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					SA JOURNAL OF DIABETES & VASCULAR DISEASE                                                                                                                                                    ADA WATCH

                                                        ADA WATCH

                    2010 UPDATE FROM ORLANDO, USA
American Diabetes Association                                                                                                                                                    25–29June2010
Contributors:J Aalbers, Dr F Mahomed, Prof WF Mollentze

CliniCaltrialupdates                                  brate or placebo. The remaining 4 733 par-                                     glycaemic-control arm due to an increased
                                                        ticipants were randomly assigned to either                                     rate of death from any cause after a mean
aCCOrdretinopathystudyshows                         the intensive blood-pressure control (< 120                                    of 3.5 years has influenced the retinopa-
intensiveglycaemiccontrol,and                       mmHg systolic blood pressure) or standard                                      thy results in this arm, potentially underes-
combinationdyslipidaemiatherapy                      therapy (< 140 mmHg).                                                          timating the retinopathy benefits of good
withfenofibratereducesretinopa-                          In this ACCORD eye study, participants                                     glycaemic control.
thyprogression                                         with retinopathy at baseline were excluded;                                       The beneficial effect of fenofibrate ther-
                                                        those included were comprehensively eval-                                      apy on the progression of diabetic retinopa-
A study group of the ACCORD study has
                                                        uated at baseline and at year four of the                                      thy at four years (6.3 vs 10.2% on placebo)
shown that targeting glycaemic control at
                                                        study. Progression of diabetic retinopathy                                     provides further support to the findings of
the 6% HbA1c level and lipid therapy with
                                                        was defined as at least three steps on the                                     the FIELD study, which also showed visual
fenofibrate instead of placebo significantly
                                                        EDTRS severity scale or development of                                         benefits with fenofibrate.
reduced the rate of progression of diabetic
                                                        retinopathy requiring photocoagulation
retinopathy.1 Intensive blood pressure con-                                                                                            1.     The ACCORD study group and ACCORD Eye study
                                                        therapy or vitrectomy.
trol did not reduce progression.                                                                                                              group. Effects of medical therapies on retinopathy
                                                            Results of the progression to retinopa-                                           progression in type 2 diabetes. N Engl J Med
   The ACCORD study was an independ-
                                                        thy and moderate vision loss are summa-                                               10.1056/NEJM oa1001288. Pub 29/6/2010.
ent study sponsored by the National Heart,
                                                        rised in Table 1.
Lung and Blood Institute and companies
                                                            The early stoppage of the intensive
did not participate in the study design or
conduct, data accrual or analysis, or manu-
script preparation, providing only the study                                                          taBleOFCOntents
                                                         CliniCAl triAl uPDAtes                                                       Once-daily liraglutide lowers systolic blood
   The more than 10 000 ACCORD patients                  ACCOrD retinopathy study shows intensive                                       pressure (sbP) in treated and untreated
with type 2 diabetes and HbA1c higher than                 glycaemic control, and combination                                           hypertensive patients ����������������������������������������3
7.5% were randomly assigned to either                      dyslipidaemia therapy with fenofibrate
                                                           reduces retinopathy progression ����������������������1                    Dietary omega-3 polyunsaturated fatty acid
the intensive glycaemic-control arm or                                                                                                  (fish oil capsules) reduced atherosclerosis
standard control. Of these participants,                 Optimising glucose control in iCu patients                                     progression in type 2 diabetes ��������������������������3
                                                           reduces costs (triuMPH three-year results) �����2
5 518 with dyslipidaemia were also ran-                                                                                               Costs of continuing sulphonylureas with
domly assigned in a two-by-two factorial                 VADt study: further analysis of results shows                                  insulin therapy in type 2 diabetes: more
                                                           intensive glycaemic control offered some                                     hypoglycaemia and weight gain but less
design to receive simvastatin and fenofi-                  renal protection to patients with more                                       insulin needed����������������������������������������������������3
                                                           advanced microvascular disease �����������������������2
                                                                                                                                      reDuCing COMPliCAtiOns OF DiAbetes
                                                         VADt trial: intensive glycaemic control did                                  infliximab treatment improves visual acuity
                                                           not prevent progression of calcified                                          in diabetic macular oedema that does not
table.1. Progression to retinopathy and moderate         atherosclerosis in patients with long-                                        respond to laser photocoagulation ������������������4
           vision loss                                     standing type 2 diabetes �����������������������������������2
