Clinical Experience of an Iontophoresis Based Glucose Measuring System

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45+/-52.99 mg/dL with a mean absolute relative error of 20+/-15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p<0.05)) and this correlation was independent of time of data collection. However, after excluding confounding variables this correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable by Clarke error grid analysis. We concluded that RIGMD does not have the reliability and accuracy required to wholly replace conventional methods. However, further technical advancements that reduce its shortcomings would make this device useful for the management of diabetes.

Clinical Usefulness of Glucose Testing from the Forearm in Diabetic Patients / 대한내분비학회지

BACKGROUND: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens(R) (i-Sens, Inc. Korea) device for diabetic patients. METHODS: We measured the glucose level at the forearm by use of CareLance(R) (vaccum assisted lancing device) and also at the finger tip simultaneously by use of the CareSens(R) device at fasting and postprandial 2 hours, respectively. At the same time, the glucose levels of venous samples were checked by the laboratory method (BIOSEN 5030, EKF, Germany) and compared with those glucose level measured by the CareSens(R) device. We also checked the ease of use of the CareLance(R) and the associated pain of the patients by means of a visual analogue scale (VAS) at the time of blood sampling. RESULTS: The glucose level obtained from the forearm and finger tip correlated well with that from the laboratory method, respectively. Error grid analysis showed that 100% of the measurements were clinically acceptable; forearm blood glucose testing by use of CareLance(R) was less painful and it was as easy to use as the finger prick (P < 0.05 and P = 0.04, respectively). CONCLUSION: Forearm testing is an acceptable alternative to finger prick testing for measuring blood glucose in diabetic patients.

Clinical Usefulness of Glucose Testing from the Forearm in Diabetic Patients / 대한내분비학회지

BACKGROUND: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens(R) (i-Sens, Inc. Korea) device for diabetic patients. METHODS: We measured the glucose level at the forearm by use of CareLance(R) (vaccum assisted lancing device) and also at the finger tip simultaneously by use of the CareSens(R) device at fasting and postprandial 2 hours, respectively. At the same time, the glucose levels of venous samples were checked by the laboratory method (BIOSEN 5030, EKF, Germany) and compared with those glucose level measured by the CareSens(R) device. We also checked the ease of use of the CareLance(R) and the associated pain of the patients by means of a visual analogue scale (VAS) at the time of blood sampling. RESULTS: The glucose level obtained from the forearm and finger tip correlated well with that from the laboratory method, respectively. Error grid analysis showed that 100% of the measurements were clinically acceptable; forearm blood glucose testing by use of CareLance(R) was less painful and it was as easy to use as the finger prick (P < 0.05 and P = 0.04, respectively). CONCLUSION: Forearm testing is an acceptable alternative to finger prick testing for measuring blood glucose in diabetic patients.

Prevalence of subclinical hypothyroidism in hypercholesterolemic adults and influence of serum TSH on the serum total cholesterol level / 대한내과학회지

BACKGROUND: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. METHODS: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol > or = 240 - or = 300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. RESULTS: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). CONCLUSION: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.

Cytotoxic T Lymphocyte Antigen-4 (CTla-4) Polymorphism in Korean Autoimmune Thyroid Disease / 대한내분비학회지

BACKGROUND: The cause of autoimmune thyroid diseases (AITD), including Graves disease and Hashimotos thyroiditis, is largely unknown. To identify the genes responsible, most attention has been focussed on the HLA regions in the early studies. However, these studies have repeatedly shown a weak association between AITD and the HLA-DR3 in Caucasians. To understand and find out the mechanisms underlying the development of AITD, a search for non-HLA linked susceptibility genes is important. A recent study from American population have indicated an association between a polymorphism of CILA-4 gene and Graves disease. To clarify the relationship of the CTLA-4 polymorphism and AITD, the allele frequency of CTLA-4 gene from the patients with Graves disease and with Hashimotos thyroiditis in Korean papulation were analysed. METHODS: The CTLA-4 exon 1 polymorphism (49, A/G) was analysed by PCR-based, RFLP (Restriction Fragment Length Polymorphism) from 92 women and 37 men with Graves disease and 50 women and 9 men with Hashimotos thyroiditis diagnosed. Also, 287 healthy controls including 155 women and 132 men with no clinical evidence or family history of thyroid disease were enrolled. RESULTS: 1) In the group of Graves disease, there was significantly more patients with alanine homozygote (GG) than in control group (P<0.0005, RR=1.40). However, there was not significant with threonine homozygote (AA) between two groups (P=0.052). In the group of Hashimotos thyroiditis, no significant differences were found between all homozygotes and heterozygote. 2) In the group of Graves disease, there were significantly more patients with alanine homozygote (GG) (P<0.0001, RR=1.85) and significantly fewer patients with threonine homozygote (AA) than in the group of Hashimoto's thyroiditis (P<0.005, RR 0.25). CONCLUSION: Regardless of sex difference, alanine homozygote (GG) at exon 1 (codon 17) of CTLA-4 is associated with Graves disease in Korean population, which suggests genetic susceptibility is some role in the pathogenesis of Graves disease.

Apolipoprotein E genotypes of normal and hyperlipidemic subjects

Apolipoprotein E (apo E) plays a role in the regulation of the lipid metabolism of humans. Apo E, 229 amino acid polypeptide, is classified into three major isoform (E2, E3, E4) according to the differences of amino acid in position 112 and 158. In the normal population apo E3 isoform is most prevalent and apo E2 or E4 is frequently associated with hyperlipoproteinemia. To find out the frequency of apo E isoform distribution in the Korean population, apo E genotyping was performed. After amplification of apoE gene by polymerase chain reaction (PCR), restriction isotyping was done by cleavage with restriction enzyme Hha I and polyacrylamide gel electrophoresis. The apo E allele frequency in 73 normal subjects was 4.8% for E2, 84.9% for E3 and 10.3% for E4. In diabetic patient with hyperlipoproteinemia, the frequency of apo E allele was 6.3% for E2, 81.0% for E3 and 12.7% for E4. There was no significant difference in apo E isoform distribution between diabetics and normal populations. But in patients with cardiovascular disease with hyperlipidemia, the apo E4 allele frequency was significantly higher than normal (20.0% vs 10.3%, p<0.005). Apo E3 was the most common isoform in normal and diabetic subjects and apo E2 isoform was rather low frequency compared to Caucasians. This pattern is similar to the Japanese population but somewhat different from other populations. From the data of a high association of apo E4 allele and cardiovascular disease with hypercholesterolemia, apo E isoform may be one of the determinants of hyperlipoproteinemia. The PCR method may be useful in apo E genotyping.