Fingerstick Method Research Articles

Validation of the quantification of phosphatidylethanol 16:0/18:1 concentrations in TASSO-M20 devices.

Phosphatidylethanol 16:0/18:1 (PEth), found in whole blood, is a biomarker for alcohol consumption with high sensitivity, specificity, and a long detection window. The TASSO-M20 device is used to self-collect capillary blood from the upper arm and has advantages over finger stick methods. The purpose of this study was to (1) validate PEth measurement using the TASSO-M20 device, (2) describe the TASSO-M20 for blood self-collection during a virtual intervention, and (3) characterize PEth, urinary ethyl glucuronide (uEtG) and self-reported alcohol in a single participant over time. PEth levels in blood samples dried on TASSO-M20 plugs were compared to those in (1) liquid whole blood (N=14) and (2) dried blood spot cards (DBS; N=23). Additionally, the self-reported drinking, positive or negative uEtG results (dip card cutoff ≥300 ng/mL), and observed self-collection of blood with TASSO-M20 devices for PEth levels were obtained over time during virtual interviews of a single contingency management participant. High-performance liquid chromatography with tandem mass spectrometry detection was used to measure PEth levels for both preparations. PEth concentrations from dried blood on TASSO-M20 plugs and liquid whole blood were correlated (0 to 1700 ng/mL; N=14; r2 =0.988; slope=0.951) and in a subgroup of samples with lower concentrations (N=7; 0 to 200 ng/mL; r2 =0.944, slope=0.816). PEth concentrations from dried blood on TASSO-M20 plugs and DBS were correlated (0 to 2200 ng/mL; N=23; r2 =0.927; slope=0.667) and in a subgroup of samples with lower concentrations (N=16; 0 to 180 ng/mL; r2 =0.978, slope=0.749). Results of the contingency management participant indicate that changes in PEth levels (TASSO-M20) and uEtG concentrations were consistent with each other and with changes in self-reported alcohol use. Our data support the utility, accuracy, and feasibility of using the TASSO-M20 device for blood self-collection during a virtual study. The TASSO-M20 device had multiple advantages over the typical finger stick method, including consistent blood collection, participant acceptability, and less discomfort as indicated by acceptability interviews.

“That was quick, simple, and easy”: Patient perceptions of acceptability of point-of-care hepatitis C RNA testing at a reception prison

Current diagnostic pathways require multiple healthcare provider visits and lead to a drop-off in the hepatitis C virus (HCV) testing and treatment care cascade. In prison settings, frequent transitioning between prisons and the community further reduces uptake of testing and treatment. The PIVOT study evaluated a 'one-stop-shop' intervention integrating point-of-care HCV RNA testing, Fibroscan®-based liver disease assessment, and treatment prescription at a reception prison in Australia. This qualitative sub-study was undertaken to assess patient acceptability of point-of-care HCV RNA testing in the reception prison setting.Twenty-four men in prison enrolled in the PIVOT study participated in semi-structured interviews; all of whom had undergone point-of-care HCV RNA testing in the PIVOT study. Patients were purposefully selected to ensure comparable representation of people with and without a history of injecting drug use and people with and without prior HCV testing experience (standard venepuncture). Sekhon's Theoretical Framework of Acceptability, consisting of seven components (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy), informed this qualitative analysis.Acceptability of fingerstick point-of-care HCV RNA testing was evident across four components: affective attitude, burden, self-efficacy, and perceived effectiveness. Patients described point-of-care testing as "quick and easy" (affective attitude), while swift results were viewed as alleviating anxiety associated with long wait times for standard pathology (burden). Patients averse to venepuncture (e.g., fear of needles or poor vein health) found the fingerstick method accessible, thereby enabling participation in HCV screening (self-efficacy). Participants attributed confidence in test results predominantly due to trust in the healthcare system or trust in the personnel administering the test (perceived effectiveness).People entering custody perceive fingerstick HCV RNA point-of-care testing to be an acceptable method and preferred this method to standard HCV testing via venepuncture. In light of these findings, prison health authorities should consider the role of opt-out point-of-care HCV RNA testing upon prison entry.

