Glucose Estimation Research Articles

The Impact of Delayed Separation of Plasma and Serum Sample on Glucose Parameter of Apparently Healthy Students of Federal School of Medical Laboratory Technology (Science), Jos, Nigeria

Background: Estimation of glucose is very important in clinical diagnosis of diabetes mellitus, hyperglycemia and hypoglycemia. The core aim of clinical laboratory service is to produce accurate, precise and reliable test results. The ability of laboratories to do this lies in the availability of well trained personnel, equipment, electricity etc. There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even further and the need for proper diagnosis cannot be overemphasized.
 Aim: In this study we have tried to evaluate the impact of delayed separation of plasma and serum from cells and clot on glucose level.
 Method: A total of fifty (50) randomly selected apparently healthy students of Federal School of Medical Laboratory Technology (Science), Jos were recruited as subject into this study. Blood samples were collected from each of the subjects into plain and anticoagulant bottles for serum and plasma respectively. An aliquot was analyzed within 10 minutes to obtain a baseline value where other values after timely delays were compared. The samples were spun but not separated from the cells/clot all through the period of the analysis. Blood glucose was determined by glucose Oxidase Colourimetric assay kit obtained from Randox Laboratories Limited United Kingdom. Data were analyzed using student’s t-test and performed using the Statistical Package for Social Sciences (SPSS) version 20.0.
 Results: Result obtained shows the mean and standard deviation of all timing for plasma and serum. In plasma it shows that the means±SD of 2, 4 and 24hours (5.2±0.7, 5.1±0.4 and 5.3±0.5 respectively) were not significantly varied when compared to the baseline (0 hour) value (5.3±0.5). That of baseline and 24 hours (5.3±0.5 and5.3±0.5 respectively) were significantly higher (P<0.001) than that of 48 and 74 hours (1.0±0.20 and 7±0.2 respectively). In serum, similar results were obtained.
 Conclusion: In conclusion, where possible, it is advised that the established best practices in processing and analysis of samples be adhered to. However, the results of this work shows reasonably stable results for blood glucose determination could be obtained within 24 hours. Therefore, instead of discarding the sample, it might seem more appropriate that the sample be analyzed and the result reported indicating the number of hours delayed within 24hours.

The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalizing the measurement of albuminuria to identify vascular risk and prevent vascular disease

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies recognize the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorized based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimize the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing.

Abstract P342: Periodontal Disease is Associated With Elevated Prediabetes Prevalence and Glucose Levels Among Non-Diabetic Adults. Results From Oral Infections, Glucose Intolerance and Insulin Resistance Study

Background: Periodontitis (a bacterially-driven, inflammatory disease) is a plausible risk factor for prediabetes and diabetes. We studied the association between clinical attachment loss (CAL – a cumulative measure of tooth-supporting tissues lost due to periodontitis), prediabetes, and glucose levels among non-diabetic younger adults. Hypothesis: We hypothesize that greater CAL is associated with higher levels of biomarkers of cardiometabolic risk cross-sectionally. Methods: We included n=1071 non-diabetic participants from the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) who underwent full-mouth periodontal examinations and provided fasting blood at baseline. Baseline enrollment occurred in two waves: Wave 1 (2011-2013; n=293) and Wave 2 (2016-2020; n=778). HbA1c and glucose were measured during clinical exams. Prediabetes was defined as fasting glucose between 100-125 mg/dL or HbA1c between 5.7-6.4% per American Diabetes Association guidelines. We computed prevalence ratios and 95% confidence intervals of prediabetes among 2 nd and 3 rd CAL tertiles (vs. 1 st tertile) via multivariable Poisson regression with robust variance estimation. Multivariable linear regression was used to assess the association between CAL tertiles (independent variable) and estimates of glucose and HbA1c. We adjusted for demographics, health variables, and study wave. Results: The mean age(SD) of participants was 32.3(9.6) years and 28% were male. Prediabetes prevalence was 8.7%. Multivariable adjusted prevalence ratios (95%CIs) for prediabetes in tertiles 2 and 3 (vs. 1) were 1.45(0.79,2.67) and 1.91(0.99,3.67), respectively, consistent with p for trend = 0.05 and stronger associations with continuous glucose and HbA1c (see Table ). Conclusion: CAL, a cumulative measure of periodontitis, was cross-sectionally associated with increased prediabetes prevalence, glucose and HbA1c.

