Academic literature on the topic 'Blood sugar monitoring. Diagnosis, Noninvasive'

ABSTRACT Introduction Gestational diabetes is a common medical disorder in pregnancy. So long, it has been usually treated by insulin. Now it has been found that oral glibenclamide can be used instead of insulin with similar glycemic control and without any adverse maternal and fetal effect. Methods A comparative study between oral glibenclamide and insulin for the management of gestational diabetes mellitus (GDM) was conducted. It was a prospective randomized study and patients attending the antenatal clinic were screened with 75 gm oral glucose between 20 to 28 weeks and GDM was diagnosed based on WHO criteria of 2 hours blood glucose ≥140 mg/dl. Women with gestational diabetes were given medical nutritional therapy (MNT) for 2 weeks. Out of this, 60 women did not achieve the target blood glucose. The goal of treatment was maintenance of mean plasma glucose (MPG) of about 105 mg%. For this the fasting plasma glucose should be around 90 mg/dl and postprandial peaks around 120 mg/dl. Patients were randomly assigned to receive glibenclamide (group A, n = 30) or insulin (group B, n = 30). In group A, glibenclamide was given 2.5 mg orally in morning and doses were increased weekly by 2.5 mg up to a maximum of 20 mg and doses >7.5 mg were given in two divided doses. In group B, insulin 0.7 units per kilogram of body weight at admission was given subcutaneously three times daily and increased weekly as necessary. Self monitoring of blood glucose with glucometer was done. Blood glucose was also measured from the laboratory every week. Glycosylated hemoglobin (HbA1c) was measured before initiation of therapy and repeated in the third trimester before confinement. Terminations of pregnancy in both the groups were done between 37 and 38 weeks. The infant birth weight, blood glucose and serum bilirubin were also recorded in all cases. Results The present study showed that the two groups had similar glycemic status (fasting blood sugar in group A was 103.5 ± 14.62 mg/dl and postprandial blood sugar was 184.1 ± 20.46 mg/dl whereas in group B it was109.3 ± 19.63 mg/dl and 194.3 ± 18.47mg/dl) at the time of entry into the study. The two groups also showed similar levels of glycemic control just before confinement (fasting blood sugar in group A was 88.23 ± 6.55 mg/ dl and postprandial blood sugar was 122.7 ± 10.3 mg/dl whereas in group B it was 88.17 ± mg/dl and 128 ± 12.38 mg/dl) and there was no significant statistical difference in the two groups (p > 0.05). The perinatal outcomes in both the groups were also nearly same. There was no significant difference in birth weight, blood sugar level of neonates and complications between the two groups. There was no case of macrosomia in the two groups and the number of infants large for gestational age (LGA) was four in group A and two in group B. Hypoglycemia in newborn was slightly higher in the group A compared to group B (4 and 3 respectively). Conclusion From our study, it is evident that the use of oral agents is a pragmatic alternative to insulin therapy in cases of gestational diabetes because of similar glycemic control, ease of administration and better patient compliance due to noninvasive treatment. How to cite this article Mukhopadhyay P, Bag TS, Kyal A, Saha DP, Khalid N. Oral Hypoglycemic Glibenclamide: Can it be a Substitute to Insulin in the Management of Gestational Diabetes Mellitus? A Comparative Study. J South Asian Feder Obst Gynae 2012;4(1):28-31.

Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers.

