The Glycomark® Test
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Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes. -
Diabetes Control in Thyroid Disease
In Brief Thyroid disease is commonly found in most types of diabetes. This article defines the prevalence of thyroid disease in diabetes and elucidates through case studies the assessment, diagnosis, and clinical management of thyroid disease in diabetes. Diabetes Control in Thyroid Disease Thyroid disease is a pathological state abnormality. Several studies, including that can adversely affect diabetes con- the Colorado study, have documented trol and has the potential to negative- a higher prevalence of thyroid disease Jennal L. Johnson, MS, RNC, FNP, ly affect patient outcomes. Thyroid in women, with prevalence rates rang- BC-ADM, CDE disease is found commonly in most ing from 4 to 21%, whereas the rate in forms of diabetes and is associated men ranges from 2.8 to 16%.1 with advanced age, particularly in Thyroid disease increases with age. In type 2 diabetes and underlying the Colorado study, the 18-year-olds autoimmune disease in type 1 dia- had a prevalence rate of 3.5% com- betes. This article defines the preva- pared with a rate of 18.5% for those lence of thyroid disease in diabetes, ≥ 65 years of age. discusses normal physiology and The prevalence of thyroid disease in screening recommendations for thy- diabetes has been estimated at 10.8%,2 roid disease, and elucidates through with the majority of cases occurring as case studies the assessment, diagnosis, hypothyroidism (~ 30%) and subclini- and clinical management of thyroid cal hypothyroidism (~ 50%).2 Hyper- disease and its impact on diabetes. thyroidism accounts for 12%, and postpartum thyroiditis accounts for Thyroid Disease Prevalence 11%.2 Of the female patients with The prevalence of thyroid disease in type 1 diabetes, 30% have thyroid dis- the general population is estimated to ease, with a rate of postpartum thy- be 6.6%, with hypothyroidism the roid disease three times that of the most common malady.1 Participants normal population. -
Understanding Your A1C Test
Diabetes Advisor Understanding Your A1C Test What is the A1C test? The A1C is a blood test that tells you what your average blood sugar (blood glucose) levels have been for the past two to three months. It measures how much sugar is attached to your red blood cells. If your blood sugar is frequently high, more will be attached to your blood cells. Because you are always making new red blood cells to replace old ones, your A1C changes over time as your blood sugar levels change. “Because you are always making new What is eAG? red blood cells to eAG stands for estimated average glucose and is your estimated average blood replace old ones, sugar. This number translates an A1C test result into a number like the one you see when you test your blood sugar at home. For example, an A1C of 7% means your A1C changes that your average sugar for the last two to three months was about 154 mg/dL. over time as your What does an A1C/eAG result mean? blood sugar levels change.” Usually, your A1C gives you general trend in your blood sugar that matches what you see with your day-to-day blood sugar checks. Sometimes, however, your A1C result may seem higher or lower than you expected. That may be because you aren’t checking your blood sugar at times when it’s very high or very low. Use the chart below to understand how your A1C result translates to eAG. First find your A1C number on the left. -
Clinical Use of Hemoglobin A1c to Improve Diabetes Management
PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test. -
Bilirubin As a New Biomarker of Diabetes and Its Microvascular
Analytica & l B y i tr o s c i h m e m e h i Biochemistry & s c t Nishimura, et al., Biochem Anal Biochem 2016, 5:1 o r i y B DOI: 10.4172/2161-1009.1000245 ISSN: 2161-1009 Analytical Biochemistry Commentary Open Access Bilirubin as a New Biomarker of Diabetes and its Microvascular Complications Takeshi Nishimura*, Masami Tanaka, Risa Sekioka and Hiroshi Itoh Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan *Corresponding author: Takeshi Nishimura, Department of Internal Medicine, School of Medicine, Keio University 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan, Tel: 81-3-5363-3797; Fax: 81-3-3359-2745; E-mail: [email protected] Rec date: Feb 06, 2016; Acc date: Feb 12, 2016; Pub date: Feb 15, 2016 Copyright: © 2016 Nishimura T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Commentary elucidate the pathophysiological role of bilirubin in type 1 DM, our results should be verified in large-scale, prospective studies. Hyperglycemia is the hallmark of diabetes mellitus [DM]; it activates certain biochemical pathways leading to micro- and macrovascular complications in diabetic patients [1]. Moreover, References hyperglycemia generates oxidative stress and causes free radical- 1. Takayanagi R, Inoguchi T, Ohnaka K (2011) Clinical and experimental mediated lipid peroxidation [2,3]. In turn, the oxidative stress causes evidence for oxidative stress as an exacerbating factor of diabetes mellitus. -
Serological (Antibody) Testing for Covid-19
