指尖毛细血管全血糖与静脉血浆血糖检测结果对比分析

目的对比分析指尖毛细血管全血血糖与静脉血浆血糖的检测结果 ,以探讨指尖毛细血管全血糖检测血糖的准确性。方法于2014年1月—2015年10月,选取在该疾控中心体检科进行血糖检测的200例受检者进行研究,按照其血糖情况进行分组,分为低血糖组、血糖正常组、糖耐量异常组、糖尿病组。分别于空腹状态时和餐后2 h,采集这200例受检者的指尖毛细血管全血和外周静脉血液,使用全自动生化分析仪进行血糖测定,对比指尖毛细血管全血和静脉血液的血糖检测结果。结果低血糖组、血糖正常组、糖耐量异常组以及糖尿病组受检者的指尖毛细血管全血血糖检测结果均与静脉血浆血糖检测结果的差异无统计学意义(P0.05)。结论指尖毛细血管全血血糖检测方法具有较高的准确性,与静脉血浆血糖检测结果较为接近,可有效反映受检者的血糖水平,可作为社区、家庭进行自我血糖监测和管理的有效方法。     

Peroral Glucose Tolerance Test

ABSTRACT Seventy patients on long-term diuretic therapy for arterial hypertension and/or congestive heart failure were investigated with regard to skeletal muscle electrolytes and the results of a peroral glucose tolerance test. A significant correlation was observed between the muscle content of potassium and the ability to handle a glucose load. Thirty patients underwent a second set of samples six months after the first one, 23 of whom had a reduction of their muscle potassium content relative to the first biopsy. They simultaneously demonstrated a significant impairment of glucose tolerance.     

血糖正常人群葡萄糖耐量试验2h血糖与冠心病发病风险关系的前瞻性队列研究

目的探讨血糖正常人群葡萄糖耐量试验2 h血糖与冠心病发病风险的关系。方法 2000年2月,在我院门诊健康体检人群中共招募到2 675例受试者(空腹血糖6.1 mmol/L,葡萄糖耐量试验2 h血糖7.8 mmol/L),将葡萄糖耐量试验2 h血糖≤空腹血糖者1 239例纳入A组,葡萄糖耐量试验2 h血糖空腹血糖者1 436例纳入B组。对两组受试者随访至2006年1月,观察其冠心病发病情况,同时记录其年龄、体质指数、空腹血糖、葡萄糖耐量试验2 h血糖、血清空腹胰岛素及总胆固醇水平、吸烟及高血压情况等。结果随访结束时,2 675例受试者共发生冠心病103例,其中男73例,女30例,冠心病年平均发病率6.4‰,男性受试者冠心病发病率高于女性(P0.05)。根据性别进行亚组分析:A组中男701例,女538例;B组中男824例,女612例。A组男性受试者体质指数、葡萄糖耐量试验2 h血糖、血清空腹胰岛素水平、高血压发病率低于B组,空腹血糖、吸烟率高于B组(P0.05);A组女性受试者年龄、葡萄糖耐量试验2 h血糖、血清空腹胰岛素水平、高血压发病率低于B组,空腹血糖、吸烟率高于B组(P0.05)。Cox比例风险模型分析结果显示,在校正潜在影响因素后,B组受试者冠心病发病风险高于A组〔校正HR=1.17,95%CI(0.96,1.43)〕,其中B组男性受试者高于A组〔校正HR=1.26,95%CI(0.92,1.45)〕,B组女性受试者高于A组〔校正HR=1.37,95%CI(0.85,2.21)〕(P0.05)。结论血糖正常人群葡萄糖耐量试验2 h血糖空腹血糖会增加冠心病发病风险。     

糖尿病患者应用尿液分析仪检测尿糖检验和血糖检验的价值

目的 分析糖尿病患者应用尿液分析仪检测尿糖检验和血糖检验的临床价值.方法 选定该院2019年8月—2020年8月收治的100例糖尿病患者,分别给予尿糖检验、血糖检验,对比两组检测准确率以及检验结果.结果 血糖检测准确率(100.00％)高于尿糖检测准确率(95.00％),差异有统计学意义(P<0.05).5例尿糖结果为...     

