Point-of-care Glucose Testing Research Articles

Summary of clinical investigation plan for The DIATEC trial: in-hospital diabetes management by a diabetes team and continuous glucose monitoring or point of care glucose testing – a randomised controlled trial

BackgroundWorldwide, up to 20 % of hospitalised patients have diabetes mellitus. In-hospital dysglycaemia increases patient mortality, morbidity, and length of hospital stay. Improved in-hospital diabetes management strategies are needed. The DIATEC trial investigates the effects of an in-hospital diabetes team and operational insulin titration algorithms based on either continuous glucose monitoring (CGM) data or standard point-of-care (POC) glucose testing.MethodsThis is a two-armed, two-site, prospective randomised open-label blinded endpoint (PROBE) trial. We recruit non-critically ill hospitalised general medical and orthopaedic patients with type 2 diabetes treated with basal, prandial, and correctional insulin (N = 166).In both arms, patients are monitored by POC glucose testing and diabetes management is done by ward nurses guided by in-hospital diabetes teams. In one of the arms, patients are monitored in addition to POC glucose testing by telemetric CGM viewed by the in-hospital diabetes teams only. The in-hospital diabetes teams have operational algorithms to titrate insulin in both arms. Outcomes are in-hospital glycaemic and clinical outcomes.DiscussionThe DIATEC trial will show the glycaemic and clinical effects of in-hospital CGM handled by in-hospital diabetes teams with access to operational insulin titration algorithms in non-critically ill patients with type 2 diabetes. The DIATEC trial seeks to identify which hospitalised patients will benefit from CGM and in-hospital diabetes teams compared to POC glucose testing. This is essential information to optimise the use of healthcare resources before broadly implementing in-hospital CGM and diabetes teams.Trial registrationProspectively registered at ClinicalTrials.gov with identification number NCT05803473 on March 27th 2023.

Point-of-care blood glucose testing: post-market performance assessment of the Accu-Chek Inform II hospital-use glucose meter

Background. A point-of-care glucose testing (POCT) is an essential component of care in patients with hyperglycemia and hypoglycemia in inpatient and outpatient medical facilities (MFs). In MFs conventional glucose meters designed for self-monitoring by patients with diabetes are commonly used for POCT. These home-use meters have two serious disadvantages: the first is large measurement bias and the second – they can’t be integrated into laboratory information systems, so measurement data have to be recorded into patient charts manually. Both factors may lead to medical errors. It is reasonable to use in the MFs specialized POCT glucose meters, as they are superior to conventional ones in accuracy and may be easily connected to laboratory information systems. With this in mind, physicians at the Russian Children’s Clinical Hospital – Branch of Pirogov Russian National Research Medical University – decided to substitute conventional meters with the Accu-Chek Inform II POCT meter, however, after preliminary performance assessment of the model.
 Aim. To test the Accu-Chek Inform II performance characteristics: accuracy, linearity, repeatability, mean absolute relative difference.
 Materials and methods. Performance of the Accu-Chek Inform II was tested by comparing the results of parallel CGL measurements with the meter and reference laboratory analyzer in capillary blood samples. Overall, 99 parallel CGL measurements were made in 45 samples. Accuracy was evaluated according to the ISO 15197-2013 and POCT12-A3 criteria.
 Results. The Accu-Chek Inform II meter met the requirements of ISO 15197-2013 and POCT12-A3 and demonstrated high linearity (correlation coefficient, r=1.0), good repeatability (mean coefficient of variation, CV=1.38%) and acceptable mean absolute relative difference (4.9%).
 Conclusion. The Accu-Chek Inform II POCT glucose meter may be efficiently and safely used in inpatient and outpatient MFs and particularly in pediatric clinics.

Evaluation of a hybrid protocol using continuous glucose monitoring and point-of-care testing in non-critically ill patients in a community hospital.