Effectiveness of the novel impression tray "cleftray" for infants with cleft lip and palate: a randomized controlled clinical trial.

ObjectivesCleft lip and palate (CLP) is one of the most common congenital deformities with worldwide prevalence. It causes a range of issues for infants that mainly involve difficulty in feeding due to abnormal oronasal communication. For this purpose, feeding plates are provided to infants to act as an artificial palate to aid in feeding. The most crucial procedure in fabrication of a feeding plate is creation of the impression using the traditional finger technique or impression trays. This preliminary research aims to compare the effectiveness of novel impression trays with that of the traditional finger technique for recording impressions of infants with CLP.Materials and MethodsThis randomized controlled trial was conducted among 30 infants who were divided into two groups based on the method of obtaining impressions Group I, finger technique; Group II, specialized acrylic tray (cleftray).ResultsUse of cleftray required less impression time, a reduced amount of material, no incidence of cyanosis/choking in infants, and lower anxiety among doctors compared to the traditional method. Additionally, there was no distortion of cleft impressions, recorded maxillary tuberosity, or other fine details. Therefore, the novel impression tray (cleftray) exhibited superior outcomes in all the parameters compared to the finger technique.ConclusionWithin the limitations of this study, we conclude that impression trays are superior to the traditional finger, spoon, or ice cream stick methods of creating impressions of CLP. However, it is necessary to conduct more clinical trials on a larger population based on other parameters to compare the effectiveness of the two techniques to draw definitive conclusions.

Feasibility and patient-reported satisfaction using a novel point-of-care fingerstick method for monitoring absolute neutrophil count for clozapine.

Clozapine is an effective antipsychotic for treatment-resistant schizophrenia. One limitation of clozapine use is required monitoring of absolute neutrophil count (ANC) because of the risk of clozapine-induced neutropenia. Standard monitoring requires venous blood draws, which is a significant barrier to clozapine use. This study assesses the feasibility of use and physician and patient satisfaction of a novel point-of-care (POC) measure of ANC using Athelas One, a device that calculates white blood cell count and ANC using a fingerstick blood sample. This is a subanalysis of a prospective, open-label clinical trial of clozapine treatment, during which patients received a venous blood draw and a capillary fingerstick at baseline and Week 2 of the study, and completed a 5-point Likert scale, comparing the 2 methods. Patients reported benefits from the fingerstick technology, including POC testing being important for their doctors and their health, improved treatment, avoiding sending blood away, and convenience. There was a trend for less concern about the effects of blood draws on health with a fingerstick, and greater physician satisfaction with POC sampling. This study suggests the feasibility, satisfaction, and ease by both clinicians and patients of using POC testing for ANC monitoring during clozapine treatment.

Comparison between clinic and home measurements of blood pressure, total cholesterol, blood sugar to identify 10-year atherosclerotic cardiovascular disease risk score

The clinical guideline recommends home monitoring for hypertension, diabetes, and hyperlipidemia maintenance therapy. The study aimed to compare the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculated using systolic blood pressure, fasting total-cholesterol, and fasting blood sugar measured at the clinic and home. This analytical cross-sectional study was done in population from villages in Sleman District, Yogyakarta. The subjects were selected purposively with the criteria of 40-79 years old and signing the informed consent. The home-measured systolic blood pressure was monitored with a digital sphygmomanometer and peripheral finger-stick methods for cholesterol and blood sugar. On the same occasion, the clinic measurements were monitored with a mercury sphygmomanometer for systolic blood pressure, and with venous plasma analyzed in the laboratory for cholesterol and blood glucose. Measurements between methods were compared with paired T-tests. The subjects (n=171) had a mean age of 52.6 (8.1) years; 21.6% were male. The systolic blood pressure, total cholesterol, and blood glucose from clinic and home measurement were 130.0 (21.1) mmHg and 137.6 (22.4) mmHg (p<0.001); 202.8 (32.8) mg/dl and 205.2 (44.8) mg/dl (p= 0.44); and 98.5 (42.9) mg/dl and 91.9 (34.6) mg/dl (p<0.001) respectively. The average ASCVD risks of the clinic and home measurements were 6.4 (6.2)% and 7.1 (6.9)% (p<0.001); however, both methods had the same ASCVD risk category at borderline risk (5-<7.5%). Conclusion: The ASCVD risk scores calculated using clinic and home measurements were statistically different.