血糖检验和尿糖检验在糖尿病患者中的临床价值

目的探讨血糖检验与尿糖检验在糖尿病患者临床诊断中的应用价值。方法回顾性分析该院于2011年1月—2013年1月收治的60例糖尿病患者的临床资料,测定患者的晨尿尿糖、空腹血糖及餐后2 h血糖值并进行分析。结果 60例糖尿病患者血糖与尿糖检验结果可见,血糖测定值与尿糖测定值呈正相关,尿糖的浓度增高,血糖的浓度也随之增高。而有4例患者尿糖检验为阴性,却存在不同程度尿糖浓度升高。结论尿糖检验可作为初步筛查糖尿病的方法,但为了确保诊断的准确性,应同时检测患者的尿糖与血糖,才能使诊断准确无误。     

A Negative Correlation Between Blood Glucose and Acetone Measured in Healthy and Type 1 Diabetes Mellitus Patient Breath

Background:

Exhaled acetone analysis has long been recognized as a supplementary tool for diagnosis and monitoring diabetes, especially type 1 diabetes. It is essential, therefore to determine the relationship between exhaled acetone concentration and glucose in blood. Usually, a direct linear correlation between this both compounds has been expected. However, in some cases we can observe a reverse correlation. When blood glucose was increasing, breath acetone declined.

Methods:

The breath analysis as a supplementary tool for diagnosing and monitoring diabetes makes sense only in case of utilization of portable analyzers. This need has created a market for gas sensors. However, commercially available acetone gas sensors are developed for measuring samples at several tens part per million. The exhaled acetone concentration was measured using commercial acetone gas sensor (TGS 822, 823 Figaro, Arlington Heights, IL, USA Inc) with micropreconcentrator in low temperature cofired ceramics. The reference analyzer–mass spectrometry (HPR-20 QIC, Hiden Analytical, Warrington, UK) was used.

Results:

Twenty-two healthy volunteers with no history of any respiratory disease participated in the research, as did 31 patients diagnosed with type 1 diabetes. Respectively, 3 healthy volunteer and 5 type 1 diabetes mellitus subjects with reverse trend were selected. The linear fitting coefficient various from 0.1139 to 0.9573. Therefore, it is necessary to determine the correlation between blood glucose concentrations and under different conditions, for example, insulin levels, as well as correlate the results with clinical tests, for example, Hb1Ac.

Conclusions:

It is well known that the concentration of acetone is strongly influenced by diet, insulin treatment, and so on. Therefore, much more complex analysis with long-term measurements are required. Thus, presented results should be regarded as tentative, and validation studies with the analysis of clinical test and in a large number of patients, including control groups, need to be carried out.     

Computer Based Quality Assessment of Hospital Capillary Blood Glucose Monitoring

A quality control (QC) programme to continually monitor the reliability of hospital ward capillary blood glucose levels has been developed based on a memory blood glucose meter interfaced to a portable microcomputer. Over a 38-week period some 12 500 ward QC tests were performed by approximately 200 accredited operators. Although the mean weekly coefficients of variation were all less than 15%, there was a marked variation between wards, with the frequency of testing of patients the major factor influencing reliability. However an external laboratory-based QC programme suggested a high degree of proficiency which was not achieved by any ward on internal QC assessment.     

Skin Capillary Density in Subjects with Impaired Glucose Tolerance and Patients with Type 2 Diabetes

In view of recent interest in the role of impaired early development and the pathogenesis of cardiovascular disease and carbohydrate intolerance in adults, this study examines whether reduced skin capillary density contributes to the limited microvascular hyperaemic responses observed in patients with Type 2 diabetes and subjects with impaired glucose tolerance (IGT). Fifteen patients with Type 2 diabetes, 15 subjects with IGT and 15 matched non-diabetic control subjects were studied. Capillary videomicroscopy was used to record images of the skin capillaries on the dorsum of the middle phalanx of the left middle finger before and after 10 min venous occlusion at 35 mmHg. There were no significant differences between the three groups in either basal capillary density (112 (71–144) caps mm⁻² Type 2 patients (median and range) vs 107 (76–140) caps mm⁻² IGT subjects vs 112(76–138) caps mm⁻² control subjects; p = 0.9, Kruskal Wallis), or following venous occlusion (122(87–157) caps mm⁻² vs 121 (90–143) caps mm⁻² vs 123 (81–147) caps mm⁻¹; p=0.9). In addition there were no differences in blood pressure, BMI or skin temperature. These results do not support the concept of impaired early development of the skin microcirculation in patients with Type 2 diabetes or IGT and suggest that mechanisms other than reduced capillary density are involved in limiting microvascular vasodilation.     

