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It would be advantageous to be able to measure glycosylated hemoglobin (GHb) from a sample of blood dried on paper and sent to the physician by the patient. Indeed, such a technique has been introduced by Isolab (Akron, OH). We tested the validity of the method to determine whether applying the blood to paper and immediately assaying it correlates with the same sample assayed by the usual whole-blood technique, the size of sample applied to paper affects apparent GHb results, time and temperature of storage of the sample paper affect apparent GHb results, and plasma glucose concentration of the sample affects GHb results. The GHb of samples assayed immediately after application to sample paper versus those assayed as whole blood showed very good correlation (r = .93, P less than .001). Volume of the drop of blood applied to paper (25-100 microliters) did not affect results. However, there was a dramatic, temperature-dependent increase in apparent GHb when samples were stored on sample paper, averaging 12.5, 16.3, and 19.5% when stored at room temperature for 3, 6, and 9 days, respectively. Overall, apparent GHb rose from 1.3-fold in 3 days at 4 degrees C to 3.8-fold in 9 days at 37 degrees C. The rate of GHb formation was proportional to plasma glucose concentration, but removal of free glucose by ethanol or glucose oxidase did not yield consistent results for this method. We conclude that these sample papers are not useful as an approach to collecting blood samples for GHb measurement.
Diabetes Care
PMID:Assessment of glycosylated hemoglobin measurement with sample collection papers. 359

The introduction of glucose oxidase strips has given blood glucose measurements a new dimension. Together with assessment of time-averaged blood glucose concentration by measurements of glycosylated hemoglobin, self-monitoring of blood glucose has proven of value in the management of diabetes mellitus in cases with intensified insulin therapy, at the beginning of insulin therapy, with frequent hyperglycemia, and a number of other management problems. The principles and information which are important for the interpretation of the two parameters are summarized.
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PMID:[Control of diabetes management: daily profile of blood glucose? self-monitoring of blood glucose? HbA1/HbA1c?]. 365 77

We present data on a filter-paper collection and assay method for measurement of glycated hemoglobin (gHb). Onto filter paper dipped into a solution of glucose oxidase (EC 1.1.3.4) and allowed to dry, approximately 20 microL of capillary blood was spotted. For analysis, we eluted the dried blood spot from the paper by soaking in water for 1 h, then measured the gHb in the eluate by affinity chromatography. Because the gHb significantly increased from day 1 to day 14 of storage, it was necessary to standardize the day of elution from the paper. We found a high correlation between gHb measured from samples stored for 14 days on treated paper and gHb measured by affinity chromatography from frozen whole blood or hemolysates (r = 0.96). This method is convenient, requiring small amounts of blood and little sample handling and assay time, and may be particularly useful in certain situations such as large-scale screening for diabetes.
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PMID:Collection of blood on filter paper for measurement of glycated hemoglobin by affinity chromatography. 369 80

Antibody to the islet cells of the pancreas is detected in the serum of many patients with recent onset, insulin-dependent diabetes. Islet cell antibodies have been detected using the procedure of indirect immunofluorescence. We have adopted an immunohistochemical procedure using glucose oxidase to the histochemical identification of islet cell antibody. This procedure was found to be more sensitive than the immunofluorescence procedure, and, in addition, it was much easier to determine when a positive reaction was present. Thus, the glucose-oxidase immunohistochemical procedure for detecting antibodies to islet cells is preferable in comparison with indirect immunofluorescence.
Diabetes 1984 Aug
PMID:Comparison of an immunohistochemical and immunofluorescence procedure to detect antibody to pancreatic islet cells. 620 95

New techniques are available for the treatment of children with insulin-dependent diabetes mellitus. These include more intensive methods of insulin delivery by multiple daily injections or continuous subcutaneous infusion by portable pumps combined with patient self-monitoring of blood glucose. Long-term diabetic control can be evaluated by measurement of glycosylated hemoglobin, HbA1 or HbA1c. Pediatric practitioners may be in doubt as to the extent to which these techniques should be incorporated into their own practices. In order to provide some guidance in this quandary, the treatment practices as of June 1982, of 53 physicians with a special interest in the treatment of diabetic children were surveyed by questionnaire. The respondents estimated that they cared for 12,350 diabetic patients less than 19 years of age. Among their patients, 72% received twice-daily injections of insulin, 3% received three or more injections daily, and only 195 patients (2.7% of the total) were treated with insulin pumps. Among patients older than 10 years of age, 50% performed self-monitoring of blood glucose four times daily on one or more days per week and 32% of these patients did so daily. Two thirds of the patients utilized glucose oxidase-impregnated strips for blood glucose estimation and the remainder used reflectance meters. Essentially all respondents utilized glycosylated hemoglobin to evaluate quality of control. The mean number of determinations was 3.8 per year. Reasons for introducing pump therapy or discontinuing its use, glycemic targets for pump patients, and experience with utilization of the pump are described.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Research and practice in the treatment of insulin-dependent diabetes: a survey of 53 pediatric diabetologists. 650 27