Health Literacy and Blood Glucose Level in Transitional Albania.

Aim: Our aim was to assess the independent association between blood glucose level and health literacy (HL) adjusting for many socio-demographic characteristics and body mass index (BMI) in an adult population in Albania, a transitional country in the South Eastern Europe.Methods: A cross-sectional study was carried out in Tirana in 2012–2014 including a population-based sample of 1,154 individuals aged ≥18 years (57% women; mean age: 45.5 ± 16.4 years; response rate: 88.6%). HL was assessed by use of HLS-EU-Q instrument. Blood glucose level was measured in a fasting state by use of rapid finger stick method. Information on socio-demographic characteristics was collected, and BMI was calculated based on measurement of height and weight in all participants. General Linear Model (GLM) and binary logistic regression were used to assess the independent association of blood glucose level and HL adjusting for all socio-demographic factors and BMI.Results: One-third of participants had pre-diabetes (100–125.9 mg/dl) and further 11% had diabetes (≥126 mg/dl) based on the measured blood glucose level. In fully-adjusted GLM, mean blood glucose level was significantly lower among individuals with excellent HL compared with their counterparts with inadequate HL (99.3 vs. 106.0, respectively). Furthermore, the odds for the presence of diabetes in the group of study participants whose HL was “inadequate” were 2.6 times higher (95% CI = 1.3–5.4) compared to those whose HL was “excellent.”Conclusion: We obtained evidence of a strong and significant inverse relationship between measured blood glucose level and HL, independent of many socio-demographic characteristics and measured BMI in a population-based study in a country of the Western Balkans.

Acute carbohydrate loading on anaerobic threshold and VO2 max in active college aged individuals

Carbohydrate (CHO) loading is believed to be an ergogenic dietary asset for aerobic performance by maximizing CHO oxidation and to combat glycogen depletion within the working muscle cells. However, evidence-based research has displayed that an increase in fat metabolism, subsequently lower CHO oxidation, may provide sufficient energy during submaximal and maximal exertion through beta oxidation.​​For this reason, active volunteers were recruited to undergo a double-blind study to determine if an acute carbohydrate loading dietary supplement was effective in enhancing performance on a maximal oxygen uptake (VO2) test.​​Eleven college aged (22.09​±1.3) students ​(male n=8, female n=3) participated in this double-blind randomized study. Subjects consumed either a CHO (1g/kg body weight) or placebo supplement followed by a 12 hour fast. Following this fast, first testing session consisted of a seven-point skin caliper for body composition (% body fat), fasting blood glucose as measured by point of care finger stick method using Abbott Precision blood glucose meter (mg/dL), and a VO2 max test (mL/kg/min) measured by a modified Tread Sport Treadmill Protocol. Prior to the second test date, the subject consumed either CHO supplement or placebo, followed by 12 hour fast. Second test day consisted of fasting blood glucose, and VO2​ max test. Protocols were matched for the second bout of testing.​​A paired samples t-test (SPSS v.26) was conducted to determine significance (​p≤0.05​) on each of the four variables: VO2 max, fasting blood glucose (GLU), anaerobic threshold (AT), and respiratory quotient (RQ). No significant differences were found when comparing groups on all variables (VO2 ​p=0.923​,GLU ​p​=0.099​,AT ​p=0.641, ​RQ ​p=0.372​).​​ Acute CHO loading has no significant impact on performance variables as defined by AT, RQ, and VO2 max.

Flash Glucose Monitoring Technology Impact on Diabetes Self-Care Behavior.

Individuals with diabetes play a significant role in the control of their condition by participating in their own care. Self-monitoring of blood glucose is of particular importance in maintaining adequate glycemic control but when obtained using traditional fingerstick methods, is often limited with by cost, fear of needles or pain and inconvenience. Flash glucose monitoring is an innovative technology available to address these barriers and help people with diabetes better manage their blood glucose levels. Data demonstrating increased frequency in glucose monitoring, patient perspectives related to self-care behaviors, and implications for practice and future research are described.

