Capillary Plasma Glucose Research Articles

Analytical Performance of the FreeStyle Libre 2 Glucose Sensor in Healthy Male Adults.

Continuous Glucose Monitoring (CGM) not only can be used for glycemic control in chronic diseases (e.g., diabetes), but is increasingly being utilized by individuals and athletes to monitor fluctuations in training and everyday life. However, it is not clear how accurately CGM reflects plasma glucose concentration in a healthy population in the absence of chronic diseases. In an oral glucose tolerance test (OGTT) with forty-four healthy male subjects (25.5 ± 4.5 years), the interstitial fluid glucose (ISFG) concentration obtained by a CGM sensor was compared against finger-prick capillary plasma glucose (CPG) concentration at fasting baseline (T0) and 30 (T30), 60 (T60), 90 (T90), and 120 (T120) min post OGTT to investigate differences in measurement accuracy. The overall mean absolute relative difference (MARD) was 12.9% (95%-CI: 11.8-14.0%). Approximately 100% of the ISFG values were within zones A and B in the Consensus Error Grid, indicating clinical accuracy. A paired t-test revealed statistically significant differences between CPG and ISFG at all time points (T0: 97.3 mg/dL vs. 89.7 mg/dL, T30: 159.9 mg/dL vs. 144.3 mg/dL, T60: 134.8 mg/dL vs. 126.2 mg/dL, T90: 113.7 mg/dL vs. 99.3 mg/dL, and T120: 91.8 mg/dL vs. 82.6 mg/dL; p < 0.001) with medium to large effect sizes (d = 0.57-1.02) and with ISFG systematically under-reporting the reference system CPG. CGM sensors provide a convenient and reliable method for monitoring blood glucose in the everyday lives of healthy adults. Nonetheless, their use in clinical settings wherein implications are drawn from CGM readings should be handled carefully.

Capillary versus Venous Glucose for the Screening 1-Hour Glucose Tolerance Test for Gestational and Pregestational Diabetes

Purpose: This study aimed to assess for disparities between capillary blood glucose and plasma glucose for the O’Sullivan 1-hour glucose tests. Methodology: Subjects included were English-speaking, non-incarcerated, adult (&gt;18 years old) pregnant patients who could give informed consent. Patients were approached at their outpatient obstetric office visits. After receiving written and verbal consent, patients were given a 50-g glucose load at the conclusion of their clinic visit. Strictly timed venous and capillary blood draws were performed at the outpatient labs. The venous and capillary blood samples were drawn within less than 5 minutes of each other and analyzed using select chemistry analyzers within less than one hour. Quality control measures, including recalibration, testing, and various quality control mechanisms, were reassessed every 24 hours. Data was tested for normal distribution with the Shapiro-Wilk test and Kolmogorov-Smirnov tests. Paired T-tests were used to compare the average difference between measurements in subjects on GraphPad. Results: One hundred patients had enrolled in the study, with ten dropping out soon after being consented. Patients were lost due to nausea and vomiting with the 50-gram glucose load (4 patients) and scheduling conflicts (6 patients). Demographics identified 84% as African American (76/90), average body mass index (BMI) being 35.4 kg/m2, and a mean age of 26. All data of the differences (capillary minus venous glucose) were found to be normally distributed. The capillary sample was significantly different from the venous sample, with the former being, on average 6.156 mg/dL higher than the latter (P 0.0008, CI 2.65 to 9.66). Subgroup analysis suggested significant differences in values among the multiparous patients (P 0.0014, CI -13.18 to -3.349), with capillary glucose being on average 8.26mg/dL higher. Similarly, patients with BMI &lt; 30 mg/kg had significantly different sample values (P 0.0031, CI -18.75 to -4.25), with capillary glucose being 11.50 mg/dL higher on average. Patients with a gestational age of 24 weeks and beyond also had significantly different samples based on collection site (P 0.0023, CI 2.7 to 11.75), with capillary being on average 7.226 mg/dL higher. Patients with BMI 30.0 to 39.9 had no significant difference between capillary and venous glucose (P 0.2393, CI -8.72 to 2.25), with capillary being 3.24 mg/dL higher on average. Patients with BMI 40 or higher also showed no significant difference between venous and capillary glucose (P 0.1053, CI -10.11 to 1.030), with capillary glucose being on average 4.52 mg/dL higher. Nineteen (21%) patients failed their glucose test based on one or both samples. In 12 patients (13%), the two samples were in agreement for test failure. However, seven patients (7.8%) had discordant results where the glucose was less than 140 mg/dL for one sample and higher for the other. Furthermore, 4 of these patients passed by the venous sample and failed with the capillary, and the reverse in sample source occurred in 3 patients. None of the patients with discordant results failed their 3-hour confirmatory test. Discussion: All pregnant patients undergo gestational diabetes mellitus (GDM) screening, and those with diabetes risk factors such as obesity and a history of GDM undergo early diabetes screening. The two-step approach commonly used in the United States is a one-hour 50-gram oral glucose tolerance test (OGTT) using a venous plasma glucose sample. If a patient fails (glucose &gt; 140 mg/dL), she undergoes a 3-hour OGTT. Other accepted cutoffs for the one-hour OGTT are 135 mg/dL and 130 mg/dL. Venous sampling has some factors which lead to inaccuracy, including ongoing glycolysis in samples and decreased concentration compared to capillary/arterial samples in postprandial patients. Capillary sampling can be inaccurate in patients with microvascular disease such as shock, COPD, and Raynaud’s disease. Our institution uses point-of-care testing (POCT) on capillary (finger-stick) using a glucometer with a 140 mg/dL cutoff. Studies are mixed in their endorsement of POCT for the diagnosis/screening of DM. This study suggests that capillary testing is more sensitive to hyperglycemia in postprandial patients and is more sensitive for non-obese, multiparous, and patients undergoing screening for gestational diabetes at 24 weeks GA and beyond. This study also suggests that if POCT/capillary testing is considered, the higher (140) cutoff may be the best. The findings do not show that there is a significant risk of missing diagnoses of GDM, but a higher incidence of needing 3-hour glucose tolerance testing due to its higher sensitivity.