SEROLOGICAL (ANTIBODY) TESTING FOR COVID-19 Serological tests detect antibodies in the blood People in the early stages of COVID-19 might generated as part of the immune response test antibody negative despite being highly to a specific infection, such as infection with infectious. Additionally, some tests might give a SARS-CoV-2, the virus that causes COVID-19. false positive result because of past or present Antibody tests are different from tests such as infection with other types of coronaviruses. polymerase chain reaction (PCR) and antigen False positive results are also more likely tests which detect the SARS-CoV-2 virus. when the percentage of the population with Many new serological tests for COVID-19 have the disease is low. The Idaho Division of Public been developed and have an emergency use Health discourages persons who have a positive authorization (EUA) from the U.S. Food and serology test from relaxing the precautions such Drug Administration (FDA). Only antibody tests as social distancing that are recommended for that have an FDA EUA should be used. The all Idahoans to prevent spread of coronavirus, Idaho Division of Public Health discourages and strongly discourages employers form the use of unauthorized serology-based assays relaxing the employee protections for an for diagnosis of COVID-19 or determining if employee solely based upon a positive serology someone is currently infected or had a prior test. infection. The immune response to SARS-CoV-2 (the Serological tests are not recommended for virus that causes COVID-19) infection is not COVID-19 diagnosis in most situations because well understood. -
Jaundice Protocol
fighting childhood liver disease Jaundice Protocol Early identification and referral of liver disease in infants fighting childhood liver disease 36 Great Charles Street Birmingham B3 3JY Telephone: 0121 212 3839 yellowalert.org childliverdisease.org [email protected] Registered charity number 1067331 (England & Wales); SC044387 (Scotland) The following organisations endorse the Yellow Alert Campaign and are listed in alphabetical order. 23957 CLDF Jaundice Protocol.indd 1 03/08/2015 18:25:24 23957 3 August 2015 6:25 PM Proof 1 1 INTRODUCTION This protocol forms part of Children’s Liver Disease Foundation’s (CLDF) Yellow Alert Campaign and is written to provide general guidelines on the early identification of liver disease in infants and their referral, where appropriate. Materials available in CLDF’s Yellow Alert Campaign CLDF provides the following materials as part of this campaign: • Yellow Alert Jaundice Protocol for community healthcare professionals • Yellow Alert stool colour book mark for quick and easy reference • Parents’ leaflet entitled “Jaundice in the new born baby”. CLDF can provide multiple copies to accompany an antenatal programme or for display in clinics • Yellow Alert poster highlighting the Yellow Alert message and also showing the stool chart 2 GENERAL AWARENESS AND TRAINING The National Institute of Health and Clinical Excellence (NICE) has published a clinical guideline on neonatal jaundice which provides guidance on the recognition, assessment and treatment of neonatal jaundice in babies from birth to 28 days. Neonatal Jaundice Clinical Guideline guidance.nice.org.uk cg98 For more information go to nice.org.uk/cg98 • Jaundice Community healthcare professionals should be aware that there are many causes for jaundice in infants and know how to tell them apart: • Physiological jaundice • Breast milk jaundice • Jaundice caused by liver disease • Jaundice from other causes, e.g. -
SIRS Is Valid in Discriminating Between Severe and Moderate Diabetic Foot Infections
Pathophysiology/Complications ORIGINAL ARTICLE SIRS Is Valid in Discriminating Between Severe and Moderate Diabetic Foot Infections 1 2 DANE K. WUKICH, MD KATHERINE MARIE RASPOVIC, DPM best of our knowledge, the use of SIRS 2 3 KIMBERLEE B. HOBIZAL, DPM BEDDA L. ROSARIO, PHD has not yet been validated as a method of discriminating between moderate and severe DFI. OBJECTIVEdThis retrospective, single-center study was designed to distinguish severe di- The aim of this study was to classify abetic foot infection (DFI) from moderate DFI based on the presence or absence of systemic fl infectionseverityinagroupofhospital- in ammatory response syndrome (SIRS). ized diabetic patients based on the pres- RESEARCH DESIGN AND METHODSdThe database of a single academic foot and ence or absence of SIRS. The reason for ankle program was reviewed and 119 patients were identified. Severe DFI was defined as local hospitalization in this group of patients infection associated with manifestation of two or more objective findings of systemic toxicity was their DFI. Our hypotheses are that using SIRS criteria. patients with DFI who manifest SIRS (i.e., severe infection) will have longer hospital RESULTSdPatients with severe DFI experienced a 2.55-fold higher risk of any amputation – – stays and higher rates of major amputa- (95% CI 1.21 5.36) and a 7.12-fold higher risk of major amputation (1.83 41.05) than patients tion than patients who don’tmanifest with moderate DFI. The risk of minor amputations was not significantly different between the two groups (odds ratio 1.02 [95% CI 0.51–2.28]). The odds of having a severe DFI was 7.82 SIRS (i.e., moderate infection). -
Lactose Tolerance Blood Test