Artículo especial por el Día Mundial del Riñón: Las sociedades científicas españolas ante la guía ESC 2021 de prevención de la enfermedad vascular: generalizar la medida de la albuminuria para identificar el riesgo vascular y prevenir la enfermedad vascular

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies, recognise the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorised based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimise the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolaemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing.

Metformin and Dapagliflozin Attenuate Doxorubicin-Induced Acute Cardiotoxicity in Wistar Rats: An Electrocardiographic, Biochemical, and Histopathological Approach

Doxorubicin is a widely used anticancer drug whose efficacy is limited due to its cardiotoxicity. There is no ideal cardioprotection available against doxorubicin-induced cardiotoxicity. This study aimed to investigate the anticipated cardioprotective potential of metformin and dapagliflozin against doxorubicin-induced acute cardiotoxicity in Wistar rats. At the beginning of the experiment, cardiac screening of experimental animals was done by recording an electrocardiogram (ECG) before allocating them into the groups. Thereafter, a total of thirty healthy adult Wistar rats (150–200 g) were randomly divided into five groups (n = 6) and treated for eight days as follows: group I (normal control), group II (doxorubicin control), group III (metformin 250 mg/kg/day), group IV (metformin 180 mg/kg/day), and group V (dapagliflozin 0.9 mg/kg/day). On the 7th day of the treatment phase, doxorubicin 20 mg/kg was administered intraperitoneal to groups II, III, IV, and V. On the 9th day (immediately after 48 h of doxorubicin administration), blood was collected from anesthetized animals for glucose, lipid profile, CK-MB & AST estimation, and ECG was recorded. Later, animals were sacrificed, and the heart was dissected for histopathological examination. We found that compared to normal control rats, CK-MB, AST, and glucose were significantly increased in doxorubicin control rats. There was a significant reversal of doxorubicin-induced hyperglycemia in the rats treated with metformin 250 mg/kg compared to doxorubicin control rats. Both metformin (180 mg/kg and 250 mg/kg) and dapagliflozin (0.9 mg/kg) significantly altered doxorubicin-induced ECG changes and reduced the levels of cardiac injury biomarkers CK-MB and AST compared to doxorubicin control rats. Metformin and dapagliflozin protected the cellular architecture of the myocardium from doxorubicin-induced myocardial injury. Current study revealed that both metformin and dapagliflozin at the FDA-recommended antidiabetic doses mitigated doxorubicin-induced acute cardiotoxicity in Wistar rats. The obtained data have opened the perspective to perform chronic studies and then to clinical studies to precisely consider metformin and dapagliflozin as potential chemoprotection in the combination of chemotherapy with doxorubicin to limit its cardiotoxicity, especially in patients with comorbid conditions like type II diabetes mellitus.

Blood glucose estimation based on ECG signal.

Successful self-management of diabetes requires Continuous Glucose Monitors (CGMs). These CGMs have several limitations such as being invasive, expensive and limited in terms of use. Many techniques, in vain, have been proposed to overcome these limitations. Nowadays, with the help of the Internet of Medical Things (IoMT) technologies, researchers are working to find alternative solutions. They succeed to predict hypoglycemia and hyperglycemia peaks using Electrocardiogram (ECG) signals. However, they failed to use it to estimate the Blood Glucose Concentration (BGC) directly and in real time. Three patients with 08days of measurements from the D1namo dataset contributed to the study. A new technique has been proposed to estimate the BGC curves based on ECG signals. We used a convolutional neural network to segment the different regions of ECG signals as well as we extracted ECG features that were required for the next step. Then, five regression models have been employed to estimate BGC using as input sixth ECG parameters. We were able to segment the ECG signals with an accuracy of 94% using the convolutional neural network algorithm. The best performance among all simulated models was provided by Exponential Gaussian Process Regression (GPR) with Root Mean Squared Error (RMSE) values of 0.32, 0.41, 0.67 and R-squared (R2) values of 98%, 80%, and 70% for patients 01, 02 and 03 respectively. The method indicates the potential use of ECG wearable devices as non-invasive for continuous blood glucose monitoring, which is affordable and durable.