Onsite healthcare worker acceptability and performance of the point-of-care Pima CD4 assay in Dar es Salaam, Tanzania.

BackgroundHealthcare workers’ acceptance of and ability to perform point-of-care testing is important for reliable and accurate results. The Alere Pima™ CD4 assay (Pima CD4) is the CD4 point-of-care test for HIV management in Tanzania.ObjectivesTo evaluate healthcare workers’ acceptance and performance of Pima CD4 testing.MethodsThe study was implemented in five high volume sites in Dar es Salaam, Tanzania, in 2011. Trained healthcare workers performed Pima testing using three whole-blood specimens collected from each patient: venous blood, fingerstick blood directly applied to a Pima cartridge (capillary-direct), and fingerstick blood collected in a microtube (capillary-microtube). Using a semi-structured interview guide, we interviewed 11 healthcare workers about specimen collection methods and Pima CD4 acceptability. Quantitative responses were analysed using descriptive statistics. Open-ended responses were summarised by thematic areas. Pima CD4 results were analysed to determine variation between cadres.ResultsHealthcare workers found Pima CD4 user-friendly and recommended its use in low volume, peripheral facilities. Both venous and capillary-direct blood were considered easy to collect, with venous preferred. Advantages noted with venous and capillary-microtube methods were the ability to retest, perform multiple tests, or delay testing. Pima CD4 results were trusted by the healthcare workers and were in agreement with laboratory Pima testing.ConclusionIn this point-of-care testing setting, the Pima CD4 assay was accepted by healthcare workers. Both venous and fingerstick capillary blood specimens can be used with Pima CD4, but fingerstick methods may require more intensive training on technique to minimise variation in results and increase acceptability.

Transition of Methotrexate Polyglutamate Drug Monitoring Assay from Venipuncture to Capillary Blood-Based Collection Method in Rheumatic Diseases.

Methotrexate (MTX) polyglutamate (MTXPG3) levels from isolated red blood cells (RBCs) collected by venipuncture have clinical utility in guiding MTX dosing for patients with rheumatoid arthritis (RA). Our objective was to transition this RBC-based therapeutic drug monitoring (TDM) assay to dried capillary blood collected by fingerstick. Patients with RA treated with MTX were enrolled. Specimens were collected by fingerstick (volumetric absorptive microsampler) and venipuncture to measure MTXPG3 from dried capillary blood, total venous blood, and isolated RBCs. MTXPG3 levels from dried capillary blood were measured using LC-MS/MS, converted to RBC equivalent (nmol/L), and compared with those from isolated RBCs (reference method). Following transition to fingerstick collection, comparability in the distributions of dried capillary and venipuncture-based RBC MTXPG3 levels was assessed using the Kolmogorov-Smirnov (K-S) test. Intraday and interday precision ranged from 2.0% to 10.9% and 3.1% to 10.8%, respectively, at MTXPG3 concentrations ranging from 5 to 100 nmol/L. In 106 participants treated with MTX, MTXPG3 levels from total venous and dried capillary blood were comparable [slope = 0.97 (95% CI, 0.92-1.03); R 2 = 0.92]. Dried capillary blood MTXPG3 converted to RBC equivalent was similar to levels from isolated RBCs (30 ± 18 nmol/L vs 33 ± 19 nmol/L; n = 106). After implementation in the clinical laboratory, RBC equivalents MTXPG3 from the fingerstick method were similar to levels from venipuncture [39 ± 22 nmol/L (n = 825) vs 39 ± 24 nmol/L (n = 47935)] (K-S test P = 0.09). Underexposure to MTX (MTXPG3 ≤5 nmol/L RBCs) was detected in 7.0% and 8.5% patient specimens collected using the fingerstick and venipuncture methods, respectively. Capillary blood MTXPG3 levels can be used to guide MTX dosing in TDM practice.