Lactose tolerance blood test Lactose tolerance tests measure the ability of your intestines to break down lactose, a type of sugar found in milk and other dairy products. How the test is performed The lactose tolerance blood test looks for glucose in your blood. Your body creates glucose when lactose breaks down. For this test, several blood samples will be taken before and after you drink the lactose solution described above. For information on how a blood sample is obtained, see venipuncture. How to prepare for the test You should not eat for 8 hours before the test. Avoid strenuous exercise for 8 hours before the test. How the test will feel There should not be any pain or discomfort when giving a breath sample. When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing. Why the test is performed Your doctor may order these tests if you have signs of lactose intolerance. Normal Values The breath test is considered normal if the increase in hydrogen is less than 12 parts per million over your fasting (pre-test) level. The blood test is considered normal if your glucose level rises more than 30 mg/dL within 2 hours of drinking the lactose solution. A rise of 20-30 mg/dL is inconclusive. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. The examples above show the common measurements for results for these tests. -
Rotational Thromboelastometry Predicts Care Level in Covid-19
medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128710; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Rotational Thromboelastometry predicts care level in Covid-19 1 2 3 4 Lou M. Almskog, MD ; Agneta Wikman, MD, PhD ; Jonas Svensson, MD ; 1 5 6 2 Michael Wanecek, MD, PhD ; Matteo Bottai, PhD ; Jan van der Linden, MD, PhD 7 8 9 ; Anna Ågren, MD, PhD . 1 Department of Anaesthesiology and Intensive Care, Capio St Göran’s Hospital, Stockholm, Sweden 2 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden 3 Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital and Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden 4 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 5 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden 6 Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden 7 Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden 8 Coagulation Unit, Division of Hematology, Karolinska University Hospital, Stockholm, Sweden 9 Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.06.11.20128710; this version posted June 12, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. -
Understanding Your Blood Test Lab Results
Understanding Your Blood Test Lab Results A comprehensive "Health Panel" has been designed specifically to screen for general abnormalities in the blood. This panel includes: General Chemistry Screen or (SMAC), Complete Blood Count or (CBC), and Lipid examination. A 12 hour fast from all food and drink (water is allowed) is required to facilitate accurate results for some of the tests in this panel. Below, is a breakdown of all the components and a brief explanation of each test. Abnormal results do not necessarily indicate the presence of disease. However, it is very important that these results are interpreted by your doctor so that he/she can accurately interpret the findings in conjunction with your medical history and order any follow-up testing if needed. The Bernards Township Health Department and the testing laboratory cannot interpret these results for you. You must speak to your doctor! 262 South Finley Avenue Basking Ridge, NJ 07920 www.bernardshealth.org Phone: 908-204-2520 Fax: 908-204-3075 1 Chemistry Screen Components Albumin: A major protein of the blood, albumin plays an important role in maintaining the osmotic pressure spleen or water in the blood vessels. It is made in the liver and is an indicator of liver disease and nutritional status. A/G Ratio: A calculated ratio of the levels of Albumin and Globulin, 2 serum proteins. Low A/G ratios can be associated with certain liver diseases, kidney disease, myeloma and other disorders. ALT: Also know as SGPT, ALT is an enzyme produced by the liver and is useful in detecting liver disorders. -
Glossary of Technical Terms
THIS DOCUMENT IS IN DRAFT FORM, INCOMPLETE AND SUBJECT TO CHANGE AND THAT THE INFORMATION MUST BE READ IN CONJUNCTION WITH THE SECTION HEADED “WARNING” ON THE COVER OF THIS DOCUMENT. GLOSSARY OF TECHNICAL TERMS This glossary contains explanations of certain technical terms used in this Document in connection with our Company and its business. Such terminology and meanings may not correspond to standard industry meanings or usages of those terms. “acetaminophen” a non-opioid analgesic and antipyretic agent used to treat pain and fever “artificial pancreas” an integrated diabetes management system that tracks blood glucose levels using a continuous glucose monitor and automatically delivers the insulin when needed using an insulin pump according to its control algorithm “ascorbic acid” a potent reducing and antioxidant agent that functions in fighting bacterial infections, in detoxifying reactions, and in the formation of collagen in fibrous tissue, teeth, bones, connective tissue, skin, and capillaries “basal insulin” a small, continuous infusion of background insulin delivered automatically at a programmed rate, all day and night “BG Port” blood glucose strip port, the port that accepts and electrically connects a disposable blood glucose strip to the electronics “BGMS” blood glucose monitoring system “BLE” bluetooth low energy “blood glucose” blood glucose, also referred to as blood sugar, is the amount of glucose in your blood, an indicator of diabetes monitoring “bolus insulin” insulin that is taken to lower abnormally high blood glucose