Incidence of Prediabetes/Diabetes among Women with Prior Gestational Diabetes and Non-Alcoholic Fatty Liver Disease: A Prospective Observational Study.

This prospective longitudinal study aims to evaluate and compare the incidence of prediabetes/diabetes among women stratified at the baseline postpartum visit according to the prior GDM and NAFLD status. Of the 309 women with baseline postpartum assessment at a median of 16 months following the index delivery, 200 (64.7%) [GDM: 137 (68.5%), normoglycaemia: 63 (31.5%)] were available for the follow-up analysis (performed at median of 54 months following the index delivery) and were participants for this study. We obtained relevant demographic, medical and obstetric details and performed a 75 g OGTT with glucose estimation at 0 and 120 min. NAFLD status was defined by ultrasonography at the baseline visit. Participants were divided into four groups: no NAFLD and no prior GDM (group 1), NAFLD but no prior GDM (group 2), prior GDM but no NAFLD (group 3), and NAFLD and prior GDM (group 4). The mean age of study participants (n = 200) was 32.2 ± 5.1 years, and the mean interval between the two visits was 34.8 ± 5.5 months. A total of 74 (37%) women had progression to prediabetes/diabetes [incidence rate of 12.8/100 woman-years]. The incidence rates (per 100 woman-years) were 8.6, 8.9, 13.4 and 15.3 in groups 1, 2, 3 and 4, respectively. The adjusted hazard ratio for incident (new-onset) prediabetes/diabetes in group 4 (reference: group 1) was 1.99 (95% CI 0.80, 4.96, P = 0.140). Among women with baseline NAFLD (irrespective of GDM status), the risk of incident prediabetes/diabetes increased with an increase in the duration of follow-up (3.03-fold higher per year of follow-up, P = 0.029) and was significantly higher in women who were not employed (6.43, 95% CI 1.74, 23.7, P = 0.005) and in women with GDM requiring insulin/metformin during pregnancy (4.46, 95% CI 1.27, 15.64, P = 0.019). NAFLD and GDM increased the risk for glycaemic deterioration in young Indian women. Future studies should focus on evaluating the effectiveness of lifestyle and behavioural interventions in such high-risk women.

Insulin Resistance in relation to Hypertension and Dyslipidaemia among Men Clinically Diagnosed with Type 2 Diabetes.

Pathophysiologically, type 2 diabetes can result from insulin resistance or insulin insufficiency alone. It is unclear whether relative insulin shortage or pronounced insulin resistance is linked to poor cardiometabolic problems like obesity. Therefore, the objective of this study was to evaluate the relationship between insulin resistance (IR), hypertension, and dyslipidaemia, in men with type 2 diabetes mellitus. One hundred and twenty-one (121) type 2 diabetic men participated in this cross-sectional study, which was conducted between September 2018 and September 2019. Sociodemographic information was collected using a self-designed questionnaire. Anthropometric data were also taken and blood samples collected for estimation of insulin, glucose, and lipid concentrations. HOMA-IR was calculated from the fasting insulin and glucose values, and a HOMA - IR ≥ 2 was considered to indicate insulin resistance. Of the 121 participants, 39.7% were classified as insulin-resistant. Levels of total cholesterol (4.82 ± 1.2 mmol/L; p = 0.007 vs. 4.25 ± 1.1 mmol/L), LDL cholesterol (3.17 ± 0.9 mmol/L; p = 0.001 vs. 2.52 ± 0.8 mmol/L), and TC/HDL-C ratio (3.93 ± 0.9; p = 0.042 vs. 3.58 ± 0.9) and the prevalence of abnormal LDL-C (14.6%; p = 0.015 vs. 2.7%) and elevated BP (83.3%; p = 0.048 vs. 67.1%) were higher in the insulin-resistant group. LDL cholesterol (AUC = 0.670; p = 0.001) better classified subjects as being insulin-resistant compared to other lipid markers. The odds of insulin resistance in dyslipidaemia were not statistically significant after adjusting for obesity. The link between insulin resistance and dyslipidaemia and hypertension in male diabetics may thus be mediated by obesity.