Inpatient glycemic management typically involves use of point-of-care (POC) glucose measurements to inform insulin dosing decisions. This study evaluated a hybrid monitoring protocol using real-time continuous glucose monitoring (rtCGM) supplemented with POC testing at a community hospital. Adult inpatients receiving POC glucose testing were monitored using rtCGM in a telemetry unit. The hybrid monitoring protocol required a once-daily POC test but otherwise primarily relied on rtCGM values for insulin dosing decisions. Outcomes assessment included surveillance error grid (SEG) and Clarke Error Grid (CEG) analysis results, the mean absolute relative difference (MARD) for available rtCGM-POC value pairs before and after study protocol application, the number of POC tests avoided, and the number of hypoglycemic events involving a blood glucose value of <70 mg/dL identified by rtCGM and POC values. Data were collected from 30 inpatients (the mean age was 69.4 years, 77% were female, 80% had type 2 diabetes, and 37% were at-home insulin users). With the protocol applied, a total of 202 rtCGM-POC pairs produced a MARD of 12.5%. SEG analysis showed 2 pairs in the "moderate" risk category, with all other pairs in the "none" or "slight" risk categories. CEG analysis showed 99% of paired values to be in the clinically acceptable range. Six hypoglycemic events in 5 patients were resolved without incident. Three hundred three POC tests were avoided, a 60% reduction for the study duration. Use of a hybrid monitoring protocol of rtCGM and POC testing in a community hospital demonstrated sustained rtCGM accuracy and was found to reduce the frequency of POC testing to manage inpatient glycemia.

A-386 Performance assessment of Point of care testing for blood glucose: a 5 year review of EQA data

Abstract Introduction WEQAS is the largest External Quality Assessment (EQA) provider for the Point of Care Testing (POCT) market within the UK supplying samples and assessment to over 30 000 sites per month with over 20 Programmes across the entire Health care sector. All the Programmes are accredited to ISO 17043.The aim of the programme is to provide support to POCT co-ordinators, to identify non compliant sites and improve the analytical performance of users. Most of the programmes are designed to allow the full assessment of all the devices within the organisation at either monthly, bimonthly or quarterly intervals. A Co-ordinator in each organisation is given a Group Administrator function for the EQA website and maintains the database for its own organisation. The role of performance surveillance is therefore devolved to each individual Co-ordinator at a local level and monitored nationally by the EQA organiser. The powerful database gives POCT Co-ordinators a wealth of information on method and analyser performance both within their own organisation and between organisations. Organisation performance summary reports, distribution letters, non-compliance reports, poor performance reports and cumulative reports are generated from one system. The POCT Users are also provided with a simple traffic light system with clear action limits. For the POCT glucose programme one sample is distributed each month with samples covering a range of 2 to 28 mmol/l annually. Methods A review of performance was undertaken between January 2018 and January 2023 for the POCT glucose Programmes for a selection of devices. Devices that were no longer available were excluded as were devices with &amp;lt;50 users in the group. This represented data from 10 360 devices per month in 2018 and 12 277 in 2023. Performance was assessed as the coefficient of variation (CV%) for the device group after outlier exclusion and calculated for a wide range of glucose concentrations. Results For devices with CV less than 5% in 2018 there was generally no further improvement in performance, however at a glucose of 2 mmol/L an improvement in performance of 0.5to 3.5% was observed for the other devices. In 2018 CVs ranged from 3.7 to 12% and 3.1 to 8.3%% at 2.5 and 26 mmol/L respectively compared with 4 to 10.3% and 3.3 to 7.2% in 2022. Conclusion Although there were numerous examples where EQA identified poor performance at an individual user level, there was little evidence to suggest that the performance of POCT glucose devices had improved significantly over the last 5 years.

Challenges with point of care glucose measurements for management of hypoglycemia in neonates

Guidelines from the Canadian Paediatric Society recommend investigating hypoglycemia at a patient blood glucose concentration of 2.6 mmol/L for patients less than 72 hours of age and 3.3 mmol/L for patients 72 hours of age or older (1). Patients with blood glucose <2.8 mmol/L after 72 hours of age require additional investigation with samples sent to the laboratory for glucose (to confirm), beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine, and acylcarnitines (1). Neonatal blood glucose concentrations are frequently monitored using point of care testing (POCT) glucose metres. In Canada, there are currently two glucose metres approved by Health Canada for use in hospitals, the Accu-Chek Inform II (Roche Diagnostics) and the StatStrip (Nova Biomedical). POCT glucose metres are accurate for monitoring glycemic control in patients with diabetes (2). However, the accuracy and precision limitations of these metres struggle to match clinical need in the context of neonatal hypoglycemia. POCT glucose results have been shown to differ by as much as 10–20% from central laboratory methods for measurements in the hypoglycemic range; importantly, this difference, or bias, is not consistent between vendors (3,4). The extent of this bias can also shift over time due to variable performance of different lot numbers of test strips, highlighting the need for ongoing evaluation of metre performance.