Abstract Introduction: Cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA) have an emerging diagnostic role in multiple malignancies including in lymphomas (Kurtz et al ASH 2017). In classical Hodgkin Lymphoma (cHL), malignant Reed Sternberg (RS) cells are rare, requiring laser capture microdissection from archival tissues or flow sorting from viable tumor cell suspensions for genotyping. We profiled ctDNA in cHL to assess the utility of ctDNA in the noninvasive evaluation of somatic single nucleotide variants (SNVs), somatic copy number alterations (SCNAs), and tumor EBV status. Methods: A total of 53 subjects with HL (29 with early stage and 24 with advanced disease) were studied encompassing a total of 95 blood and tissue samples (72 from Stanford, 23 from UZ Leuven). Plasma samples were sequenced with CAPP-Seq (Newman et al Nat Biotech 2016), using a panel informed by the genotyping of primary tumor biopsies. The genotypes of cHL patients were compared to that of 189 patients with other B-cell malignancies. Given the thoracic distribution of most cHL, we also compared ctDNA levels to that of 55 lung carcinomas. ctDNA levels were calculated as the product of the cfDNA concentration and the mean allelic fraction of somatic mutations. Results: The median pretreatment ctDNA level in cHL was 125 hGE/mL (15 - 5277 hGE/mL), corresponding to a median variant allelic fraction (VAF) of 3.2% (0.3 - 13.9%) (Fig 1A). Pretreatment ctDNA burden was greater in cHL cases than in follicular lymphoma (FL) cases (p = 0.002), but was not significantly different from that of diffuse large B-cell lymphoma (DLBCL) (p = 0.26). Plasma genotyping in cHL and DLBCL also identified similar numbers of SNVs, recovering a median of 108 mutations in cHL and 117 mutations in DLBCL (p = 0.53). In samples with available diagnostic PET/CT, pre-treatment ctDNA levels in cHL were significantly correlated with total metabolic tumor volume (MTV) (Spearman ρ = 0.615, p = 0.006) (Fig 1B), but not with diagnostic PET/CT SUVmax, stage, bulky status (>10 cm), B-symptoms, or presence of extranodal disease. Surprisingly, despite the lower tumor purity of RS cells in cHL tumor masses than that of malignant B-cells in DLBCL, the relationship between ctDNA and PET/CT estimates of disease burden in cHL was highly similar to that of DLBCL. Specifically, cHL and DLBCL were statistically indistinguishable for the ratio between ctDNA levels and MTV (mean ctDNA/MTV of 2.1 vs 1.5 hGE/mL per cm3 tumor, p = 0.38), and both were significantly higher than that of non small cell lung carcinoma (NSCLC) (p < 0.0001) (Fig 1C). In patients with available mid-treatment cfDNA (n = 10), we monitored ctDNA concentrations and observed that circulating tumor burden falls rapidly, with a third of our patients reaching undetectable levels within the first month after start of therapy. PD-L1 copy number gains, previously shown to be prognostic for survival in cHL treated with checkpoint inhibitors, were observed in 42% of cHL patients with ctDNA VAFs above our SCNA limit of detection (1%) and were genotyped significantly more frequently than in other non-PMBCL B-cell malignancies (42% vs 18%, p = 0.005) (Fig 1D). Coding SNVs in the most commonly mutated genes involved STAT6 (24%), SOCS1 (20%), GNA13 (20%), TNFAIP3 (18%), and B2M (16%) while noncoding SNVs in IGK and IGH were more abundant in cHL and DLBCL respectively (Fig 1E). EBV tumor cell presence has previously been shown to be prognostic in cHL (Keegan et al JCO 2005). Prior to therapy, EBV cfDNA constituted a significantly larger fraction of total cfDNA in patients confirmed by EBER ISH to have EBV+ cHL than in either EBER-negative cHL patients or healthy controls (p < 0.0001) (Fig 1F). Conclusions: Levels of ctDNA in cHL are higher than might be expected based on tumor purity, with pre-treatment levels similar to DLBCL and higher than FL. ctDNA allows for reliable noninvasive genotyping of cHL at diagnosis, encompassing coding and non-coding SNVs and additional clinically significant factors such as tumor EBV status and SCNAs. Additional cases are currently being profiled and expanded analyses of genotyping and monitoring will also be presented at the meeting. Disclosures Dührsen: Celgene: Honoraria, Research Funding; AbbVie: Consultancy, Honoraria; Roche: Honoraria, Research Funding; Janssen: Honoraria; Amgen: Research Funding; Gilead: Consultancy, Honoraria. Hüttmann:Roche: Other: Travel expenses; Celgene: Other: Travel expenses. Gaidano:Gilead: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Morphosys: Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria. Westin:Apotex: Membership on an entity's Board of Directors or advisory committees; Celgen: Membership on an entity's Board of Directors or advisory committees; Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees. Advani:Regeneron: Research Funding; Kyowa: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Infinity: Research Funding; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millenium: Research Funding; Cell Medica: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Agensys: Research Funding; Forty Seven Inc.: Research Funding; Celgene: Research Funding; Janssen: Research Funding; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Kura: Research Funding; Astra Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Gilead/Kite: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Autolus: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Celgene: Research Funding; Roche/Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board, Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees, Other: Participated in an advisory board; Merck: Research Funding.