High Sensitivity Cardiac Troponin-T STAT in Type 2 Diabetes Mellitus Patients and Healthy Individuals: A Comparative Study

Introduction: Diabetes Mellitus (DM) is a metabolic disorder that shares the phenotype of hyperglycaemia, with several factors contributing to the disease, including decreased insulin secretion and glucose utilisation, as well as increased glucose production. There is a strong association between DM and Cardiovascular Disease (CVD). High-sensitivity cardiac troponin T (hs-cTnT), which is a marker of subclinical myocardial damage, is used in the risk stratification of asymptomatic individuals. Aim: To estimate and compare hs-cTnT Short Turn Around Time (STAT) levels in diabetic patients without Acute Myocardial Infarction (AMI) with age and sex matched controls and also to investigate the correlation between hs-cTnT STAT and Glycated Haemoglobin (HbA1c) levels. Materials and Methods: A comparative cross-sectional study was conducted in the Department of Biochemistry and Outpatient Clinic, Department of Medicine, Government Medical College, Kozhikode, Kerala, India, from April 2019 to April 2020. The study subjects were divided into two groups: Group 1 consisted of 58 patients with Type 2 Diabetes Mellitus (T2DM) without AMI, and Group 2 comprised 58 healthy individuals who were age and sex matched. No specific sampling technique was employed. After obtaining consent, T2DM patients who attended the outpatient clinic were evaluated with fasting blood glucose, HbA1c, Electrocardiogram (ECG), and hs-cTnT STAT estimation. Controls were selected and evaluated for the same from apparently healthy bystanders of other patients, medical and paramedical staff, and others willing to participate. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 software. Results: The mean value of Fasting Blood Sugar (FBS) and HbA1c was higher in T2DM patients compared to healthy individuals. hs-cTnT showed a positive moderate correlation with HbA1c (rho=0.53), which was statistically significant (p-value<0.001). Simple linear regression analysis showed that in the case group, for a 1% increase in HbA1c levels, there was a 2.38 unit increase in hs-cTnT levels, which was statistically significant (p-value<0.001). Conclusion: hs-cTnT levels are significantly elevated in T2DM patients without overt CVD compared to age and sex matched healthy individuals. T2DM is a risk factor for increased levels of biomarkers for atherosclerotic CVD, and proper glycaemic control reduces the levels of hs-cTnT in T2DM patients.

Association of Lipid Accumulation Product with Insulin Resistance in Type 2 Diabetes Mellitus: A Cross-sectional Study

Introduction: The increased incidence of diabetes and Cardiovascular Disease (CVD) is attributed to the rising obesity rates, which is one of the major factors contributing to Insulin Resistance (IR). Although there is a close relationship between obesity and IR, not all cases of obesity lead to cardiometabolic complications. Visceral fat is considered to be the primary cause of IR. Lipid Accumulation Product (LAP) is postulated as a new continuous biomarker of visceral adiposity. Aim: To determine the association between LAP and IR in T2DM. Materials and Methods: This institution-based cross-sectional study was conducted over a period of three months at the Department of Biochemistry, Rajarajeswari Medical College and Hospital in Bengaluru, Karnataka, India. A total of 60 Type 2 diabetic patients (including newly diagnosed and known cases) were recruited as cases, along with 30 healthy controls. Height, weight, and Waist Circumference (WC) were measured. Fasting blood samples were collected for laboratory biochemical estimation of glucose, Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and fasting insulin. Statistical analysis for continuous variables was performed using unpaired Student’s t-test, and Analysis of Variance (ANOVA) test was used for group comparisons. Results: Fasting serum insulin (p-value=0.007), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (p-value=0.001), and LAP index (p-value<0.001) were significantly higher in the case group. LAP index was divided into quartiles, Insulin and HOMA-IR showed statistical significance across the quartiles (p-value=0.005). The lipid profile analysis across LAP quartiles revealed a progressive increase in TG levels (p<0.001) and a decrease in HDL levels from Q1 to Q4 quartiles. Conclusion: The study concludes that increased LAP levels are associated with IR in T2DM. LAP can serve as a useful marker for cardiometabolic risk in early-stage T2DM, enabling better disease stratification for improved prognosis.