Performance of the FreeStyle Libre Flash Glucose Monitoring System during an Oral Glucose Tolerance Test and Exercise in Healthy Adolescents.

This study's aim was to assess FreeStyle Libre Flash glucose monitoring (FGM) performance during an oral glucose tolerance test (OGTT) and treadmill exercise in healthy adolescents. This should advance the feasibility and utility of user-friendly technologies for metabolic assessments in adolescents. Seventeen healthy adolescents (nine girls aged 12.8 ± 0.9 years) performed an OGTT and submaximal and maximal treadmill exercise tests in a laboratory setting. The scanned interstitial fluid glucose concentration ([ISFG]) obtained by FGM was compared against finger-prick capillary plasma glucose concentration ([CPG]) at 0 (pre-OGTT), -15, -30, -60, -120 min post-OGTT, pre-, mid-, post- submaximal exercise, and pre- and post- maximal exercise. Overall mean absolute relative difference (MARD) was 13.1 ± 8.5%, and 68% (n = 113) of the paired glucose data met the ISO 15197:2013 criteria. For clinical accuracy, 84% and 16% of FGM readings were within zones A and B in the Consensus Error Grid (CEG), respectively, which met the ISO 15197:2013 criteria of having at least 99% of results within these zones. Scanned [ISFG] were statistically lower than [CPG] at 15 (-1.16 mmol∙L-1, p < 0.001) and 30 min (-0.74 mmol∙L-1, p = 0.041) post-OGTT. Yet, post-OGTT glycaemic responses assessed by total and incremental areas under the curve (AUCs) were not significantly different, with trivial to small effect sizes (p ≥ 0.084, d = 0.14-0.45). Further, [ISFGs] were not different from [CPGs] during submaximal and maximal exercise tests (interaction p ≥ 0.614). FGM can be a feasible alternative to reflect postprandial glycaemia (AUCs) in healthy adolescents who may not endure repeated finger pricks.

Source and Amount of Carbohydrate Affect Postprandial Glucose and Insulin in Normal Subjects

To determine if source and amount of carbohydrate affected postprandial glucose and insulin responses, seven nondiabetic subjects consumed 0, 25, 50, 75 or 100 g carbohydrate (total carbohydrate minus total dietary fiber) portions of barley, spaghetti, bread or potato. By ANOVA, both source and amount of carbohydrate had significant effects on incremental response areas for capillary glucose (P = 0.001), plasma glucose (P = 0.01) and plasma insulin (P = 0.03), but there was no source × amount interaction. By regression analysis, source of carbohydrate explained a similar amount of the variability of glucose and insulin responses, 46–64%, as the amount of carbohydrate, 47–57%. Together, carbohydrate source and amount accounted for 85–94% of the variability of mean glucose and insulin responses. We conclude that, for individual foods with different glycemic indices, both source and amount of carbohydrate influence the postprandial glucose and insulin responses of nondiabetic subjects.

Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden

ObjectiveTo assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance...

The role of TRPC6 calcium channels and P2 purinergic receptors in podocyte mechanical and metabolic sensing.

Podocyte calcium (Ca2+) signaling plays important roles in the (patho)physiology of the glomerular filtration barrier. Overactivation of podocyte transient receptor potential canonical (TRPC) channels including TRPC6 and purinergic signaling via P2 receptors that are known mechanosensors can increase podocyte intracellular Ca2+ levels ([Ca2+]i) and cause cell injury, proteinuria and glomerular disease including in diabetes. However, important mechanistic details of the trigger and activation of these pathways in vivo in the intact glomerular environment are lacking. Here we show direct visual evidence that podocytes can sense mechanical overload (increased glomerular capillary pressure) and metabolic alterations (increased plasma glucose) via TRPC6 and purinergic receptors including P2Y2. Multiphoton microscopy of podocyte [Ca2+]i was performed in vivo using wild-type and TRPC6 or P2Y2 knockout (KO) mice expressing the calcium reporter GCaMP3/5 only in podocytes and in vitro using freshly dissected microperfused glomeruli. Single-nephron intra-glomerular capillary pressure elevations induced by obstructing the efferent arteriole lumen with laser-induced microthrombus in vivo and by a micropipette in vitro triggered >2-fold increases in podocyte [Ca2+]i. These responses were blocked in TRPC6 and P2Y2 KO mice. Acute elevations of plasma glucose caused >4-fold increases in podocyte [Ca2+]i that were abolished by pharmacological inhibition of TRPC6 or P2 receptors using SAR7334 or suramin treatment, respectively. This study established the role of Ca2+ signaling via TRPC6 channels and P2 receptors in mechanical and metabolic sensing of podocytes in vivo, which are promising therapeutic targets in conditions with high intra-glomerular capillary pressure and plasma glucose, such as diabetic and hypertensive nephropathy.

Glucose management team significantly improves glycaemic care and commitment to in‐hospital guidelines within arthroplastic patients

Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to. To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values. We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3months. None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1group, 50% and in the AGS2group, 53% were appropriately managed (p<.001). The events of hyperglycaemia (CPG >7.8mmol/L at least twice) and of severe hyperglycaemia (CPG >10mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications. AGS intervention significantly improves adherence to guidelines and glucose values.

The Accuracy of Continuous Glucose Monitoring in the Medical Intensive Care Unit.

To assess the accuracy of continuous glucose monitoring (CGM) in medical intensive care unit (MICU) patients. A Medtronic Enlite® sensor accuracy was assessed versus capillary blood glucose (CBG) and plasma glucose (PG) using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plots. Using CBG as a reference, MARD was 6.6%. Overall, 99.7% of the CGM readings were within the "no risk" zone. No significant differences in accuracy were seen within vasopressor subgroups. Using PG as the reference, MARD was 8.8%. The surveillance error grid analysis showed 95.2% of glucose readings were within the "no risk" zone. There were no device-related adverse events. The CGM sensor showed acceptable accuracy in MICU patients, regardless of vasopressor use.

Community-level screening for type 2 diabetes risk in Mexicans living in Colorado

Introduction: Many Mexican immigrants to the US are medically underserved and have a higher risk for type 2 diabetes; early identification of risk factors can prompt referrals to lifestyle changes and primary care in this population. We used a cross-sectional study design to assess diabetes risk using an existing community partnership, a public health professional, and a lay health promoter model to identify individuals at high risk for diabetes without imposing tests that are difficult to perform or sustain in a community setting. Materials and Methods: Between January 1st, 2018, and December 31st, 2019, a community-based approach for type 2 diabetes-risk screening was conducted by lay health workers using a standard protocol including an educational component, the FINDRISC questionnaire, and capillary plasma glucose criteria. Basic descriptive statistics were obtained for demographic, lifestyle, and diabetes risk factors. Results: Our team screened 783 adult individuals (444 females and 339 males) for type 2 diabetes risk. 29% of participants (35.6% of females and 20.6% of males) were at high risk of type 2 diabetes because they had FINDRISC scores of 14 or higher. We also identified other risk factors, 79% of females and 86% of males were overweight or obese, and 39% had high blood pressure; consequently, we referred 427 patients to their PCP or a new medical home. Conclusions: The use of a community-based intervention using the FINDRISC type 2 diabetes risk assessment tool is a suitable, easy to perform intervention that can be applied in community settings by community lay health promoters.