The day-to-day variability of blood glucose concentrations in juvenile diabetes means that it is often more reasonable to aim to achieve a generally good pattern of blood glucose control, rather than regularly to assess the next insulin dose after each blood glucose measurement. This means that immediate assessment by the patient of his blood glucose concentrations is not always necessary. We have investigated control in 22 insulin-requiring diabetic patients by means of a monthly series of four blood samples taken during a day into collector bottles and transported to a laboratory for blood glucose assay. The overall means before breakfast, before lunch, before dinner, and before bed were 6.1, 5.8, 7.3, and 7.2 mmol/L, respectively. In many patients, sufficiently good control can be obtained by this method so that it is not necessary to ask them to measure their own blood glucose concentrations or to ask them to obtain the fairly expensive meters for reading glucose oxidase strips. Control would then probably be best assessed by a series of three daily profiles taken once per month, with, if necessary, the results being discussed with the patient. On the other hand, in more unstable diabetes, home assessment by patients of blood glucose measurements is indicated.
Diabetes Care
PMID:Clinic- rather than self-monitoring of home blood samples: relevance of day-to-day variability to decision making. 699 61

The glycosylated hemoglobin, hemoglobin A1c, (HbA1c), which reflects average plasma glucose of the previous few weeks, has recently been used to monitor humans with diabetes mellitus. Further understanding of the HbA1c elevation rate would improve interpretation of HbA1c. We determined glycosylated hemoglobin elevation rates in 5 dogs with induced diabetes. Hemoglobin A1C was determined by an established column chromatographic technique; plasma glucose by glucose oxidase. Values were determined on 13 normal dogs and compared with values obtained weekly from surgically or chemically induced diabetic dogs. Hemoglobin A1c increased in a fashion that could be predicted by modelling. The model predicts that large changes in Hb A1c will occur within the first few weeks of a sudden change in glucose and that a new plateau will be reached at a time equal to the erythrocyte life span. In the present experiment abnormally elevated HbA1c occurred after 2 wk of hyperglycemia. The results should approximate the elevation rate after acute onset and sustained severe hyperglycemia in humans, because humans and canine are hematologically similar and thus extend previously reported studies on human out-patient diabetics.
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PMID:Elevation rate of glycosylated hemoglobins in dogs after induction of experimental diabetes mellitus. 712 Dec 62

The advent of electrochemical sensors for intermittent sampling of blood gases and hydrogen ions in the clinic, intensive care, and surgical units has revolutionized diagnostic and critical care medical technics. The use of electrochemical sensors for continuous transcutaneous monitoring of blood gases is further enhancing the medical surveillance of patients. The more recent introduction of glucose and other electroenzymatic sensors has stimulated broad research in the development of metabolic monitoring. For the present research, the glucose sensor widely used for the rapid specific micro-analysis of whole blood and plasma is explored for possible use as an in vivo intravascular or tissue-implanted sensor. This sensor is based on the polarographic measurement of hydrogen peroxide generated by glucose oxidase (EC 1.1.3.4) held between two membranes. The first membrane allows the diffusion of glucose, ions, and many other small molecules, while the second membrane allows the diffusion of the glucose-generated hydrogen peroxide to the platinum surface, but excludes ascorbic acid, bilirubin, and uric acid. Such sensors respond rapidly and specifically when acutely implanted subcutaneously in cats and dogs. They function well as glucose-sensor-tipped venous catheters. One sensor was repeatedly used for in vitro polarograms, subcutaneous and blood glucose monitoring, over a period of ten months, with storage in the cold between uses, with the complete retention of its response characteristics.
Diabetes Care
PMID:Implanted electroenzymatic glucose sensors. 717 79

Enzymatic electrodes are described for the specific and sensitive determination of glucose in blood. The probes are based on the conversion of B-D-glucose by glucose oxidase chemically attached to the surface of a Pt electrode. The peroxide liberated is sensed by measurement of the current generated at +0.7 volts vs. S.C.E. The enzyme, chemically attached to pig intestine via glutaraldehyde coupling is quite stable for months, even at room temperature. Other glucose electrodes developed at the University of New Orleans, using Pt (measurement of the O2 consumed at - 0.7 volts vs. S.C.E.) and I- probes are also described.
Diabetes Care
PMID:Enzymatic glucose electrodes. 717 80

A series of enzyme electrodes for measurement of glucose have been constructed. The electrodes contain glucose oxidase immobilized on platinum, either with or without co-immobilization of catalase. When placed in buffered glucose, the enzyme electrodes show a potentiometric response to glucose with respect to a Ag/AgCl reference electrode. This response is reproducible in the physiologic range of glucose concentrations. The immobilization technique, some of the environmental variables such as oxygen concentration and pH, and several compounds that might interfere with the selectivity of the enzyme electrodes for glucose have received preliminary study. This direct potentiometric approach is undergoing further evaluation to determine the basic electrochemical mechanism responsible for the potentiometric signal and whether it can be adapted for continuous in vivo monitoring of the glucose concentration in body fluids.
Diabetes Care
PMID:Potentiometric measurement of glucose concentration with an immobilized glucose oxidase/catalase electrode. 717 83


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