Clarke Error Grid Analysis for Performance Evaluation of Glucometers in a Tertiary Care Referral Hospital

2021 ◽  
Author(s):  
Sohini Sengupta ◽  
Anil Handoo ◽  
Inaamul Haq ◽  
Karamvir Dahiya ◽  
Sanjay Mehta ◽  
...  
Keyword(s):  
Performance Evaluation ◽  
Tertiary Care ◽  
Referral Hospital ◽  
Grid Analysis ◽  
Clarke Error Grid ◽  
Error Grid

scholarly journals Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Fenghua Sun ◽  
Waris Wongpipit ◽  
Wendy Y. J. Huang ◽  
Stephen H. S. Wong
Keyword(s):  
Young Adults ◽  
Glucose Monitoring ◽  
Postprandial Glucose ◽  
Relative Difference ◽  
Flash Glucose Monitoring ◽  
Grid Analysis ◽  
Crossover Studies ◽  
Freestyle Libre ◽  
Clarke Error Grid ◽  
Error Grid

Aims: To investigate the accuracy of FreeStyle LibreTM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults.Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast.Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland–Altman analysis showed a bias of −1.03 mmol⋅L–1 in SIT, −0.89 mmol⋅L–1 in 20iP + CONT, −0.82 mmol⋅L–1 in iP + CONT, and −1.23 mmol⋅L–1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6–100% of the values in all trials fell within zones A and B.Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.

scholarly journals Blood glucose prediction using multi-objective grammatical evolution: analysis of the “agnostic” and “what-if” scenarios

2021 ◽  
Author(s):  
Sergio Contador ◽  
J. Manuel Colmenar ◽  
Oscar Garnica ◽  
J. Manuel Velasco ◽  
J. Ignacio Hidalgo
Keyword(s):  
Ad Hoc ◽  
Fitness Function ◽  
Grammatical Evolution ◽  
Diabetic Patients ◽  
Regression Problem ◽  
Multi Objective ◽  
Grid Analysis ◽  
Future Events ◽  
Clarke Error Grid ◽  
Error Grid

AbstractIn this paper we investigate the benefits of applying a multi-objective approach for solving a symbolic regression problem by means of Grammatical Evolution. In particular, we extend previous work, obtaining mathematical expressions to model glucose levels in the blood of diabetic patients. Here we use a multi-objective Grammatical Evolution approach based on the NSGA-II algorithm, considering the root-mean-square error and an ad-hoc fitness function as objectives. This ad-hoc function is based on the Clarke Error Grid analysis, which is useful for showing the potential danger of mispredictions in diabetic patients. In this work, we use two datasets to analyse two different scenarios: What-if and Agnostic, the most common in daily clinical practice. In the What-if scenario, where future events are evaluated, results show that the multi-objective approach improves previous results in terms of Clarke Error Grid analysis by reducing the number of dangerous mispredictions. In the Agnostic situation, with no available information about future events, results suggest that we can obtain good predictions with only information from the previous hour for both Grammatical Evolution and Multi-Objective Grammatical Evolution.

scholarly journals Continuous Glucose Monitoring in the Intensive Care Unit Following Total Pancreatectomy with Islet Autotransplantation in Children: Establishing Accuracy of the Dexcom G6 Model

2021 ◽  
Vol 10 (9) ◽  
pp. 1893
Author(s):  
Natalie Segev ◽  
Lindsey N. Hornung ◽  
Siobhan E. Tellez ◽  
Joshua D. Courter ◽  
Sarah A. Lawson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Total Pancreatectomy ◽  
Glucose Monitoring ◽  
Absolute Difference ◽  
Grid Analysis ◽  
Clarke Error Grid ◽  
Islet Autotransplantation ◽  
Error Grid

Hyperglycemia is detrimental to postoperative islet cell survival in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT). This makes continuous glucose monitoring (CGM) a useful management tool. We evaluated the accuracy of the Dexcom G6 CGM in pediatric intensive care unit patients following TPIAT. Twenty-five patients who underwent TPIAT had Dexcom G6 glucose values compared to paired serum glucose values. All paired glucose samples were obtained within 5 minutes of each other during the first seven days post TPIAT. Data were evaluated using mean absolute difference (MAD), mean absolute relative difference (MARD), %20/20, %15/15 accuracy, and Clarke Error Grid analysis. Exclusions included analysis during the CGM “warm-up” period and hydroxyurea administration (known drug interference). A total of 183 time-matched samples were reviewed during postoperative days 2–7. MAD was 14.7 mg/dL and MARD was 13.4%, with values of 15.2%, 14.0%, 12.1%, 11.4%, 13.2% and 14.1% at days 2, 3, 4, 5, 6 and 7, respectively. Dexcom G6 had a %20/20 accuracy of 78%, and a %15/15 accuracy of 64%. Clarke Error Grid analysis showed that 77% of time-matched values were clinically accurate, and 100% were clinically acceptable. The Dexcom G6 CGM may be an accurate tool producing clinically acceptable values to make reliable clinical decisions in the immediate post-TPIAT period.

scholarly journals DECISION MAKING FOR DEVICE CLOSURE IN ADULTS WITH ‘HYPERTENSIVE PDA’–NON-INVASIVE CRITERIA: IMMEDIATE RESULTS