                                                                                                                                      Point-of-care testing of diabetic keto-acidosis
                                                         Once-weekly exenatide injection improves                                       avoids unnecessary DKA work-ups in
                    progressionof      Moderate         blood sugar control more than daily oral                                     hyperglycaemic patients presenting at
                     retinopathy         visionloss       sitagliptin or pioglitazone and induces                                      emergency departments �����������������������������������4
                                                           more weight loss (DurAtiOn-2 study)�������������2
treatment              n       (%)        n      (%)                                                                                  rotating glucometer usage after achieving
                                                         PAtHOgenesis OF tyPe 2 DiAbetes                                                glucose control in the first patient improves
Glycaemic therapy                                        intramyocellular lipid accumulation does not                                   HbA1c levels in resource-constrained settings
 Intensive          104/1429    (7.3) 266/1629 (16.3)       occur in pre-diabetes, but only after                                       in Kenya��������������������������������������������������������������4
                                                            manifestation of hyperglycaemia ���������������������2
 Standard           149/1427 (10.4) 273/1634 (16.7)                                                                                   Poor glycaemic control slows wound healing ������4
                                                         insulin resistance study (irAs) shows problems
Dyslipidaemia                                               for HbA1c levels as diagnostic tool ��������������������2                 encouraging and educating physicians can
 With fenofibrate    52/806     (6.5) 145/908 (16)                                                                                      result in earlier insulin prescription with
                                                         new metabolic syndrome definition and value                                    enhanced HbA1c control�������������������������������������4
 With placebo        80/787    (10.2) 136/893 (15.2)       of waist circumference evaluated in type 2
                                                           diabetes ��������������������������������������������������������������3   Cardiovascular outcomes trial initiated for
Antihypertensive                                                                                                                        liraglutide �����������������������������������������������������������4
 Intensive           67/647    (10.4) 145/749 (19.4)     DiAbetes tHerAPy
                                                         Metformin protects against antidepressant
 Standard            54/616     (8.8)   113/13 (15.8)      diabetes risk? �����������������������������������������������������3

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OptimisingglucosecontroliniCu                           Vadttrial:intensiveglycaemiccon-                     sitagliptin group and 1.2% in the pioglita-
patientsreducescosts(triuMpH                             troldidnotpreventprogressionof                     zone group.
three-yearresults)                                          calcifiedatherosclerosisinpatients                       Patients in the exenatide group lost on
                                                             withlong-standingtype2diabetes                       average 2.3 kg, compared with a mean
Targeting lower glucose levels (9.18 mg/dl,
                                                                                                                      weight loss of 0.8 kg in the sitagliptin
AACE guideline) in ICU patients has been                     The VADT trial was able to show reduced
                                                                                                                      group and a mean weight gain of 2.8 kg in
shown to reduce length of stay (LOS) and                     cardiovascular events in participants with
                                                                                                                      the pioglitazone group. No major episodes
ICU costs ($8 000) in the extended three-                    low levels of calcified coronary athero-
                                                                                                                      of hypoglycaemia (abnormally low blood
year period of the TRIUMPH study involving                   sclerosis at baseline. This newly presented
                                                                                                                      sugar) occurred in any group.
more than 11 000 patients.                                   study evaluated 197 patients with calcified
                                                                                                                          The most frequent adverse events with
    The use of intensive insulin therapy (IIT)               atherosclerosis at baseline, as measured
                                                                                                                      exenatide and sitagliptin were nausea (24
also reduced complications and improved                      by CT scan and after 4.6 years in both the
                                                                                                                      and 10%, respectively) and diarrhoea (18
outcomes. The benefit of IIT was confirmed                   intensive glycaemic-control arm and the
                                                                                                                      and 0%, respectively); while upper respira-
in this study, which compared intervention                   normal control group.
                                                                                                                      tory tract infection (10%) and peripheral
ICUs to control ICUs, which did not apply                        These scans showed no treatment ben-
                                                                                                                      oedema (fluid retention/swelling in the
the intensive insulin therapy protocol.                      efit of intensive versus standard therapy
                                                                                                                      legs) (18%) were the most frequent events
                                                             with regard to either pre-existing coronary
Source: Presidents Poster, 0433-PP. Sadhu AR, Ang AC,                                                                 with pioglitazone.