Saliva as a diagnostic tool for glucose estimation in diabetic patients

Saliva as a diagnostic tool for glucose estimation in diabetic patients

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

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

The mechanism of Hager's test for glucose

There are several colour tests for glucose detection, not being the case for glucose estimation. Thus, the quantitative test for glucose due to Hager is fairly important. The test is based on an oxido-reduction process. It employs mercury oxide, sodium chloride, and sodium acetate in a slightly acidic medium (2.5% acetic acid). In the presence of glucose, this reagent precipitates the very insoluble dimercury dichloride which is related to glucose content and concentration. Since the reaction route has not been described, and less the reaction mechanism, both are provided in this communication. Each step is fully commented and the electron flow is given. The reactive intermediate is H-O-Hg+ which reacts with nucleophilic species. This way hydroxymercury glucose-enolate is formed, as well as, chloromercury hydroxide. Protolysis of both intermediates and reaction with chloride ions gives the two key intermediates, chloromercury glucose-enolate and the cation Cl-Hg+. A bimolecular reaction between these intermediates occurs via a concerted mechanism (redox reaction). The oxidation product is 2-ketoglucose (glucosone), whereas the reduced compound is dimercury dichloride.

A comparative study of BMI and eGFR in pre- and post-menopausal women with and without diabetes

Background: Obesity is a most important disorder associated with menopause. The mechanisms of the increase in body weight after menopause are not clearly understood. Earlier studies reported that the changes in sex hormone levels at menopause may have adverse effects on kidney function. The renoprotection activity of female sex hormones seems to decrease after menopause. Aim and Objectives: In this study, it was aimed to evaluate body mass index (BMI) and estimated glomerular filtration rate (eGFR) along with fasting blood glucose, follicle-stimulating hormone (FSH), and estradiol in healthy pre- and postmenopausal women with or without diabetes. Materials and Methods: A total of 92 subjects including 37 non-diabetic, 15 diabetic premenopausal women, and 25 diabetic and 15 non-diabetic postmenopausal women were included in the study. For all the subjects, BMI was calculated using height (cm) and weight (kg) and recorded as kg/m2. Fasting blood samples were collected for glucose estimation by GOD/POD method, serum creatinine by Jaffe’s method, and FSH and estradiol were estimated by ELISA method using commercial kits. A simplified MDRD equation was used to estimate GFR (mL/min/1.73 m2) = 186 × [serum creatinine] − 1.154 × [age] − 0.203 (× 0.742 if female). Values were reported as mean + standard deviation. The data were analyzed by one-way ANOVA with Tukey‒Kramer post hoc test using SPSS version 20 and P < 0.05 was taken as statistically significant at 95% confidence interval. Results: Results of the study showed that BMI was higher and eGFR was significantly reduced in postmenopausal women with and without diabetes compared to premenopausal women with or without diabetes. Conclusion: The study was concluded that the observed increased BMI and reduced eGFR in postmenopausal women need lifestyle changes to control BMI and measures to improve kidney function are to be considered to improve quality of life in postmenopausal women.

Gingival crevicular glucose estimation and patient’s perception of pain during routine dental examination - a concept based on a novel patented periodontal device

Background/Aim. Diabetes mellitus is a common metabolic disease-causing high mortality and morbidity worldwide. So, physicians need to identify this condition early to implement prevention strategies. The study aimed to test the concept of a novel periodontal device that can be attached to a glucose monitoring device as an innovative tool to screen for periodontitis and diabetes mellitus simultaneously during a routine dental examination. Therefore, correlation of blood glucose between the conventional finger-prick blood glucose (FPBG) and gingival crevicular blood glucose (GCBG) method, along with estimation of patient's pain perception by visual analogue scale (VAS). Methods. A crosssectional comparative study was conducted among 250 participants whose GCBG and FPBG were estimated. VAS score scale was recorded for each patient immediately after the procedure. Results. The mean GCBG value was 151.19 ? 42.64 mg/dL, while mean FPBG was 150.48 ? 42.95 mg/dL, showing a high Pearson's correlation (r=0.9932; p< 0.00001). Mann-Whitney U for VAS score between both the groups showed a statistically significant difference (p < 0.00001). Conclusion. The GCBG method was well tolerated by patients, and highly correlated with peripheral blood glucose levels. The proposed concept of the novel periodontal device appeared to be a feasible option for examining periodontium and screening diabetes simultaneously in dental clinics.