Understanding Oral Glucose Tolerance: Comparison of Glucose or Insulin Measurements During the Oral Glucose Tolerance Test with Specific Measurements of Insulin Resistance and Insulin Secretion

The extent to which the oral glucose tolerance test can be used to estimate insulin secretion and insulin resistance has been evaluated by comparing glucose and insulin concentrations during an oral glucose tolerance test with specific measurements of insulin secretion and insulin resistance in 85 normoglycaemic subjects and 23 subjects with impaired glucose tolerance (IGT). Insulin secretion was measured by the first phase insulin response to intravenous glucose and insulin resistance by the insulin tolerance test which measures the decline of plasma glucose after the injection of a bolus of insulin. The best measure of insulin secretion was the ratio of the 30 min increment in insulin concentration to the 30 min increment in glucose concentration following oral glucose loading. This correlated with the first phase insulin release following intravenous glucose (r=0.61, p < 0.001) but not insulin resistance (r= ?0.05, p >0.05). Insulin resistance could be estimated by the fasting insulin, proinsulin, or split proinsulin concentrations. However, fasting split proinsulin appeared to discriminate best between insulin resistance (r = ?0.53, p < 0.001) and insulin secretion (r = 0.07, p > 0.05). Relative insulin resistance estimated by homeostasis model assessment (HOMA) also correlated well with insulin resistance (r= ?0.57, p < 0.001) but not insulin secretion (r= 0.01, p > 0.05). We conclude that the oral glucose tolerance test can be used to derive estimates of the relative roles of insulin secretion and insulin resistance in population studies of glucose tolerance.     

高血压合并糖耐量减低患者血清瘦素水平与尿微量白蛋白的相关性

目的通过分析血清瘦素水平与尿微量白蛋白、体质指数、空腹胰岛素和稳态模型评价胰岛素抵抗指数等指标的相关性,探讨其在高血压合并糖耐量减低发生机制中可能起到的作用。方法采用放射免疫法检测198例高血压病患者和47例正常对照者的血清瘦素、尿白蛋白排泄率、空腹胰岛素、血清与尿β2微球蛋白等指标。结果女性血清瘦素水平显著高于男性(P<0.001)。高血压患者中糖耐量减低者的血清瘦素水平和尿白蛋白排泄率显著高于对照组(13.6±8.0μg/L比3.87±1.48μg/L和18.8±12.5μg/min比5.47±2.19μg/min,P<0.05)及糖耐量正常者(13.6±8.0μg/L比6.08±2.03μg/L和18.8±12.5μg/min比10.0±5.2μg/min,P<0.05),低于合并糖尿病者(13.6±8.0μg/L比16.6±8.7μg/L和18.8±12.5μg/min比30.5±12.3μg/min,P<0.05)。其中肥胖者的血清瘦素水平显著高于非肥胖者(15.1±9.0μg/L比11.6±6.0μg/L,P<0.05)。尿微量白蛋白者血清瘦素水平显著高于尿白蛋白正常者(16.0±9.9μg/L比11.7±5.6μg/L,P<0.05)。本实验在控制了性别和体质因素后,糖耐量减低组的血清瘦素水平与尿白蛋白排泄率(r=0.543,P<0.001)、尿β2微球蛋白(r=0.337,P<0.01)、血清β2微球蛋白(r=0.230,P<0.05)、脉压(r=0.364,P<0.001)、胰岛素抵抗指数(r=0.325,P<0.01)、空腹胰岛素(r=0.302,P<0.01)和收缩压(r=0.290,P<0.01)呈显著正相关。多因素Backward逐步回归分析表明,性别、尿白蛋白排泄率、胰岛素抵抗指数和脉压与血清瘦素相关最显著。结论性别和体质指数是影响瘦素水平的决定性因素。高血压患者中合并IGT的发生发展是多因素综合作用的结果,此阶段可能已存在早期肾功能损伤。     