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.

876-P: Accuracy of Continuous Glucose Monitoring Compared with Capillary Blood and Venous Plasma Glucose Measurements in Medical Intensive Care Unit Patients

Objective: To assess the accuracy of the subcutaneous continuous glucose monitoring (CGM) sensor by comparing to the capillary blood glucose (CBG) and venous plasma glucose (VPG) measurements in the medical intensive care unit (MICU) patients. Subjects and Methods: In a prospective study in patients in the MICUs, Medtronic Enlite sensor was inserted in the abdominal area. Paired sensor glucose readings with reference glucose values (CBG and VPG) were collected from MICU patients receiving intravenous insulin infusion therapy. The accuracy was assessed using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plot. Results: Twelve patients completed the study (age 69.3 ± 11.6 years; BMI 21.6 ± 2.9 kg/m2; APACHE II score 21.8 ± 6.3 and duration of CGM use 108.7 ± 41.1 hours). A total of 353 paired CGM and CBG glucose readings and 125 paired CGM and VPG readings were included in the analysis. Using CBG as the reference, MARD was 7.2%. The modified Bland-Altman plot showed 95% of the limit of agreement (LoA) was -18.4% to 19.2%. The SEG analysis showed that 100% of paired glucose values were within zones A or B. No clinically significant difference in the accuracy was seen between subgroups of vasopressor use (MARD 6.1% in the vasopressor group vs. 6.8% in the non-vasopressor group, p = NS). Using VPG as the reference, the MARD was 8.8%. The modified Bland-Altman plot showed 95% LoA of - 22.6% to 28.2%. The SEG analysis showed 95.2% of glucose readings were within zones A or B. Conclusion: The accuracy of the subcutaneous CGM sensor in MICU patients was comparable to that observed in non-critical care settings, with no device-related adverse events. The sensor accuracy remained within the similar range when using VPG as the references compared to using CBG as the references. No differences in terms of accuracy between the vasopressor and non-vasopressor groups were found in this study. Disclosure N. Laichuthai: None. P. Buranasupkajorn: None. W. Khovidhunkit: Speaker’s Bureau; Self; Amgen, AstraZeneca. Funding Quality Improvement Fund; King Chulalongkorn Memorial Hospital; Thai Red Cross Society (1-62-30101-A-11)

The Effect of Glycemia on Choroidal Thickness in Different Stages of Diabetic Retinopathy

Objective: The purpose of this study was to evaluate the influence of renal and glycemic parameters on choroidal thickness (CT) in patients with diabetes with and without diabetic retinopathy (DR). Methods: This cross-sectional study included patients with and without diabetes. Patients underwent comprehensive ocular examination. CT was obtained using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode. Clinical parameters were body mass index, mean arterial pressure, glycated hemoglobin, fasting plasma glucose, estimated glomerular filtration rate, and capillary plasma glucose (CPG) a few minutes before EDI-SD-OCT. Results: The study included 275 participants: 42 with diabetes and no DR, 43 with mild nonproliferative diabetic retinopathy (NPDR), 46 with moderate NPDR, 39 with severe NPDR, 24 with proliferative diabetic retinopathy (PDR), 40 with previous panretinal photocoagulation (PRP) treatment for DR, and 41 without diabetes. The diabetic patients had thinner subfoveal CT than the nondiabetic participants (280.5 ± 83.4 vs. 327.1 ± 48.8 µm, p < 0.001). After multivariable adjustment, CT was significantly correlated with age, DR stage, and CPG. In patients with mild and moderate NPDR, a higher level of CPG was associated with thicker CT. This relationship was not found in patients with PDR. Conclusion: CPG had the strongest correlation with CT in patients with NPDR (mild, moderate, and severe), but not in PDR and PRP PDR patients. Our study suggests that the glucose level at the time of the test should be aggregated to other systemic and ocular parameters, such as age and axial length, when studying the choroid using SD-OCT.