WILL STANDARDIZATION BE A NEW APPROACH TOWARDS EVIDENCE BASED MEDICINE?

Harmonization and standardization are important when disease is dened by clinical biochemistry results. Evidence based medicine is the conscious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. There are very few studies proving standardisation and it's application in laboratory medicine. The objective of this study is to verify the trueness and portability of patient reports by standardization of glucose estimation using two different methods in two different analysers. Methods of estimation compared are hexokinase and GOD-POD. Instruments used are Abbott Architect c8000 and ERBA XL-640 respectively. After the analysis, the results obtained are comparable and methods are traceable and therefore can be used interchangeably for patient report evaluation. Through this experiment we conclude that standardization enables uniform interpretability, which is important in integrating health systems into modern clinical environment

DISTURBANCES IN SERUM CALCIUM AND PHOSPHATE LEVELS IN PRE-DIABETES AND TYPE 2 DIABETES MELLITUS

Objective: To evaluate serum calcium and phosphate levels in Pre-diabetic, Diabetic & non-diabetic subjects. Material and Methods: This comparative cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, from July to December 2021. The study used a non-probability consecutive sample to include 300 people. Those people have been divided into three groups; diabetics, pre-diabetics and non-diabetics with a hundred people in every group. Blood specimens had been taken for the estimation of calcium, phosphate, HbA1c, plasma glucose and insulin in fasting in their respective tubes. SPSS version 24 was used to inspect the data. All descriptive variables had their means and standard deviations calculated. To examine descriptive characteristics within and between all groups, one way ANOVA and post hoc LSD were performed, and p-values 0. 05 were considered significant. Results: Calcium and Phosphorus levels were lower in Diabetic group (Ca= 1.97±0.16mmol/l, PO4 = 0.76±0.07 mmol/l) as compared to pre-diabetic group (Ca= 2.15±0.18 mmol/l, PO4 = 0.93±0.06 mmol/l) and higher in non-diabetic group (Ca= 2.33±0.10mmol/l, PO4 = 1.19±0.20 mmol/l) than both other groups. A one-way ANOVA and Post Hoc LSD revealed that the difference between and within groups was statistically significant with a p value of 0.01. Conclusion: Our research has shown that as glycemic control slowly deteriorates, blood calcium and phosphate levels fall. Keywords: Calcium, Phosphorus, Pre-diabetes, Type 2 diabetes mellitus.

Fetuin A levels and its correlation with lipid profile in type 2 diabetes mellitus patients

Type 2 diabetes mellitus (T2DM), is a chronic metabolic disorder. Due to its complex pathophysiology, several biomarkers have been studied for identifying its complications. Fetuin A has been proposed to be linked with insulin resistance and its comorbidities and may be helpful in understanding the pathophysiology of the disease condition. Therefore, the present study is aimed to evaluate the Fetuin A levels in Type 2 diabetes mellitus patients and its correlation with blood sugar, renal profile and lipid profile. This prospective study was conducted in SRVS Government Medical College, Shivpuri, Madhya Pradesh, India. In this study, 90 T2DM patients as cases and 90 healthy subjects as controls were recruited. Demographic details, physical and clinical examination were done. Patients with cardiovascular diseases, thyroid diseases, liver disease, pregnant women were excluded from the study. Under aseptic conditions, 5 ml of fasting venous blood samples were collected, centrifuged to obtain serum sample. The obtained serum sample was used for the estimation of fasting glucose, post-prandial glucose, renal profile (serum urea, creatinine and uric acid), lipid profile (serum total cholesterol, triglycerides, HDLC, LDLC and VLDL) using commercially available autoanalyzer kits. Serum Fetuin A levels were estimated by using ELISA method. Whole blood sample was used for the estimation of HbA1c. The results were represented as Mean±SD. and percentage. Spearman’s correlation was applied. The p value <0.05 considered statistically significant. In this study, in T2DM cases, males were 51 and females were 39 and in controls, males were 50 and females were 40. In the current study, age (63.8±5.7 years), BMI (26.2±1.6 kg/m) SBP (130.8±13.2 mmHg), DBP (90.6±12.7 mmHg), FBS (158.7±14.5 mg/dl), PPBS (228.5±31.8 mg/dl), HbA1c (7.8±0.7 %), Urea (32.1±9.4 mg/dl), Creatinine (1.0±0.1 mg/dl), Uric acid (6.2±2.8 mg/dl), total cholesterol (228.4±33.0 mg/dl), triglycerides (160.0±15.2 mg/dl), LDLC (165.6±33.6 mg/dl), VLDL (32.0±3.0 mg/dl) and Fetuin A (363.9±126.2 micg/ml) levels were significantly increased and HDLC (30.7±3.9 mg/dl) levels were reduced in T2DM cases than the healthy controls. Fetuin A level were significantly positively correlated with FBS (r=0.686), PPBS (r=0.656), HbA1c (r=0.694), Urea (r=0.342), Creatinine (r=0.564), Uric Acid (r=0.588), Total Cholesterol (r=0.700), Triglycerides (r=0.405), LDLC (r=0.728), and VLDL (r=0.528) and negatively correlated with HDLC (-0.681).Elevated fetuin A and atherogenic lipid profile may be a risk for cardiometabolic diseases.