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S762-67
Author(s):  
Ahsan Beg ◽  
Abdul Malik ◽  
Amjad Mahmood ◽  
M Younas ◽  
Fakher -e- Fayaz
Keyword(s):  
Pulmonary Hypertension ◽  
Retrospective Study ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Tertiary Care ◽  
Referral Hospital ◽  
Device Closure ◽  
X Ray ◽  
Non Invasive ◽  
The Mean

Objective: To find the mean pulmonary artery pressures (PAP) in adults (>12 years) Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ after the device closure. Residual PDA and immediate complications (embolization, pulse loss, obstruction in the aorta or pulmonary artery) are to be reported. Study Design: Retrospective study. Place and Duration of Study: Tertiary Care Referral Hospital, from Aug 2007 to Jun 2020. Methodology: This retrospective study is descriptive. Data collected by convenience sampling from 3 tertiary care referral hospital. 981 patients were undergone PDA device closure during the period from Aug 2007 to June 2020. After informed consent, an initial assessment was done by history, clinical examination, x-ray chest PA view, electrocardiography (ECG), and transthoracic echocardiography (TTE). Reversible pulmonary hypertension was labeled based on non-invasive criteria including room air saturation >93% and cardiomegaly on x-ray chest. Patients who had <93% and normal heart size on x-ray chest were excluded. The lower limit for age was 12 years. Results: Nine Hundred Eighty One patients had undergone PDA device closure. 32 (n=32/981 3.3%) had fulfilled our inclusion criteria. The mean age was 22 ± 9 (13–45) years. Mean weight was 41 ± 11 (25-66) kg. Successful device closure was done in 30 patients (93.7%). Mean diameter of PDA was 7 ± 0.1 (4.5-13 mm. Mean PAP decreased from 59 ± 13 mmHg to 38 ± 19 mmHg (p<0.05). Commonest device used was Shasma duct occluder (n=16/32 50%) followed by Occlutech Duct Occluder (n=7/32 21.9%), while 2 had muscular VSD device (n=5/32 15.6%). In 2 patients, there was an underestimation of the size of PDA so the device was retrieved and replaced with another larger one successfully. Two patients had the device fully dropped into the main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. None of our patients had device embolization or residual shunt on echo performed next day to the procedure. Neither any patient had residual pulmonary hypertension on echocardiography. There was no significant obstruction in the aorta in any patients. Two patients had mild left pulmonary artery obstruction. There was no significant obstruction in the aorta in any of our patients. There was pulse loss in 3 patients which were treated successfully with heparin infusion with no residual damage. Conclusion: Device closure is a feasible option in adults with hypertensive PDA while the decision of reversibility is based on non-invasive criteria.

scholarly journals Antibiotics: Need for new fences”, a prospective utilization evaluation of cephalosporin's and its combination in tertiary care referral hospital

2020 ◽  
Vol 8 (1) ◽  
pp. 123-127
Author(s):  
Dilip Chandrasekhar ◽  
Jaffer Chalil Parambil ◽  
P.B. Chinnu ◽  
Cyriac T. Mundadan ◽  
Danisha Pattani
Keyword(s):  
Tertiary Care ◽  
Referral Hospital

scholarly journals The Accuracy and Precision of the Continuously Stored Data from Flash Glucose Monitoring System in Type 2 Diabetes Patients during Standard Meal Tolerance Test

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Rengna Yan ◽  
Huiqin Li ◽  
Xiaocen Kong ◽  
Xiaofang Zhai ◽  
Maoyuan Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Standard Meal ◽  
Grid Analysis ◽  
Sensor Glucose ◽  
Interstitial Glucose ◽  
Error Grid ◽  
Diabetes Patients

Background. The purpose of this study was to investigate the accuracy of the continuously stored data from the Abbott FreeStyle Libre flash glucose monitoring (FGM) system in Chinese diabetes patients during standard meal tests when glucose concentrations were rapidly changing. Subjects and Methods. Interstitial glucose levels were monitored for 14 days in 26 insulin-treated patients with type 2 diabetes using the FGM system. Standard meal tests were conducted to induce large glucose swings. Venous blood glucose (VBG) was tested at 0, 30, 60, and 120 min after standard meal tests in one middle day of the first and second weeks, respectively. The corresponding sensor glucose values were obtained from interpolating continuously stored data points. Assessment of accuracy was according to recent consensus recommendations with median absolute relative difference (MARD) and Clarke and Parkes error grid analysis (CEG and PEG). Results. Among 208 paired sensor-reference values, 100% were falling within zones A and B of the Clarke and Parkes error grid analysis. The overall MARD was 10.7% (SD, 7.8%). Weighted least squares regression analysis resulted in high agreement between the FGM sensor glucose and VBG readings. The overall MTT results showed that FGM was lower than actual VBG, with MAD of 22.1 mg/dL (1.2 mmol/L). At VBG rates of change of -1 to 0, 0 to 1, 1 to 2, and 2 to 3 mg/dl/min, MARD results were 11.4% (SD, 8.7%), 9.4% (SD, 6.5%), 9.9% (SD, 7.5%), and 9.5% (SD, 7.7%). At rapidly changing VBG concentrations (>3 mg/dl/min), MARD increased to 19.0%, which was significantly higher than slow changing BG groups. Conclusions. Continuously stored interstitial glucose measurements with the FGM system were found to be acceptable to evaluate VBG in terms of clinical decision during standard meal tests. The continuously stored data from the FGM system appeared to underestimate venous glucose and performed less well during rapid glucose changes.

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