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Glucose Test (glucose + test)

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Medical Sciences	100%

Selected Abstracts

Prehospital management of diabetic emergencies , a population-based intervention study

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2003
A. Holstein
Background: Diabetes-related emergencies are frequent and potentially life-threatening. A study was performed to obtain reliable data about the prevalence of diabetic emergencies and to improve the quality of prehospital care of patients with diabetes-related emergencies. Methods: A prospective population-based study in a German emergency medical service district in the period from 1997 to 2000 was conducted. After initial diabetes training for the entire emergency team, a standardized protocol was introduced for prehospital emergency therapy of severe hypoglycaemia (SH) and severe hyperglycaemic disorders. A rapid blood glucose test was performed on all emergency patients with the exception of resuscitations and deaths. Indicators of treatment quality before and after these interventions were compared. Results: A rapid blood glucose test was performed in 6631 (85%) of the 7804 emergencies that occurred during the period investigated. The prevalence of acute diabetic complications was 3.1%, and 213 cases of SH and 29 severe hyperglycaemic disorders were recorded. Education of the emergency team led to a significant improvement in the quality of treatment. Larger volumes of iv 40% glucose solution (50 ± 20 ml (1997,2000) vs. 25 ± 17 ml (1993,96); P < 0.0001) were administered to patients with SH. Insulin-treated patients who were well educated about their diabetes were more often treated only at the emergency scene, after SH (25% vs. 8%; P = 0.007), and without complications. In 50 patients who experienced sulfonylurea-induced SH, the mandatory additional glucose infusions and hospitalization for further observation reduced mortality from 4.9% to 0% (P = 0.2). Conclusion: Training of the emergency team is an effective and efficient intervention to improve quality of treatment and prognosis outcome for patients with diabetic emergencies. Treatment of SH at the emergency scene only was demonstrated to be safe in type 1 diabetic patients who had previously received structured patient education. [source]

Evaluation of HOMA and QUICKI as measures of insulin sensitivity in prepubertal children

PEDIATRIC DIABETES, Issue 3 2003
Wayne S. Cutfield
Abstract:, Background:,Simple fasting sample methods to measure insulin sensitivity (SI) such as homeostasis model assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) have been widely promoted in adult studies but have not been formally evaluated in children. The aim of this study was to compare HOMA and QUICKI to the minimal model as measures of SI in prepubertal children. Method:, The study population consisted of twins (n = 44), premature (n = 17), small for gestational age (SGA) (15), and normal (n = 3) prepubertal children. The insulin-sensitivity index derived by the minimal model (SIMM) was calculated by the minimal model with plasma glucose and insulin data from a 90-min frequently sampled intravenous glucose test with tolbutamide. The HOMA resistance index (RHOMA) and QUICKI were calculated from fasting plasma glucose and insulin values. Results:, The correlation between RHOMA and SIMM (r = ,0.4, p < 0.001) was no better than that between fasting insulin and SIMM (r = ,0.4, p < 0.001). QUICKI was poorly correlated with SIMM (r = 0.2, p = 0.02). The correlation between SIMM and RHOMA is largely confined to low SI values (<10 × 10,4/min µU/mL). In seven SGA subjects, the introduction of growth hormone treatment led to an expected fall in SIMM by 8.2 ± 2.8 × 10,4/min µU/mL (p = 0.02) that was not detected by either RHOMA (p = 0.1) or QUICKI (p = 0.2). Similarly, SIMM values were lower in obese (n = 9) compared to non-obese subjects (p = 0.04); however, no difference was found between these two groups with either RHOMA (p = 0.21) or QUICKI (p = 0.8). Conclusion:, As measures of SI in prepubertal children, RHOMA is no better than fasting insulin and QUICKI, a poor measure. Neither RHOMA nor QUICKI was able to detect changes in SI induced by either obesity or growth hormone therapy. [source]

Long-term follow-up of women with gestational diabetes mellitus: The South Australian Gestational Diabetes Mellitus Recall Register

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010
Catherine R. CHITTLEBOROUGH
Background:, Women who have had gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes. Early detection and management of type 2 diabetes are important for reducing associated complications and costs. Aims:, To evaluate an existing register for long-term follow-up of women who have been diagnosed with GDM. Methods:, Recruitment to the GDM Recall Register began at the diabetes centres of two hospitals in South Australia from July 2002, and was expanded to include a third hospital from September 2005. Women enrolled on the Register are sent an annual letter reminding them that they are at increased risk of developing type 2 diabetes and encouraging them to get their blood glucose checked. An update form is also included for women to complete and return to the Register. Results:, As at 30 June 2009, 817 women were enrolled on the Register. Of women diagnosed with GDM at the participating hospital sites, recruitment to the Register was 68.4% in 2002 and 64.4% in 2007. Of the 429 women who had been sent their first reminder letter, 46.4% had returned the update form. Of these, 56.3% had undergone a glucose test for diabetes. Two women reported developing type 2 diabetes. Conclusions:, Expansion of the GDM Recall Register is likely to result in increased opportunities for early detection of diabetes for this high-risk group in South Australia, therefore allowing earlier intervention and treatment to prevent or reduce serious, costly diabetes-related complications. [source]

Disturbed glucose metabolism is associated with left ventricular dysfunction using tissue Doppler imaging in patients with myocardial infarction

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2007
Loghman Henareh
Summary Aims:, To investigate the association between glucose abnormalities and left ventricular (LV) function assessed by tissue Doppler imaging (TDI) in patients with previous history of myocardial infarction and without known diabetes mellitus. Patients and methods:, In a cross-sectional study, 123 patients, aged 31,80 years, with a history of previous myocardial infarction and without known diabetes mellitus were examined with TDI echocardiography. A standard oral glucose test (OGTT) with 75 g of glucose was performed. Results:, Two-hour plasma glucose were significantly and negatively associated with TDI parameters such as LV ejection time; early diastolic filling velocity (E,- v); ratio of the early to late diastolic filling velocity (E,/A,) and positively associated with regional myocardial performance index (MPI) (P<0·05). Left ventricular ejection time and MPI were significantly higher; E,/A, and E,- v were significantly lower in patients with disturbed glucose metabolism compared with patients with normal glucose tolerance (P<0·01). These differences remain significant also when the patients with DM were excluded. Conclusions:, The present study demonstrates that disturbed glucose metabolism is associated with more pronounced LV dysfunction using TDI in patients with myocardial infarction. These abnormalities in LV function were more common not only in subjects with diabetes, but also in patients with prediabetic condition, impaired glucose intolerance. [source]

Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2010
SJ Meltzer
Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010;117:407,415. Objective, To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis. Design, Prospective randomised controlled trial. Setting, University teaching hospital. Population, Pregnant women (n = 1594) presenting for GDM screening. Methods, Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) ± 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS ± 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit. Main outcome measures, Costs (direct and indirect) and prevalence of GDM diagnosis. Results, The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS , 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT. Conclusions, Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS ± OGTT) accomplished this better than the one-step method (75-g OGTT). [source]