Nursing Perspectives on the Use of Continuous Glucose Monitoring in the Intensive Care Unit.

The COVID-19 pandemic necessitated rapid implementation of continuous glucose monitoring (CGM) in the intensive care unit (ICU). Although rarely reported, perceptions from nursing staff who used the systems are critical for successful implementation and future expanded use of CGM in the inpatient setting. A 22-item survey focused on CGM use was distributed to ICU nurses at two large academic medical centers in the United States in 2022. Both institutions initiated inpatient CGM in the spring of 2020 using the same CGM+point of care (POC) hybrid protocol. The survey employed a 1- to 5-point Likert scale regarding CGM sensor insertion, accuracy, acceptability, usability, training, and perceptions on workload. Of the 71 surveys completed, 68 (96%) nurses reported they cared for an ICU patient on CGM and 53% reported they had independently performed CGM sensor insertion. The ICU nurses overwhelmingly reported that CGM was accurate, reduced their workload, provided safer patient care, and was preferred over POC glucose testing alone. Interestingly, nearly half of nurses (49%) reported that they considered trend arrows in dosing decisions although trends were not included in the CGM+POC hybrid protocol. Nurses received training through multiple modalities, with the majority (80%) of nurses reporting that CGM training was sufficient and prepared them for its use. These results confirm nursing acceptance and preference for CGM use within a hybrid glucose monitoring protocol in the ICU setting. These data lay a blueprint for successful implementation and training strategies for future widespread use.

Establishing quality indicators for point of care glucose testing: recommendations from the Canadian Society for Clinical Chemists Point of Care Testing and Quality Indicators Special Interest Groups.

Monitoring quality indicators (QIs) is an important part of laboratory quality assurance (QA). Here, the Canadian Society of Clinical Chemists (CSCC) Point of Care Testing (POCT) and QI Special Interest Groups describe a process for establishing and monitoring QIs for POCT glucose testing. Key, error prone steps in the POCT glucose testing process were collaboratively mapped out, followed by risk assessment for each step. Steps with the highest risk and ability to detect a non-conformance were chosen for follow-up. These were positive patient identification (PPID) and repeat of critically high glucose measurements. Participating sites were asked to submit aggregate data for these indicators from their site(s) for a one-month period. The PPID QI was also included as part of a national QI monitoring program for which fifty-seven sites submitted data. The percentage of POCT glucose tests performed without valid PPID ranged from 0-87%. Sites without Admission-Discharge-Transfer (ADT) connectivity to POCT meters were among those with the highest percentage of POCT glucose tests performed without valid PPID. The percentage repeated critically high glucose measurements ranged from 0-50%, indicating low compliance with this recommendation. A high rate of discordance was also noted when critically high POCT glucose measurements were repeated, demonstrating the importance of repeat testing prior to insulin administration. Here, a process for establishing these QIs is described, with preliminary data for two QIs chosen from this process. The findings demonstrate the importance of QIs for identification and comparative performance monitoring of non-conformances to improve POCT quality.

Finger-Stick Artifactual Hypoglycemia in the Emergency Department: A Case Report

BackgroundArtifactual hypoglycemia is a low glucose measurement in a normoglycemic patient. Patients in a shock state or with extremity hypoperfusion can metabolize a higher proportion of the glucose in the poorly perfused tissue, and blood obtained from those tissues may have far lower glucose concentration than the blood in the central circulation. Case ReportWe present the case of a 70-year-old woman with systemic sclerosis, progressive functional decline, and cool digital extremities. The initial point-of-care testing (POCT) for glucose was 55 mg/dL from her index finger, with subsequent repeated low POCT glucose reading, despite glycemic repletion and contradictory euglycemic serologic readings from her peripheral i.v. sites. Two separate POCTs were then obtained from her finger and her antecubital fossa, which had vastly different glucose readings; the latter was in congruence with her i.v. draws. The patient was diagnosed with artifactual hypoglycemia. Alternative sources of blood to avoid artifactual hypoglycemia on POCT samples are discussed. Why Should an Emergency Physician Be Aware of This?Artifactual hypoglycemia is a rare but commonly misdiagnosed phenomenon that can occur in emergency department patients when peripheral perfusion is limited. We encourage physicians to confirm peripheral capillary results with a venous POCT or explore alternative sources of blood to avoid artificial hypoglycemia. Small absolute errors can matter when the erroneous result is hypoglycemia.