Timely diagnosis and monitoring of ulcerative colitis (UC) in children is extremely relevant. In recent years, much attention has been paid to improving noninvasive UC diagnosis methods, which are available and convenient in the practice of a doctor. In this regard, we analyzed the significance of changes in noninvasive laboratory parameters of sick children with different clinical and endoscopic UC activity. Materials and methods. A prospective analysis of data of 80 patients diagnosed with UC at the age of 1 to 18 years with varying degrees of clinical and endoscopic activity of the disease was performed. Results. Significant changes in the studied laboratory parameters’ levels were revealed depending on the degree of clinical and endoscopic UC activity in children. The changes in fecal calprotectin content, levels of albumin, hemoglobin, and platelets were particularly substantial and informative in the blood of sick children when comparing remission with moderate and high clinical and endoscopic UC activity. A decrease in platelet counts was also found when UC activity increased. Conclusion. The studied laboratory parameters are informative noninvasive markers of UC activity in children. These indices can be used in the diagnosis of UC activity and monitoring of the course of the disease.

Abstract Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.

Background. Acetone,β-hydroxybutyric acid, and acetoacetic acid are three types of ketone body that may be found in the breath, blood, and urine. Detecting altered concentrations of ketones in the breath, blood, and urine is crucial for the diagnosis and treatment of diabetic ketosis. The aim of this study was to evaluate the advantages of different detection methods for ketones, and to establish whether detection of the concentration of ketones in the breath is an effective and practical technique.Methods. We measured the concentrations of acetone in the breath using gas chromatography-mass spectrometry andβ-hydroxybutyrate in fingertip blood collected from 99 patients with diabetes assigned to groups 1 (−), 2 (±), 3 (+), 4 (++), or 5 (+++) according to urinary ketone concentrations.Results. There were strong relationships between fasting blood glucose, age, and diabetic ketosis. Exhaled acetone concentration significantly correlated with concentrations of fasting blood glucose, ketones in the blood and urine, LDL-C, creatinine, and blood urea nitrogen.Conclusions. Breath testing for ketones has a high sensitivity and specificity and appears to be a noninvasive, convenient, and repeatable method for the diagnosis and therapeutic monitoring of diabetic ketosis.

In our current environment virtually any information, including health-related data, can be readily accessible due to the ubiquity of smart devices and health monitoring smart device accessories, such as activity, sleep, heart rate, pulse, and blood pressure tracking devices. However, currently available self-monitoring devices are restricted to extra-corporeal data, leaving many important physiological parameters such as glucose, hormone, and electrolyte level changes uncharted. Of notable interest in the area of self-monitoring is that of blood glucose levels in the pre-diabetic population. Continuous glucose monitoring (CGM) devices utilised by diabetics are invasive and cost prohibitive for general consumers and therefore uncommonly used pre-diagnosis. These devices are thus unlikely to enable the lifestyle changes and administration of the appropriate adjustments in a timely manner to pre-diabetics, which may prevent the progression to diabetes. This dissertation discusses and demonstrates the development of a minimally invasive wearable device for the continuous sensing of glucose, with Bluetooth wireless connectivity to enable data transfer to a smart device. Three major components of this device are: 1) microneedles, which serve to penetrate the skin to access the underlying dermal interstitial fluid, and to immobilise the glucose sensor; 2) fluorescent glucose sensor, which senses glucose in the dermal interstitial fluid whilst being immobilised to the microneedles; and 3) wearable fluorescence detection system, which interrogates and evaluates the light signal generated by the microneedle sensing platform. The microneedles are unique compared to the previous microneedle sensing devices, in that the sensing moiety can be chemically integrated into the microneedles to allow for continuous fluid sampling and analyte monitoring to take place simultaneously in situ. Glucose sensing is enabled by modular fluorescent sensors, consisting of glucose receptors, a reporting fluorophore, and an immobilisation site. The wearable fluorometer is 5.1 x 3.2 x 1.9 cm in dimension, is battery-powered, has an adjustable dynamic range, and exhibits fluorescence detection capability comparable to that of the gold standard microplate reader device. In vitro and in vivo assessments demonstrate that the microneedle sensing platform and the detector are able to perform their intended functions, and more importantly, can be integrated compatibly into the final envisioned system. Beyond the intended overall application of continuous glucose monitoring, each component and their fabrication methods have the potential to be utilised for the continuous monitoring of other health metrics. When these components are assembled, the end product is a wearable continuous sensing system that is easy to use, almost painless, minimally invasive, and overall, accessible in terms of convenience and cost to the general consumer.

Thesis (M.S.)--Florida State University, 2004.
Advisor: Dr. Jeanne Flannery, Florida State University, School of Nursing, Dept. of Graduate Studies. Title and description from dissertation home page (viewed Sept. 29, 2004). Includes bibliographical references.