231-LB: Innovative Blood Sampling Technology for Convenient, Nearly Painless, and Accurate Monitoring of Diabetes

Monitoring HbA1c levels in individuals affected by diabetes remains the standard of care for ensuring proper management of the condition. Typically, HbA1c is measured by venipuncture or fingerstick blood collection methods at regular intervals, and for nearly all diabetic patients, monitoring HbA1c is a lifelong endeavor. In general, venipuncture and fingerstick are standard blood collection procedures, which are considered inconvenient and painful. Patient surveys have shown that venipuncture induces fear (needle phobia) in more than 20% of adults and in 60% of children. We have designed, developed, and validated an innovative blood sampling device to collect and stabilize capillary blood from the patient’s upper arm. Using small skin incisions and vacuum, the device draws and deposits the blood onto self-contained matrices. The matrices’ cartridge is then shipped at room temperature to a clinical laboratory for HbA1c measurement. We conducted a clinical study at three sites within the U.S. to validate the use of the device on 146 enrolled participants. The primary study objective was to compare HbA1c measurement in samples collected by the device and venipuncture. Pain measurements were conducted to assess the discomfort associated with the use of the device, in comparison to venipuncture and fingerstick. The data demonstrated a strong correlation between the device and venipuncture (y=1.01-0.0131, R2=0.997) over a range of HbA1c values between 4.91 and 13.34%. Device lot-to-lot and operator-to-operator reproducibility studies showed CVs of 0.7% and 0.8%, respectively. Assessment of discomfort showed an average pain score of 1 for the device (on a scale 0 to 10) and the device was preferred over venipuncture and fingerstick by 79% of the subjects. We clinically validated an innovative blood sampling technology that provides a convenient, nearly painless, safe and effective alternative to venipuncture and fingerstick for HbA1c measurement in diabetic individuals. Disclosure E. Romeo: Employee; Self; Drawbridge Health, Inc. P.K. Bryant-Greenwood: None. K.N. Castorino: Consultant; Self; Abbott. Research Support; Self; Abbott, Dexcom, Inc., Drawbridge, Novo Nordisk Inc., Sanofi US. D.R. Liljenquist: None. B.L. Jordan: Employee; Self; Drawbridge Health. Employee; Spouse/Partner; Innovation Endeavors, LLC. M. Harrington: Employee; Self; Drawbridge Health. T. Holscher: Employee; Self; Drawbridge Health. C. Alexander: Consultant; Self; CAlexanderConsulting, LLC. V. Dokukin: Employee; Self; Drawbridge Health. M. Nerlekar: Employee; Self; Drawbridge Health. L. Williamson: Other Relationship; Self; Drawbridge Health. J. Sloane: Other Relationship; Self; Drawbridge Health.

Early Screening Strategies for Diabetes Mellitus by Leveraging Dental Visits Using Optimal Screening Tools Available Onsite.

Diabetes mellitus (DM) continues to be a major health concern in the Western hemisphere, and the management of type 2 DM (T2DM) is an ongoing challenge for the American healthcare system despite major advances in DM research. T2DM imparts a massive economic burden, and a major challenge in managing T2DM continues to be timely screening. Adults are more likely to visit a dentist than a primary care physician. This study was designed to compare current screening standards recommended by the American Diabetes Association with the use of gingival-crevicular blood and its compatibility with traditional methods using a fingerstick. Patients routinely presenting to the dental clinic were offered participation in the trial and, after informed consent, checked for blood glucose levels using the fingerstick method as a control. The control values were compared to the results of the gingival-crevicular blood glucose test obtained during the dental procedure from the same patient (i.e., patients were their own controls). A total of 226 study participants were included. Of these, 127 (56.1%) participants were women, whereas 99 (43.9%) participants were men. The sample size was derived using the Slovin’s equation (Power = 80%) statistical test. We used the Pearson coefficient test to measure the statistical difference between the two tests. We found no significant difference in glucose readings between the fingerstick method and the gingival methods of collection (t = -1.134, P = 0.258). A small sample was also tested for glycosylated hemoglobin (HbA1c) using the same sample collecting methods. However, due to the cost restraints involved in using HbA1c kits, a statistically significant cohort could not be collected. By incorporating this interdisciplinary approach, testing for DM during routine dental visits can be a vital resource for the early diagnosis of DM, potentially leading to significant savings in future healthcare costs.