Ingram-Drake LA, et al. Length of stay – cost-savings of     artery calcium (CAC) or abdominal aortic
intensive insulin therapy in ICU patients – 3-year results   artery calcium (AAC).                                    Source: Oral presentation, ADA
of the TaRgeted InsUlin therapy to iMProve Hospital
outcomes (TRIUMPH) program.                                  Source: Presidents Poster 0405-PP. Saremi A, Anderson
                                                             RJ, Duckworth WC, et al. Intensive glucose lowering
                                                             therapy and progression of coronary (CAC) and            patHOgenesisOFtype2
Vadtstudy:furtheranalysisof                             abdominal aortic artery calcium (AAC) in the Veterans
resultsshowsintensiveglycae-                              Affairs Diabetes Trial (VADT).                           diaBetes
protectiontopatientswithmore                            Once-weeklyexenatideinjection                         doesnotoccurinpre-diabetes,but
advancedmicrovasculardisease                               improvesbloodsugarcontrolmore                       onlyaftermanifestationofhyperg-
The Veterans Affairs Diabetes Trial (VADT)                   thandailyoralsitagliptinorpiogli-                   lycaemia
in type 2 diabetes, although not able to                     tazoneandinducesmoreweight
                                                                                                                      Using prior gestational diabetes (GDM) as a
show reduced cardiovascular events com-                      loss(duratiOn-2study)
                                                                                                                      model to study early changes in the devel-
pared to average control in this further                     A convenient, once-weekly injection of                   opment of type 2 diabetes, the researchers
analysis of renal outcomes, provided data                    exenatide in patients with type 2 diabe-                 used magnetic resonance imaging (MRI)
not yet published on the microvascular pro-                  tes was more effective at improving blood                and MR spectroscopy to measure left ven-
tection achieved by intensive control (INT).                 sugar control and inducing weight loss                   tricular function and myocardial lipid accu-
   In the VADT trial, the average age of                     than were either daily oral sitagliptin or               mulation in the cardiac septum of women
patients was 60 years, duration of diabe-                    pioglitazone.                                            with prior GDM with normal glucose toler-
tes was 11 years, with HbA1c levels of 9.4%                     In this 26-week, randomised trial, the                ance, in women with prior DGM and type
at the outset of the study. With regard to                   patients included all had type 2 diabetes                2 diabetes, and controls without GDM and
renal function, patients were excluded if                    and had been treated with metformin.                     with normal glucose tolerance.
the serum creatinine was above 1.6 mg/dl.                    The mean baseline glycosylated haemo-                        There was no difference in left ventricu-
Renal progression was evaluated in terms                     globin (HbA1c) concentration in the cohort               lar function between the groups except
of worsening urine albumin:creatinine ratio                  was 8.5%, the mean fasting plasma glu-                   for stroke volume, which was decreased in
(ACR) and sustained worsening of esti-                       cose was 9.1 mmol/l, and the mean body                   women with type 2 diabetes. Also, these
mated glomerular filtration rate (eGFR).                     weight was 88.0 kg.                                      women showed increased intramyocellu-
   It was found that INT did not independ-                      The study included patients from the                  lar lipid content compared to the women
ently attenuate ACR or eGFR progression                      USA, India and Mexico. Patients were ran-                with GDM and normal glucose toler-
but did retard ACR progression by 72% in                     domly assigned to exenatide 2 mg injected                ance and decreased levels of high-density
those who had photocoagulation, and by                       once weekly plus daily oral placebo (170                 lipids, which were inversely related to the
95% in those requiring cataract surgery.                     patients); daily oral sitagliptin 100 mg plus            intramyocellular lipid content.
The beneficial effect of INT was also more                   placebo injected once weekly (172); or
evident in patients with a BMI ≥ 34 kg/m2.                   daily oral pioglitazone plus placebo injected            Source: Abstract ADA, 0014-OR. Winhofer Y, Krissak
   In conclusion, INT had no independent                     once weekly (172). All patients continued                M, Anderwald C, et al. Cardiac function and lipid
beneficial renal effect but afforded some                                                                             metabolism in women with prior gestational diabetes.
                                                             their metformin treatment throughout the
protection in those with more advanced                       study.
microvascular disease, lower baseline BP or                     Four hundred and ninety-one patients
higher baseline BMI.                                         received at least one dose of the study                  showsproblemsforHBa1clevelsas
                                                             drug and were included in the final analysis             diagnostictool
Source: Presidents Poster 0412-PP. Agrawal L, Azad N,
Emanuele N, et al. Renal outcomes in Veterans Affairs        (160 exenetide, 166 sitagliptin, 165 piogli-             The IRAS study of some 417 patients at
Diabetes Trial.                                              tazone). Treatment with exenatide reduced                risk of developing diabetes has shown that
                                                             HbA1c by 1.5%, compared with 0.9% in the                 the 6.5 and 5.7% HbA1c thresholds have

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SA JOURNAL OF DIABETES & VASCULAR DISEASE                                                                                                                ADA WATCH

a low sensitivity of detecting the onset of              diabetes in the 10 years of the extended                in patients receiving fish oil capsules, com-
both diabetes and pre-diabetes, as defined               Diabetes Prevention Programme Outcomes                  pared to patients following the diet recom-
by previous definitions of diabetes, using               Study (DPPOS) in those patients not receiv-             mended by ESC/EASD.