Experimental blood glucose estimation from photoplethysmography recordings on distal finger phalange

Blood glucose concentration shows the quality and health of an individual. High glucose levels in the blood flow indicate atypical behavior of the human system. Currently, there is an acceptable test method to estimate glucose level; it consists in taking out a blood sample by the finger with a pin prick. However, the blood sample test has some disadvantages because it can produce some non-desired issues, such as infections, especially a typical case in people living with diabetes. Therefore, this work is motivated by applying reflective Photoplethysmography (PPG), a non-invasive technique based on a light source and a photodetector near the human body's skin. In this case, we propose two different blood glucose sensors using the infrared diodes LTE-302 and COM-09349 with a photodetector FDS-100. It is worth noting that both designs have multiple development stages, and all of them are self-designed and validated through various test samples with three healthy volunteers, one woman and two men. The results present an error of about 14 % for the first sensor, while for the second sensor is about 7.9 %. Moreover, the sensor measurements are compared against a commercial glucometer, the One Touch Select Plus Flex, and the specifications of the NORM ISO 15197:2013 standard. Finally, the reflective PPG technique could be applied as a non-invasive method to estimate the blood glucose level in the human body.

Association of ABCA1 R219K and C69T single nucleotide polymorphisms with type 2 diabetes mellitus: A case control study

Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder associated with alterations in the metabolism of carbohydrates, proteins and lipids. ATP binding cassette transporter 1 (ABCA1) encoding the ABCA1 protein plays a critical role in the reverse cholesterol transport of high‑density lipoprotein-cholesterol (HDL-c) metabolism. ABCA1 gene single nucleotide polymorphisms (SNPs) have been found to be associated with abnormalities in the serum levels of HDL‑c, thereby disrupting the cholesterol removing ability of cells. The aim of the present study was to determine the association between the R219K and C69T SNPs of ABCA1 gene variants and T2DM. For this purpose, a case control study was conducted among 50 patients with T2DM who were selected as cases, and 50 age‑ and sex‑matched patients without comorbidities were selected as the controls. Venous blood samples were collected from all participants following overnight fasting. Plasma glucose, glycated hemoglobin (HbA1c) and lipid profile estimations were performed using an autoanalyzer with standard methods. ABCA1 gene polymorphisms were determined using the polymerase chain reaction‑restriction fragment length polymorphism method. The body mass index for both the case and control groups was found to be above the revised cut‑off value for obesity. HDL‑c levels were below the optimum level in the case and control group. The distribution of genotype and dominant alleles of the C69T and R219K SNPs of the ABCA1 gene did not differ significantly between the case and control groups. The present study suggests the existence of a defective ABCA1 genotype in the studied population, predisposing these individuals to a decrease in serum HDL‑c levels. This interferes with cholesterol sequestration from foam cells and creates an inflammatory state, which is aggravated by obesity. Thus, HDL‑c becomes dysfunctional from inflammation‑mediated structural modifications and paves the way for atherogenic dyslipidemia associated with T2DM.