The effect of visceral fat and elevated blood glucose on anxiety levels in college age students

Anxiety is prevalent among young adults; research shows metabolic inflexibility, the inability to oxidize fat, can increase the occurrence of hyper-aroused states. Fasting blood glucose is the current protocol for assessing metabolic impairment. However, recent studies have shown young adults may have normal fasting blood glucose levels with underlying irregularities in postprandial glucose regulation, insulin secretion and cortisol release, which causes a pattern of visceral fat accumulation. Visceral fat of the volunteers was assessed using the DXA (Dual-energy X-ray absorptiometry) full body scanning method; the waist was assessed by taking the circumference at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest to formulate a waist to height ratio (WHtR); fasting glucose levels were measured via point-of-care (POC) finger-stick method using the Abbott Precision blood glucose meter and anxiety levels. The Pearson R correlation test showed significance between GAD-7 and VAT Volume at r = 0.513 VAT Mass r = 0.514 body fat percentage r = 0.407 and Android r = 0.419. This correlation between GAD-7 and VAT Volume and VAT Mass shows the physiological connection between elevated visceral fat and heightened anxiety. High amounts of visceral fat may lead to an increase in insulin and cortisol levels. The study may suggest that increased fasting blood glucose is not necessarily the best predictor of metabolic dysregulation in a population of healthy college students.

Evaluation of Iron Stores by Zinc Protoporphyrin Analysis in Blood Donors.

Zinc protoporphyrin (ZPP) testing has been studied previously as a substitute for ferritin (fer) testing of blood donors in determining iron stores. To determine whether ZPP testing could be performed using specimens collected via the capillary (cap) finger-stick (FS) method, similar to predonation hemoglobin (HB) testing. Also, we evaluated the correlation among FS HB, venous (ven) ZZP, FS ZPP, and ven fer levels as predictors of iron depletion. Blood donations from 328 study participants were evaluated using FS HB assay; we also performed ven ZPP, cap ZPP, and ven fer testing. We assessed the donors for subclinical iron deficiency (fer levels <26 ng/mL and ZPP levels >100 μmol/mol heme). Subclinical iron deficiency was present among first-time and repeat blood donors at all HB levels. Variation among test results (FS HB, ven fer, ven ZPP, and FS ZPP) was statistically significant (P <.001). Insufficient correlation existed regarding FS HB and ven fer test results to support use of ZPP to determine iron stores in blood donors.

Correlations between gingival crevicular blood glucose and capillary blood glucose: A preliminary report.

INTRODUCTION:Oral health plays an important role for screening of many systemic diseases. Hence, dentists play an important role in screening for systemic diseases as well. Early diagnosis of any systemic diseases can prevent long-term complications. Diabetic is one of the common chronic diseases. Hence, the study had been undertaken to evaluate whether gingival crevicular blood (GCB) can be used to screen for diabetes during routine oral health checkups.MATERIALS AND METHODS:This analytical study included thirty participants who visited the Department of Periodontics, who fulfilled inclusion criteria and were willing to participate. Blood samples were collected by finger stick method and periodontal probing. The glucose levels of both the samples were estimated using glucometer and correlated the levels from both the methods.RESULTS:Correlation between capillary finger stick blood glucose and GCB glucose was high (0.97) and was significant at 0.01 level.CONCLUSION:Blood oozing during routine periodontal examination can be used for diabetes mellitus screening in dental office.

Closing the Loop.