Implementation of Six Sigma in Glucose POCT Quality Control at Dr. Soetomo General Academic Hospital

Point of Care Testing (POCT) is important for the examination of critically ill patients in the emergency room and intensive care unit. The evaluation of the analytic quality of POCT is needed to ensure the quality of patient care at Dr. Soetomo General Academic Hospital. The purpose of this study is to evaluate the analytical quality of POCT at Dr. Soetomo General Academic Hospital. This was an observational analytical study that was done at Dr. Soetomo General Academic Hospital Surabaya in July 2017. Point of care testing quality analysis was based on 20 within run Internal Quality Control (IQC). Internal quality control data was used to calculate the mean, SD, and CV%. CV% was calculated with the following equation "CV%=(SD í— 100)/mean". Bias % = [ control mean – control true value]/control true value x 100. The sigma value was obtained from Total Error Allowance (TEa) – Bias/CV. TEa in this study was based on ISO 15197:2003. The results of the glucose examination (58 samples) from Dimension EXL 1, 2, 3 (hexokinase method) compared with 7 glucose POCT (glucose oxidase:i-STAT Nova Biomedical method). The correlation was calculated with Spearman statistical analysis using the SPSS version 23.0. the mean CV of seven POCTs=3.5% (1.7%-5%), mean bias of seven POCT=7.75% (4.8%-12.5%), the mean six sigma of 7 POCT=6.77 (4.0–11.6). The best POCT with a six sigma value of &gt; 6 was glucometer K14_2, Palem 1 and GRIU. The glucometer with the lowest six sigma values but still had good quality control were K14_1 and ROI. All glucometers had a good correlation with r value &gt; 0.8 (p=0.000). Glucose POCT in Dr. Soetomo General Academic Hospital all had good quality and met world-class standards. Further study using IQC 2 levels is recommended for a better POCT quality evaluation.

67-LB: Nursing Perspectives on Hospital Use of Dexcom Continuous Glucose Monitor in Patients with Suspected or Known COVID-19 during Insulin Infusion

The coronavirus disease 2019 pandemic resulted in the need for remote glucose monitoring in intensive care unit (ICU) patients requiring insulin infusions. While rarely reported, perceptions from nursing staff are critical for successful implementation and expanded use. A hybrid continuous glucose monitoring (CGM) and intermittent point of care (POC) glucose monitoring was developed at the study institution. After 1.5 years of protocol use, an anonymous survey was distributed electronically to ICU nurses to obtain their perspectives on CGM utilization. The survey employed a 1-5 Likert scale regarding CGM sensor insertion, accuracy, acceptability, and usability as well as perceptions on reduced room entry and reduced workload. Of the 51 surveys completed, 50 (98%) nurses reported they cared for an ICU patient enrolled in the CGM protocol and 31 (62%) started or replaced a CGM sensor. A representative sample of questions and responses is shown in table 1. ICU nurses overwhelmingly reported CGM was accurate, reduced their workload, provided safer patient care, and was preferred over POC glucose testing alone. These results confirm nursing acceptance and preference for CGM use within a hybrid glucose monitoring protocol in the ICU setting. Disclosure J. Pattison: None. K. M. Dungan: Advisory Panel; Dexcom, Inc., Consultant; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Elsevier, Nova Biomedical, Novo Nordisk, Tolerion, Inc., Other Relationship; UpToDate, Research Support; Abbott, Dexcom, Inc., Novo Nordisk, Sanofi, ViaCyte, Inc., Speaker’s Bureau; Academy for Continued Healthcare Learning, Cardiometabolic Health Congress, Medscape. E. Buschur: Advisory Panel; Beta Bionics, Inc., Research Support; Dexcom, Inc. M. C. Exline: Other Relationship; Abbott. L. G. Jones: None. C. May: None. M. Mcnett: None. K. Smetana: None. E. R. Faulds: Advisory Panel; Dexcom, Inc., Research Support; Dexcom, Inc., Speaker’s Bureau; Medscape.

