HBOT on capillary beds. Differences in venous values across the time points were not significant. Venous serum glucose samples processed in an accredited laboratory may be more consistently accurate, but capillary point-of-care testing avoids delays in sample processing and provides glucose data that are of clinical relevance. The FreeStyle Optium™ Neo H glucometer is safe to use and provides a reliable measurement of blood glucose in the HBOT environment.

Utilização do Finnish Diabetes Risk Score (FINDRISC) como ferramenta para identificação, prevenção e conscientização da diabetes mellitus em adultos da cidade de Santos

Avaliar a funcionalidade da ferramenta Finnish Diabetes Risk Score (FINDRISC) na identificação, prevenção e conscientização da Diabetes mellitus tipo2 (DM2) na cidade de Santos. Trata-se de um estudo transversal, analítico e descritivo. Foram avaliadas 96 pessoas e os participantes foram entrevistados, realizou-se a aferição da pressão arterial (PA), medições antropométricas, glicemia capilar de jejum (GCJ) e analisados os resultados obtidos no FINDRISC. Para análise estatística, aplicaram-se nos dados a análise de variância e teste do qui-quadrado. A prevalência de DM2 foi de 17%. Entre os fatores de risco modificáveis as maiores prevalências foram: Circunferência abdominal alterada (86%), IMC&gt;25kg/m² (75%), PA alterada (57%) e GCJ&gt;100mg/dL (48%). A maior associação para ocorrência de DM2 foi “antecedentes familiares” com aumento de risco em 3,3 vezes (P&lt;0,02). Dos entrevistados que afirmaram não ter diagnóstico de DM2, 40% estava com o valor de GCJ acima de 100 mg/dL e 7,5% da amostra com valores acima de 126mg/dL sendo que destes, 85% apresentavam risco elevado em desenvolver DM2 pela pontuação FINDRISC. Os resultados demonstram a eficácia da ferramenta FINDRISC em identificar DM2 e a necessidade da realização das campanhas preventivas ou de promoção de saúde para o rastreamento e orientação de pessoas com elevado risco.

Characterizing Perioperative Blood Glucose on an Enhanced Recovery After Surgery Pathway for Cesarean Delivery [06P

INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways are standardized, evidence-based approaches to the care of surgical patients. One component of ERAS pathways is maintaining euglycemia pre- and post-operatively. METHODS: We conducted an IRB approved retrospective cohort study evaluating capillary blood glucose (CBG) values among women on the ERAS cesarean delivery pathway (ERAS CD) during the first year of implementation (4/1/2017–3/31/2018, n=531). Pregestational diabetics on insulin prior to pregnancy were excluded. ERAS CD pathway patients received a pre-op, 1-hour post-op, and post-op day 1 and 2 CBG. We calculated average CBG and percentage of time in-range, defined as any CBG between 70–140 mg/dL for all patients on the ERAS CD pathway, and stratified for type 2 diabetics (T2DM), gestational diabetics (GDM), and non-diabetics. RESULTS: Most patients had CBGs in-range preoperatively (n=268, 95.4%): 89.6% for T2DM, 89.8% for GDM, and 97.1% for non-diabetics. The average pre-op CBG was 87.5±15.7 mg/dL overall, 96.2±30.4 mg/dL for T2DM, 90.4±17.0 mg/dL for GDM, and 86.4±14.8 mg/dL for non-diabetics. Post-operatively, 94.3% (n=502) of patients had CBGs in-range: 66.8% for T2DM, 87.1% for GDM, and 95.5% for non-diabetics. The average post-op CBG was 90.9±17.8 mg/dL overall, 99.2±26.6 mg/dL for T2DM, 94.9±20.6 mg/dL for GDM, and 90.2±17.2 mg/dL for non-diabetics. CONCLUSION: Preoperatively most patients had in-range CBGs. Postoperatively, CBGs for non-diabetics and GDM remained primarily in-range, while CBGs for T2DM were more variable. For non-diabetic women it may not be useful to check pre- or post-operative CBGs as most will be within range. Further studies are needed to evaluate this aspect of care.