For individuals living with diabetes, monitoring blood glucose has classically been accomplished in an open-loop fashion through the utilization of a continuous glucose monitor (CGM), finger stick method, or both. A closed-loop artificial pancreas (AP) system has the potential to significantly reduce the burdens of type 1 diabetes (T1DM) patients. Creating a fully closed-loop automated insulin delivery system involves a progression from in silico studies, to clinical trials, and finally to outpatient studies to assess the system’s ability to cope with the challenges of daily life. Outpatient studies are currently being performed to evaluate the difficulties presented by meals, exercise, and nighttime glycemic control. Other studies are attempting to determine if benefit lies in a dual-chamber system that delivers both insulin and glucagon. Three components constitute an AP system: a CGM, an insulin pump, and a control algorithm that calculates insulin dosing based on the input from the CGM. There are currently three leading algorithms in the field of AP research: model predictive control (MPC), proportional-integral-derivative (PID), and fuzzy logic (FL). All three algorithms have shown high success rates in the field of AP research and are being studied in order to fine-tune control of blood glucose variability. In addition, the development of auxiliary safety systems is being pursued as means of diminishing insulin dosing error (1,2). In making the AP system a highly mobile, outpatient device, consumer electronics and technology such as 3G and Wi-Fi are being leveraged in the development of remote monitoring platforms to assist those living with diabetes. Smartphones may be used as a platform for the AP system, while 3G and Wi-Fi allow physicians to monitor patients with diabetes online from distant locations. However, the usefulness and costs of such remote monitoring features remain a controversial subject in healthcare. The past year has brought notable advancements in the field of AP research. Systems currently in development and testing phases may transform diabetes care from an open-loop, selfmonitoring routine to a fully automated closed-loop process where an individual with diabetes may be relieved from paying constant attention to their condition. Past clinical trials are being moved to outpatient studies, representing a significant leap toward a marketable AP consumer product. As current studies are constantly challenging AP technology, new limitations reveal areas for progression, innovation, and improvement. The following articles highlight this year’s most significant and intriguing strides toward ‘‘closing the loop’’ and show promise for the future of diabetes care.

Elite Female Athletes' Ventilatory Compensation to Decreased Inspired O2 During the Wingate Test

Purpose: The purpose of this study was to determine if anaerobic performance as measured by the Wingate is decremented in elite female athletes when fraction of inspired oxygen is decreased from 20.9% to 10%. Method: Nine collegiate female soccer players (Mweight = 63.2 ± 10 kg, Mheight = 164 ± 4.7 cm, Mage = 18.6 ± 0.5 year) performed 1 Wingate test under each condition separated by at least 24 hr. Oxygen consumption was measured breath by breath using a Sensor-Medics metabolic cart. Postexercise blood lactates were measured using the finger-stick method. During normoxic and hypoxic (10% inspired oxygen [O2]) conditions, participants inhaled air from a 300-L weather balloon during the 30-s test. Results: Peak power, minimum power, average power, postexercise blood lactate, preexercise and postexercise blood O2 saturation, and total O2 consumed during exercise and during recovery were not statistically different between conditions. However, the Fatigue Index and peak ventilation were significantly greater during hypoxia than normoxia (35 ± 11% vs. 27 ± 9% & 91.6 ± 14.2 L/min vs. 75.2 ± 11.1 L/min, respectively, p < .05, Cohen's d = − 0.80 and − 1.29, respectively). Ventilation was elevated during hypoxia within 5 s of beginning the Wingate and remained elevated throughout exercise. This increased ventilation was sufficient to maintain oxygen consumption during exercise. Conclusion: Under hypoxic conditions, the ventilatory response to the Wingate test is perhaps more important than aerobic capacity per se in determining whether or not Wingate performance is decremented.

Prevalence of Diabetes Mellitus in a Population-Based Sample of Adults in Tirana, Albania

Aims: Our aim was to assess the prevalence of diabetes mellitus through self-reports and measurement of fasting glucose level in a representative sample of Albanian adults residing in Tirana. Study Design: Cross-sectional study. Place and Duration of Study: The survey was conducted in urban Tirana during AprilJuly 2012. Methods: A population-based sample of 795 individuals aged ≥18 years was included in this study (60% women; overall mean age: 50.3±18.7 years; response rate: 79.5%). Finger stick method was used to measure fasting glucose level in all participants. Furthermore, weight and height were measured. Data on socio-demographic and socioeconomic factors were also collected. General linear model was used to assess the association of mean glucose level with demographic and socioeconomic characteristics and anthropometric indices. Original Research Article British Journal of Medicine & Medical Research, 4(3): 852-861, 2014 853 Results: The overall prevalence of self-reported diabetes was 11.8%. In multivariableadjusted analysis, among non-diabetic individuals, age and body mass index were significantly and positively associated with mean fasting glucose levels. Conversely, among diabetic individuals, no statistically significant differences of mean glucose levels were observed upon multivariable-adjustment. Conclusions: The prevalence of diabetes mellitus in this representative sample of primary health care users in Tirana was higher than previous reports from Albania. The management and control of diabetes is not adequate in the Albanian primary health care system, exposing individuals to a high risk for future diabetic complications.