649-P: Real-Time Continuous Glucose Monitoring in the Hospital Identifies and Prompts Treatment for Hypoglycemia

Reliance on point-of-care (POC) blood glucose measurements for inpatient diabetes management can result in long between-measurement intervals, which contribute to undetected and untreated dysglycemia. The G6 real-time continuous glucose monitoring (RT-CGM) system (Dexcom) allows for remote monitoring. In the hospital, this may reduce the need for close interactions and infectious disease transmission between patients and hospital staff. A man in his mid-60s was admitted to a non-intensive care unit in an acute care facility with a diagnosis of COVID-19. His preadmission type 2 diabetes was managed with twice-daily intermediate-acting insulin and prandial rapid-acting insulin; steroids and POC glucose testing (prandial and bedtime with a FreeStyle Precision Pro meter [Abbott]) were added to this regimen. A G6 was placed on the abdomen and was set to alert the staff to glucose values ≤85 mg/dL or predicted to be &amp;lt;55 mg/dL within 20 minutes. Two hypoglycemic events occurred which triggered three G6 alerts (Figure) . The G6 alerts prompted ad hoc POC measurements that confirmed the hypoglycemic events, prompted appropriate interventions, and documented the patient’s return to euglycemia. All seven G6 readings were within 20 mg/dL or 20% of POC values ≤100 or &amp;gt;100 mg/dL, respectively. Inpatient RT-CGM use can detect existing or impending hypoglycemia and assist in diabetes management. Disclosure M.Baker: Other Relationship; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. Funding Dexcom, Inc.

950-P: Point-of-Care Glucose Testing in the Preoperative Area prior to Surgery: Is It Useful?

Background: Maintaining perioperative glycemic control is important for patients undergoing a surgical procedure to prevent postoperative complications. Methods: The authors conducted a pilot project designed to detect and manage perioperative hyperglycemia in a women’s hospital in Virginia. Point of Care (POC) fasting blood glucose tests were performed on the day of surgery in high risk patients. Criteria for screening were: known diabetes, BMI &amp;gt;30 and age &amp;gt; 45. Patients with hyperglycemia were treated according to a protocol using a bolus of intravenous insulin and/or insulin infusion. Results: Of the 1478 patients undergoing surgery, 1187 (80%) met criteria for POC glucose testing during the 12 week pilot. Forty-eight percent had fasting blood glucose values of either impaired glucose/prediabetes (100 mg/dL-125mg/dl) or higher (see figure) . Seven patients had a fasting glucose of &amp;gt; 200 mg/dl and met criteria to receive insulin in the O.R. Six of these seven patients had known diabetes. A single patient with previously undiagnosed diabetes qualified for insulin therapy. In no circumstance was surgery delayed or cancelled due to hyperglycemia. Conclusion: Screening for hyperglycemia in the preoperative area is a valuable tool for identifying patients who may benefit from intraoperative insulin therapy. The vast majority of patients who require rescue insulin therapy in the operating room have known diabetes. Disclosure S.Ahmad: None. K.K.Edmiston: None. B.Good: None. M.W.Jeffery: Other Relationship; Medtronic. P.W.Clougherty: None. S.Clement: Research Support; Novo Nordisk. Funding Division of Endocrinology, Medicine Service Line, Inova Health System

The Current Status of Preclinical Endocrine Education in U.S. Medical Schools

ObjectiveTo characterize the current landscape of preclinical medical endocrine education in U.S. allopathic medical schools. MethodsU.S. endocrine curriculum directors were asked to voluntarily complete a 16-question email survey surveying the status of endocrine preclinical education at their medical school. ResultsSixty-nine of 155 (45%) endocrine block director respondents completed the online survey between July 2021 and September 2021. A larger incoming class, a longer duration of the endocrine curriculum, and the offering of a separate endocrine curriculum (ie apart from the teaching of other organ systems) were each independently associated with an increased number of faculty teaching the course. Schools that used a gland-/organ-based curriculum only and those that used a combination of gland-/organ-based curriculum with topic-based curriculum differed significantly in their use of large lectures, small groups, and several curriculum components, including point of care glucose testing, continuous glucose monitoring, and insulin pumps. ConclusionThis survey study reports the current landscape of preclinical endocrine education in the United States and describes opportunities to improve interest in pursuing endocrinology as a career.