The Short Insulin Tolerance Test: Feasibility Study Using Venous Sampling

The short insulin tolerance test (ITT) is both a simple and valid method of quantifying insulin sensitivity although arterialization of samples and the risk of hypoglycaemia remain as potential difficulties. We examined the safety and reproducibility of using venous sampling with insulin doses of 0.1U kg⁻¹ and 0.05 U kg⁻¹ in healthy subjects. Whole blood glucose concentrations were measured contemporaneously and the rate of plasma glucose decline (mmol l⁻¹ min⁻¹) for each test was estimated from unlogged venous plasma glucose concentrations measured at 1 min intervals. The mean rates of plasma glucose decline for the 0.1 U kg⁻¹ and 0.05 U kg⁻¹ insulin doses were 0.26 mmol l⁻¹ min⁻¹ (n = 11, range = 0.17–0.41, intrasubject coefficient of variation (CV) = 9.4%) and 0.25 mmol l⁻¹ min⁻¹ (n = 6, range 0.19–0.46, intrasubject CV = 15.9%), respectively. Reversal of significant hypoglycaemia was necessary in one subject before 15 min post-insulin. We found that: (1) venous sampling provides a reproducible measure of glucose uptake after insulin, (2) contemporaneous bedside glucose sampling identifies those at risk of significant hypoglycaemia during the ITT, and (3) the 0.1 U kg⁻¹ dose response is more reproducible and no less safe than the half dose response. We conclude that the current ITT protocol would be made safer and simpler with the above modifications although further studies comparing venous with arterialized sampling are needed.     

Capillary Bedside Blood Glucose Measurement in Neonates: Missing a Diagnosis of Galactosemia

A number of factors may lead to inaccuracy in measurement of capillary blood glucose with a glucometer. Measurement of other carbohydrate molecules such as galactose and fructose along with glucose can potentially be a cause of error. We report a newborn patient who was referred to our hospital with conjugated bilirubinemia, hepatomegaly and high capillary blood glucose levels measured with a glucometer. Simultaneous biochemical measurements revealed normal blood glucose levels. Further investigation led to a diagnosis of classical galactosemia. Capillary blood glucose level measured with glucometer also dropped to normal values following cessation of breastfeeding and initiation of feeding with a lactose-free formula.     

Evaluation of a Continuous Blood Glucose Monitoring System Using Central Venous Microdialysis

Background

Glycemic control in critically ill patients has been shown to be beneficial. In this prospective study, we evaluated the accuracy and technical feasibility of a continuous glucose monitoring system using intravascular microdialysis.

Method

Fifty patients undergoing cardiac surgery were monitored using a 4 Fr intravenous microdialysis catheter (Eirus SLC™, Dipylon Medical AB, Solna, Sweden) percutaneously placed with the tip of the catheter positioned in the superior vena cava. The catheter was connected to the Eirus™ monitoring system, and the patients were monitored for up to 48 h postoperatively in the intensive care unit (ICU). As reference, arterial blood samples were taken every hour and analyzed in a blood gas analyzer.

Results

Data were available from 48 patients. A total of 994 paired (arterial blood gas microdialysis) samples were obtained. Glucose correlation coefficient (R2) was 0.85. Using Clarke error grid analysis, 100% of the paired samples were in region AB, and 99% were in region A. Mean glucose level was 8.3 mmol/liter (149 mg/dl), mean relative difference was 0.2%, and mean absolute relative difference was 5%. A total of 99.2% of the paired samples were correct according to International Organization for Standardization (ISO) criteria. Bland-Altman analysis showed that bias ± limits of agreement were 0.02 ± 1.1 mmol/liter (0.36 ± 20 mg/dl).

Conclusions

Central venous microdialysis using the Eirus monitoring system is a highly accurate and reliable method for continuous blood glucose monitoring up to 48 h in ICU patients undergoing cardiac surgery. The system may thus be useful in critically ill ICU patients.     