A Convenient Method for Measuring Blood Ascorbate Concentrations in Patients Receiving High-Dose Intravenous Ascorbate

Objective: A simple method of using fingerstick blood glucose (FSBG) monitors to estimate blood ascorbate values after high-dose intravenous (IV) ascorbate infusion is evaluated as a substitution for high-performance liquid chromatography (HPLC) measurement. Methods: In 33 participants, readings from FSBG monitors were taken before and after IV ascorbate infusions at various time points, with the postinfusion FSBG readings subtracted from the baseline glucose readings. The results of the subtractions (AAFSBG) were correlated with ascorbate concentrations detected by HPLC (AAHPLC). Results: A linear regression was found between ascorbate concentrations detected by the fingerstick method (AAFSBG) and by HPLC (AAHPLC). The linear correlations were identical in healthy subjects, diabetic subjects, and cancer patients. Analysis of variance obtained an AAFSBG/AAHPLC ratio of 0.90, with a 90% confidence interval of (0.69, 1.20). The corrections of AAFSBG improved similarity to AAHPLC but did not significantly differ from the uncorrected values. Conclusion: The FSBG method can be used as an approximate estimation of high blood ascorbate concentration after IV ascorbate (>50 mg/dL, or 2.8 mM) without correction. However, this measurement is not accurate in detecting lower or baseline blood ascorbate. It is also important to highlight that in regard to glucose monitoring, FSBG readings will be erroneously elevated following IV ascorbate use and insulin should not be administered to patients based on these readings.

Whole genome transcript profiling from fingerstick blood samples: a comparison and feasibility study

BackgroundWhole genome gene expression profiling has revolutionized research in the past decade especially with the advent of microarrays. Recently, there have been significant improvements in whole blood RNA isolation techniques which, through stabilization of RNA at the time of sample collection, avoid bias and artifacts introduced during sample handling. Despite these improvements, current human whole blood RNA stabilization/isolation kits are limited by the requirement of a venous blood sample of at least 2.5 mL. While fingerstick blood collection has been used for many different assays, there has yet to be a kit developed to isolate high quality RNA for use in gene expression studies from such small human samples. The clinical and field testing advantages of obtaining reliable and reproducible gene expression data from a fingerstick are many; it is less invasive, time saving, more mobile, and eliminates the need of a trained phlebotomist. Furthermore, this method could also be employed in small animal studies, i.e. mice, where larger sample collections often require sacrificing the animal. In this study, we offer a rapid and simple method to extract sufficient amounts of high quality total RNA from approximately 70 μl of whole blood collected via a fingerstick using a modified protocol of the commercially available Qiagen PAXgene RNA Blood Kit.ResultsFrom two sets of fingerstick collections, about 70 uL whole blood collected via finger lancet and capillary tube, we recovered an average of 252.6 ng total RNA with an average RIN of 9.3. The post-amplification yields for 50 ng of total RNA averaged at 7.0 ug cDNA. The cDNA hybridized to Affymetrix HG-U133 Plus 2.0 GeneChips had an average % Present call of 52.5%. Both fingerstick collections were highly correlated with r2 values ranging from 0.94 to 0.97. Similarly both fingerstick collections were highly correlated to the venous collection with r2 values ranging from 0.88 to 0.96 for fingerstick collection 1 and 0.94 to 0.96 for fingerstick collection 2.ConclusionsOur comparisons of RNA quality and gene expression data of the fingerstick method with traditionally processed sample workflows demonstrate excellent RNA quality from the capillary collection as well as very high correlations of gene expression data.