Comparison of POCT glucose meters and analysis of the interference factor

Abstract Objectives Not many reports have covered large-scale point of care testing (POCT) blood glucose comparisons, and many interfering factors affect detection. This study aims to verify the performance of POCT blood glucose meters and discusses the factors that interfere with detection. Methods Accuracy and precision verification in five glucose concentration groups-high 1 (H1), High 2 (H2), medium 1 (M1), medium 2 (M2), and low (L); comparison of different test methods and specimens; and also the influence of iodophor was investigated in a dilution experiment. Results A total of 58 out of 64 Accu-Chek Inform II POCT blood glucose meters (ACI II) qualified for testing. A proportional significant difference in the relative bias was observed with the POCT instruments in the intermediate and high glucose concentration groups (H=15.364, p=0.02). There were significant differences among the five groups with compliance rates (χ 2=21.03, p=0.00); Group L showed higher values than groups H1 and H2. The precision verification met the requirements issued by the Consensus. Significant differences were found between the three detection methods. The measurement of the Glucose Oxidase Method (Cobas B 123) was lower than that of the HITACHI Plasma Hexokinase Method and the Glucose Dehydrogenase Method on the ACI II (p=0.005 and 0.003) in the preliminary study. No differences were seen among the three types of specimens (p&gt;0.05). The glucose results were incorrect in the presence of iodophor interference. Conclusions The ACI II and Cobas B123 (with a slightly negative bias) provide sufficiently accurate measurements, and all types of blood specimens can be applied. Iodophor, a disinfectant, interferes with glucose measurement.

Korelasi Glukosa Kapiler Metode Glucose Dehidrogenase-Nicotinamide Adenine Dinucleotide Dengan Glukosa Serum Metode Heksokinase

Rapid and accurate measurement of capillary glucose level using point-of-care testing (POCT) is needed to maintain the patient’s normoglycemic status in obtaining adequate management. The glucose POCT method should be evaluated to determine analytical performance by comparing with the hexokinase method as a reference method to provide accurate and reliable results. Objectives: To determined the correlation between capillary glucose using glucose dehydrogenase-nicotinamide adenine dinucleotide (GDH-NAD) and serum glucose hexokinase methods. Methods: This analytic cross-sectional study on 42 outpatients who underwent fasting blood glucose examination at Dr. M Djamil Padang General Hospital. This study was conducted from February until September 2020. Capillary fasting blood glucose was measured using glucose POCT GDH-NAD method and serum glucose with hexokinase method. The Spearman correlation test was used to analyze data, significant if p&lt;0.05. Results: The subjects were 28 male (66.7%),14 female (33.3%) with mean age and hematocrit level was 56.12±12.97 years and 40.90±2.42%, respectively. The median capillary glucose GDH-NAD method and serum glucose hexokinase method were 100.00 mg/dL each, with a median difference was 3.00 mg/dL. Spearman correlation test showed very strong positive correlation and statistically significant (r=0,961;p=&lt;0,001). Conclusion: Capillary glucose GDH-NAD method had a very strong positive correlation with serum glucose hexokinase method.Keywords: hexokinase, fasting glucose level, GDH-NAD, glucose POCT

Telemetric Continuous Glucose Monitoring During the COVID-19 Pandemic in Isolated Hospitalized Patients in Denmark: A Randomized Controlled Exploratory Trial.