糖尿病性眼肌麻痹患者血液流变学和血糖的相关性分析

目的探讨糖尿病性眼肌麻痹患者血液流变学改变与血糖的相关性。方法对36例糖尿病性眼肌麻痹患者与36例健康对照者进行血液流变学检测,并通过t检验对糖尿病性眼肌麻痹患者血糖与血液流变学指标的相关性进行分析。结果糖尿病组血糖、全血黏度、血浆黏度、红细胞比容、红细胞沉降率、纤维蛋白原等与健康对照组比较差异有统计学意义(P<0.05)。糖尿病患者除红细胞变形指数与血糖呈负相关外,其余血液流变指标均与血糖呈正相关。结论糖尿病性眼肌麻痹患者血液流变学异常增高,导致微循环障碍是诱发眼肌麻痹的主要原因之一。     

A Novel Test for IGT Utilizing Metabolite Markers of Glucose Tolerance

Background:The oral glucose tolerance test (OGTT) is the only method to diagnose patients having impaired glucose tolerance (IGT), but its use has diminished considerably in recent years. Metabolomic profiling studies have identified a number of metabolites whose fasting levels are associated with dysglycemia and type 2 diabetes. These metabolites may serve as the basis of an alternative test for IGT.Method:Using the stable isotope dilution technique, quantitative assays were developed for 23 candidate biomarker metabolites. These metabolites were measured in fasting plasma samples taken just prior to an OGTT from 1623 nondiabetic subjects: 955 from the Relationship between Insulin Sensitivity and Cardiovascular Disease Study (RISC Study; 11.7% IGT) and 668 subjects from the Diabetes Mellitus and Vascular Health Initiative (DMVhi) cohort from the DEXLIFE project (11.8% IGT). The associations between metabolites, anthropometric, and metabolic parameters and 2hPG values were assessed by Pearson correlation coefficients and Random Forest classification analysis to rank variables for their ability to distinguish IGT from normal glucose tolerance (NGT). Multivariate logistic regression models for estimating risk of IGT were developed and evaluated using AUCs calculated from the corresponding ROC curves.Results:A model based on the fasting plasma levels of glucose, α-hydroxybutyric acid, β-hydroxybutyric acid, 4-methyl-2-oxopentanoic acid, linoleoylglycerophosphocholine, oleic acid, serine and vitamin B5 was optimized in the RISC cohort (AUC = 0.82) and validated in the DMVhi cohort (AUC = 0.83).Conclusions:A novel, all-metabolite-based test is shown to be a discriminate marker of IGT. It requires only a single fasted blood draw and may serve as a more convenient surrogate for the OGTT or as a means of identifying subjects likely to be IGT.     

An Automated Discontinuous Venous Blood Sampling System for Ex Vivo Glucose Determination in Humans

Background

Intensive insulin therapy reduces mortality and morbidity in critically ill patients but places great demands on medical staff who must take frequent blood samples for the determination of glucose levels. A cost-effective solution to this resourcing problem could be provided by an effective and reliable automated blood sampling (ABS) system suitable for ex vivo glucose determination.

Method

The primary study aim was to compare the performance of a prototype ABS system with a manual reference system over a 30 h sampling period under controlled conditions in humans. Two venous cannulae were inserted to connect the ABS system and the reference system. Blood samples were taken with both systems at 15, 30, and 60 min intervals and analyzed using a Beckman glucose analyzer. During the study, blood glucose levels were altered through four meal ingestions.

Results

The median Pearson coefficient of correlation between manually and automatically withdrawn blood samples was 0.976 (0.953−0.996). The system error was −3.327 ± 5.546% (−6.03−0.49). Through Clark error grid analysis, 420 data pairs were analyzed, showing that 98.6% of the data were in zone A and 1.4% were in zone B. Insulin titration error grid analysis revealed an acceptable treatment in 100% of cases. A 17.5-fold reduction in the occurrence of blood-withdrawal failures through occluded catheters was moreover achieved by the added implementation in the ABS system of a “keep vein open” saline infusion.

Conclusions

Our study showed that the ABS system described provides a user-friendly, reliable automated means for reproducible and accurate blood sampling from a peripheral vein for blood glucose determination and thus represents a promising alternative to frequent manual blood sampling.