Effects of Modified Arm Swing Exercise Program on Capillary Plasma Glucose and Body Composition in People with Uncontrolled Type 2 Diabetes

OBJECTIVES: A quasi-experimental research aimed at examining effects of Modified Arm Swing Exercise (MASE) Program on capillary plasma glucose (CPG) and body composition in people with uncontrolled type 2 diabetes (T2DM). MATERIAL AND METHODS: Twenty-four people with uncontrolled T2DM from a Ban Phai Rong Wua Sub-district Health Promoting Hospital, Suphanburi province, Thailand who met the inclusion criteria were selected into the study and received the MASE Program for 12-week. Data were collected using a demographic questionnaire and measurements of CPG, body mass index (BMI), visceral fat and skeletal muscle at baseline, 8th, and 12th week after MASE program, analyzed by descriptive statistics and repeated measure ANOVA. RESULT: After the MASE Program, mean CPG, BMI and visceral fat tended to be decrease, and skeletal muscle was likely to have increased; however, all variables were not statistically significant different at the least interval (F (2, 46) = 1.80, p &gt; 0.05; F (2, 46) = 0.31, p &gt; 0.05; F (2, 46) = 0.32, p &gt; 0.05; F (2, 46) = 3.12, p &gt; 0.05, respectively). CONCLUSION: The MASE Program should be recommended to people with uncontrolled T2DM for more than12 weeks for better outcomes.

Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study.

IntroductionUnderstanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden.MethodsThis study enrolled 25,356 adults (35–64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population.ResultsChinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women.ConclusionsChinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-00690-3) contains supplementary material, which is available to authorized users.

Performance of Variables in Screening for Gestational Diabetes.

Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM. Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015–2016. Values for RPG in gestational weeks 23–28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves. Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66–0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68–0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53–0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68–0.82). Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.

The prevalence of obesity and overweight, associated demographic and lifestyle factors, and health status in the adult population of Jeddah, Saudi Arabia.

Background:Obesity is a risk factor for many chronic diseases, and its prevalence and trends vary among populations. Saudi Arabia shows a greater rise in prevalence than many other countries. We aimed to study the association between several chronic disorders, demographic, and lifestyle factors with increased body mass index (BMI) in the adult population of Jeddah.Methods:Data were obtained from a door-to-door cross sectional study. A three-stage stratified cluster sampling technique was adopted. Individuals in selected households agreeing to participate were interviewed to complete a predesigned questionnaire covering demographic and lifestyle variables, medical history, and family history of chronic diseases. This was followed by anthropometric and blood pressure measurements. A random capillary plasma glucose (RPG) was measured, followed by further testing using fasting plasma glucose and glycated hemoglobin (HbA1c) to verify whether participants were normal, diabetic, or prediabetic. Multiple logistic regression analyses were used to adjust for confounding factors.Results:A total of 1419 individuals were included in the study: 667 men and 752 women. The prevalence of overweight and obesity was 35.1 and 34.8%, respectively, in men, and 30.1% and 35.6%, respectively, in women. Both overweight and obesity increased in prevalence to 60 years of age, and decreased in the oldest age group in both sexes. After adjusting for age, risk of obesity in men was increased with having a postgraduate degree [odds ratio (OR), 95%CI = 2.48, 1.1–5.61] and decreased with increased physical activity (OR, 95%CI = 0.49, 0.26–0.91). Risk of prediabetes and diabetes was increased in obese women (OR, 95%CI = 2.94, 1.34–6.44, and 3.61, 1.58–8.26 respectively), that of hypertension in obese men (OR, 95%CI =2.62, 1.41–4.87), and that of dyslipidemia in both sexes (OR, 95%CI = 2.60, 1.40–4.83 in men, and 2.0, 1.01–3.85 in women). A family history of dyslipidemia was associated with reduced risk of obesity among women (OR, 95%CI = 0.33, 0.12–0.92), whereas, in people with above normal weight (BMI ⩾25), there was increased risks of prediabetes, diabetes, and dyslipidemia among women (OR, 95%CI = 2.50, 1.21–5.17; 3.20, 1.45–7.03, and 1.88, 1.02–3.49, respectively ), and of hypertension among men (OR, 95%CI = 1.80, 1.00–3.23).Conclusions:The prevalence of overweight and obesity in the Saudi population remain high, indicating ineffectiveness or lack of preventive measures. Risk of prediabetes, diabetes, dyslipidemia, and hypertension increased with increasing BMI, with some sex differences in these associations.

How to improve opportunistic screening by using EMRs and other data. The prevalence of undetected diabetes mellitus in target population in Croatia

ObjectivesOpportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record. Study designWe conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45–70 years. MethodsFirst, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation. ResultsPrevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41–3.15, P < .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78–.61, P < .001). ConclusionsTotal yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.

Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau.

BackgroundTwins may be at increased risk of dysglycaemic disorders due to adverse fetal conditions. Data from Africa regarding this association is limited. We studied impaired glucose tolerance (IGT) and other types of dysglycemia among twins and singletons in Guinea-Bissau.MethodsThe study was conducted from February 2011 until March 2012 at the Bandim Health Project, a health and demographic surveillance system site in the capital Bissau. Twins (n = 209) and singletons (n = 182) were recruited from a previously established cohort. Oral glucose tolerance tests (OGTT) were performed, along with anthropometrics and collection of clinical and dietary data.ResultsMedian age was 16.6 and 14.2 years between twins and singletons, respectively (P = 0.08). Mean birth weight was 2410 vs. 3090 g, respectively (P < 0.001). Twins had higher median fasting- and two hour capillary plasma glucose, 5.4(3.2–8.2) vs. 5.0(3.2–11.5) mmol/L (P < 0.001) and 6.8(3.4–11.3) vs. 6.2(3.2–12.1) mmol/L (P < 0.001), respectively, compared to singletons. The prevalence of IGT was 2.5 % (5/209) vs. 3.5 % (6/182) (RR = 0.73, 95 % CI: 0.20–2.64). 12 % (25/209) of twins had impaired fasting glucose (IFG), compared to 3.5 % (6/182) of singletons (3.63, 1.53–8.62). Dysglycemia (IGT and/or IFG or overt diabetes) was found in 17 % (35/209) vs. 9 % (16/182) (1.90, 1.08–3.37), respectively.ConclusionsTwins had higher glucose levels in both the fasting and postprandial state. This may indicate a detrimental effect of the twin fetal environment on glucose metabolism later in life, a result contrary to Scandinavian register studies. The IGT burden was low in this young age group and the risk was similar in twins and singletons.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0126-6) contains supplementary material, which is available to authorized users.

Unreliable Fingerstick Glucose Measurement in Systemic Sclerosis

ABSTRACT Objective: A female with systemic sclerosis was found to have apparent hypoglycemia on fingerstick blood glucose measurements while being asymptomatic. Methods: Clinical assessment, laboratory studies, and glucose-meter testing performed in clinic presented in addition to a brief literature review. Results: Per glucometer, glucose measurements increased with more proximal blood sampling on the right upper extremity, revealing values of 33, 68, and 77 mg/dL. Simultaneous venous laboratory blood glucose was 89 mg/dL. In addition, an evaluation for possible insulinoma yielded negative laboratory values. Conclusion: Certain conditions of impaired microcirculation can result in a spurious discrepancy between capillary glucose values and venous plasma glucose concentrations, a state known as pseudohypoglycemia. Awareness of damaged microvasculature in connective tissue disorders may prevent unnecessary workup of pseudohypoglycemia.

Postprandial capillary-venous glucose gradient in Type 1 diabetes: magnitude and clinical associations in a real world setting.

AimsTo determine the magnitude of the peripheral glucose gradient in patients with Type 1 diabetes in a real world setting and to explore its relationship with insulin dose and macronutrient intake.MethodsAll patients used mealtime analogue insulin. The glucose gradient was assessed using antecubital fossa venous and finger‐stick capillary samples, collected concurrently at room temperature. Baseline sampling occurred before the administration of an insulin dose and breakfast of the patient's choosing. Breakfast was consumed an average of 15 min after baseline. The macronutrient content of breakfast was documented. Sampling was repeated 1 and 2 h after baseline.ResultsThe mean (95% CI) plasma capillary–venous glucose gradient values for 43 patients were: pre‐breakfast, 0.21 (0.08–0.34) mmol/l; 1 h after baseline, 0.87 (0.66–1.07) mmol/l; and 2 h after baseline, 0.52 (0.33–0.71) mmol/l. Glucose gradient and dietary carbohydrate intake (g/kg body weight) were positively correlated at both 1 h (P < 0.01) and 2 h after baseline (P < 0.01). No relationship was observed between this gradient and mealtime insulin dose, or the glucose concentration at either time point.ConclusionsIn patients with Type 1 diabetes, a clinically significant glucose gradient is present after the ingestion of a carbohydrate‐rich meal. As postprandial capillary and venous plasma glucose concentrations are not equivalent, defining the site of sample collection is important.