Objective: To investigate whether telemetric continuous glucose monitoring (CGM) in hospitalized and isolated patients with diabetes mellitus and coronavirus disease 2019 (COVID-19) is associated with better glycemic outcomes and fewer patient health care worker contacts compared to blood glucose monitoring by traditional point-of-care (POC) glucose testing and to investigate the user aspect of implementing a CGM-system in-hospital. Materials and Methods: A randomized controlled exploratory trial was performed on hospitalized and isolated patients with diabetes and COVID-19 from May 2020 until February 2021 at Nordsjællands Hospital, Denmark. Participants were randomized to nonblinded telemetric CGM (as the only glucose monitoring method) or traditional POC glucose testing + blinded CGM. The primary endpoint was time in range (TIR) based on CGM data in both groups. A questionnaire about the user aspect of the CGM system was answered by health care personnel (HCP). Results: We included 64 participants in the analysis, 31 in the CGM group and 33 in the POC glucose group. TIR median was 46% for the CGM group and 68% for the POC glucose group (P = 0.368). The mean glucose value for the CGM group was 11.1 and 10.8 mmol/L in the POC glucose group (P = 0.372). CGM was associated with fewer POC glucose measurements (P < 0.001). Out of 30 HCPs, 28 preferred telemetric CGM over POC glucose testing. Conclusion: Remote glucose monitoring by CGM did not improve glycemic outcomes compared to traditional POC glucose testing, but was associated with fewer patient-personnel contacts, saving time for HCPs performing diabetes-related tasks. Most HCPs preferred CGM. The study is registered at http://www.clinicaltrials.gov (#NCT04430608).

The clinical effect of glucose meter selection upon the detection of neonatal hypoglycemia.

Neonatal hypoglycemia is a common, transitional metabolic state that may lead to poor neurodevelopmental outcomes if unrecognized or managed inadequately. Given its frequency of presentation and immense clinical significance, a myriad of clinical practice guidelines have been published outlining appropriate screening, diagnosis, and treatment principles-many endorsing the use of glucose point-of-care testing (POCT). Unfortunately, the well-intended 'march' toward POCT, with bedside glucose meters as screening devices in the NICU, has resulted in unintended consequences with critical implications: a lack of international traceability to the 'gold' standard glucose method by POCT devices, under-recognition of POCT limitations, and a reliance upon a technology primarily driven to detect hyperglycemia in the adult population as opposed to neonatal hypoglycemia. As providers continue to advocate for improved POCT, there must be robust communication between providers and the clinical laboratory in the selection, standardization, and interpretation of glucose POCT to ensure optimal neonatal glucose detection.

EVALUASI ANALITIK POCT METODE GLUCOSE DEHYDROGENASE PARAMETER GLUKOSA PADA SPESEIMEN SERUM DAN PLASMA EDTA

Diabetes is a non-communicable disease that can be prevented and detected as early as possible by routine glucose checks. Point Of Care Testing (POCT) as a diabetes test screening tool is widely used by health care institutions and is even used independently by the wider community. Blood glucose can be measured by serum, plasma, and whole blood specimens. The standard specimen for glucose measurement using POCT is whole blood. Based on the author's survey, the use of the POCT tool in several health care institutions was not following the insert of the tool kit, one of which was the type of specimen used. Many laboratories use EDTA serum and plasma specimens for glucose testing using the POCT device. There are many methods used in the POCT tool, one of these methods is the glucose dehydrogenase method. Therefore analytic evaluation is necessary to ensure the accuracy and accuracy of laboratory examination results in glucose examination. This type of research is the analytical method with a comparative design. The data was collected using the total sampling method. The data is reported using Microsoft Excel and SPSS applications. The number of samples for analytic evaluation was 40 samples. Based on the results of tests performed in duplicate, there were clinical differences in glucose values using serum and plasma EDTA samples so that the use of these samples was not suitable for use for diagnostic purposes using the POCT glucose dehydrogenase method. There was a statistical difference in serum glucose and plasma EDTA against whole blood that was examined using the POCT glucose dehydrogenase method with a correlation value (R) of 0.9722 and 0.9695.

74-LB: Sudden Changes in Interstitial Glucose Sensing by Remote Real-Time Continuous Glucose Monitoring as a Marker of Hypoperfusion in Critically-Ill Patients with COVID-19

