Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes:Prospective cohort study

Objective: To assess the clinical utility of point of care (POC) capillary blood glucose (CBG) in the assessment of gestational diabetes (GDM) during oral glucose tolerance test (OGTT).Design: Prospective cohort study.Setting: Antenatal clinics at King’s College Hospital.Population: Women screening for GDM between March and June 2020.Methods: CBG was measured using POC-StatStrip® (Nova) and venous plasma glucose (VPG) was measured by Roche (Cobas 8000 c702) analyser. GDM was diagnosed based on NICE-2015 criteria. The two methods were compared statistically using Analyse-It (v 5.40.2)Main outcome measures: Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for POC-StatStrip® compared to VPG measured by reference laboratory method.Results: 230 women were included. The number and the percentage of women with glucose concentration above the GDM thresholds using POC-StatStrip® vs. Lab-VPG measurement was 15 (6.5%) vs. 8 (3.4%) at fasting and 105 (45%.6) vs. 72 (31.1%) at 2-hour respectively. Sensitivity, specificity and 95% CI for POC-StatStrip® were 88% (52-99) and 97% (93-98) at fasting and 97% (91-99) and 79% (71-84) at 2-hour respectively. However, the specificity and the NPV for POC-StatStrip® concentrations ≤5.0 mmol/L at fasting or <7.5mmol/L at 2-hour were 100% and the sensitivity and the PPV for concentration >9.5mmol/L at 2-hour was 100 %.Conclusion: In our cohort POC-CBG measurement cannot entirely replace laboratory method in OGTT, however, it can be used to rule out/rule in GDM when the glucose concentrations are ≤5.0mmol/L at fasting or <7.5/>9.5mmol/L at 2-hour

Challenges in assessing the efficacy of systemic corticosteroids for severe wheezing episodes in preschool children

This letter addresses the controversial issue of the use of oral corticosteroids during wheezing exacerbations in preschool-aged children by demonstrating findings of a prematurely terminated multi-center clinical trial, discussing lessons learned, and suggesting future directions