Introduction: During the COVID-19 pandemic, we implemented a protocol combining continuous glucose monitoring (CGM) with a computerized intravenous insulin infusion algorithm to care for patients with severe COVID-19. Objective: To examine glucose trends surrounding cardiac arrest events to evaluate the performance of CGM sensors during severe clinical instability. Methods: We reviewed eight cases of patients with type 2 diabetes diagnosed with COVID-19 requiring ICU care on IV insulin and CGM therapy experiencing severe clinical decompensation leading to cardiac arrest. Index events (cardiac arrest) were identified by staff documentation in the electronic health record. Clinical characteristics, mean arterial pressure (MAP), and point-of-care (POC) glucose values surrounding the index event were collected. CGM data was paired with MAP and POC glucose values. Rapid declines in the glucose trend [rate of change (ROC) ≥3mg/dl/min] were identified during this time of clinical instability. Results: The mean age of patients was 61.3±13.8 years. All patients were treated with steroid therapy, vasopressors, and mechanical ventilation. 62.5% were on CRRT. Four (50%) patients had sudden cardiac arrest and drop in MAP, while the other four patients had a more prolonged decline in MAP prior to cardiac arrest. CGM values in those with sudden arrest showed an abrupt decline (≥3mg/dl/min) an average of 16.7±13.7 min following cardiac arrest. Rapid down trending of CGM values in those with prolonged hypotension occurred on average about 6 hours prior to cardiac arrest. During these episodes, the CGM values stopped correlating with POC tests. Conclusions: Real-time CGM in critically-ill patients may provide clinical information beyond glucose control. Rapid declines in CGM values (≥3mg/dl/min) not correlating with POC glucose testing are associated with both sudden and prolonged changes in arterial pressure. Disclosure J. Hester: None. G. M. Davis: None. F. J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Research Support; Self; Dexcom, Inc., Merck &amp; Co., Inc. M. Rabinovich: None. N. Poindexter: None. S. Tekwani: None.

Pseudohypoglycemia: A Simple Approach to Complex Phenomenon

Background: Pseudohypoglycemia is a condition where the measured glucose level is falsely lower than the actual level. It can be due to impaired circulation or in vitro glycolysis. Clinical Case: Patient 1: A 58-year-old male with a past medical history of sickle cell trait was admitted for alcohol intoxication. Low blood glucose levels were found on finger stick point-of-care testing (POCT). Fasting and postprandial glucose levels were between 17 and 60 mg/dL. The patient was asymptomatic, alert with no tremor, palpitation, or sweating. Glucose POCT was repeated from the earlobe each time a low finger stick level was found, showing normal glucose levels ranging between 85 to 115 mg/dL, confirmed with venous blood glucose measurement. On examination, the patient had mild skin thickening of the hands, with no acrocyanosis, calcinosis, or finger ulceration—normal peripheral pulses with no signs of heart failure. Lab results showed macrocytic anemia, otherwise normal metabolic panel. ANA, anti-Scl-70, and anticentromere antibodies were negative. Patient 2: A 91-year-old female admitted for decompensated heart failure was incidentally found to have fasting glucose levels on finger stick POCT ranging between 30–50 mg/dL. Postprandial glucose on finger stick POCT was ranging between 55–120 mg/dL. Venous glucose levels were ranging between 90 and 180 mg/dL. The patient was alert and asymptomatic. Examination showed bilateral acrocyanosis, poor peripheral circulation with capillary refill > 5 seconds, pitting pedal edema, elevated JVP, and crackles on chest auscultation. Labs showed BNP levels of 1130 pg/mL (n < 100 pg/mL), with ejection fraction of about 35% on echocardiography. Heart failure management was optimized, and warming of the hands with blankets improved peripheral circulation, with capillary refill < 2 seconds, and resolution of cyanosis coinciding with matching of finger stick POCT glucose levels to that of venous blood. Both patients were asymptomatic at the time of low POCT glucose and thus did not fulfill Whipple’s triad (measured hypoglycemia, symptomatic, a reversal of symptoms on glucose administration). Furthermore, they had no history of diabetes or the use of any hypoglycemic agents. Thus, normal venous blood glucose levels documented at the time of low POCT glucose lead to a diagnosis of pseudohypoglycemia. The etiology in patient 1 was likely due to peripheral vascular disease. In patient 2, the cause was likely due to congestive heart failure, with poor peripheral perfusion. Clinical Lesson: Low glucose levels are frequently encountered in clinical practice. It is essential to check if the non-diabetic patient is symptomatic or not. It is worth checking glucose levels from other sites in asymptomatic patients who do not fulfill Whipple’s triad before preceding into an elaborate hypoglycemia work-up.