fasting glucose values (≥ 11.1 mmol/l),                  ing metformin. There was no association                    The dosage of omega-3 was 1 g EPA,
impaired glucose tolerance (IGT) (2-h glu-               between antidepressant medication usage                 1 g DHA and 0.1 g alpha-tocopherol ace-
cose: 7.8–11.0 mmol/l) and impaired fast-                and diabetes risk in patients receiving met-            tate. Interestingly, total cholesterol, HDL
ing glucose (IFG) (fasting glucose: 5.6–6.9              formin.                                                 cholesterol and triglyceride levels improved
mmol/l).                                                     This ADA-sponsored research confirms
    The sensitivity and specificity of HbA1c ≥           the strong positive and statistically signifi-
6.5% for detecting incident diabetes was                 cant association between continuous anti-                          
                                                                                                                 table.1. Change in SBP from baseline to week 26
22 and 99.5%, respectively. The low sen-                 depressant medication use and increased                            (mmHg)
sitivity of these HbA1c cut-off points could             diabetes risk found in the three-year fol-
jeopardise the timely implementation of                  low-up period of the DPP in those patients                                                    difference
protective lifestyle and pharmacological                 on the placebo and intensive lifestyle arm.                                                    between
interventions.                                           The researchers noted that this association
                                                                                                                                       liragutide         and
                                                         was still significant when controlled for               patientgroup           1.8mg placebo placebo
Source: Presidents Poster, 0424-PP. Haffer SM,
Wagenknecht LE, Hanley AJ, et al. HbA1c and fasting
                                                         depression symptom level.
                                                                                                                 Overall                  –2.55      0.19      –2.37
and 2-h glucose concentrations for detecting worsening       While acknowledging that this find-
of glucose tolerance status in individuals with normal   ing does not allow the interpretation of a              AH treat at week 26      –2.03      0.76      –2.79
glucose tolerance at baseline: the Insulin Resistance    protective effect of metformin, it does alert           No AH treat              –3.07    –1.13       –1.95
Atherosclerosis Study.
                                                         clinicians to the higher diabetes risk facing
                                                         patients who are being treated also for
newmetabolicsyndromedefinition                       long-term depression.                                   in those patients on the fish oil capsules.
andvalueofwaistcircumference                        Source: Presidents Poster. Abstract No 0479-PP. Rubin   Source: Abstract 0193-OR. Dragomir AD, Radulian
evaluatedintype2diabetes                             RR, Marrero DG, Yong MA, et al. Antidepressant          G, Rosu E, et al. One-year administration of dietary
                                                         medication use and risk of developing diabetes during   omega-3 polyunsaturated fatty acid decreases oxidative
The recent consensus definition of the                                                                           stress and atheroscerlosis progression in type 2
                                                         the Diabetes Prevention Program and the Diabetes
metabolic syndrome allows for both the                   Prevention Programme Outcomes study.                    diabetes.
IDF and NCEP ATP III cut-off points for the
diagnosis of a large waist in Caucasians. Its                                                                    Costsofcontinuingsulphonyl-
value in predicting type 2 diabetes has not              Once-dailyliraglutidelowers                          ureaswithinsulintherapyintype2
yet been assessed.                                       systolicbloodpressure(sBp)in                       diabetes:morehypoglycaemiaand
    This prospective study assessed and fol-             treatedanduntreatedhypertensive                     weightgainbutlessinsulinneeded
lowed up for eight years, more than 500                  patients                                                There is no consensus on whether insulin
non-diabetic Caucasians undergoing coro-
                                                         A meta-analysis of six randomised, control-             secretagogues should be maintained when
nary angiography for evaluation of stable
                                                         led trials (n = 3 967) has shown that the               analogue insulin therapy is added to the
CAD. At baseline, 50% of the patients met
                                                         reduction in SBP with liraglutide was inde-             type 2 diabetes regimen, while metformin
the novel consensus metabolic syndrome
                                                         pendent of concomitant antihypertensive                 is continued.
definition but the predictability of this defi-
                                                         treatment (AH), and that this reduction                     This multinational study of almost 1 000
nition was enhanced when the NCEP ATP
                                                         was additive to concomitant antihyper-                  insulin-naïve patients tracked diabetes
III waist circumference cut-off values of
                                                         tensive therapy. The evaluation was done                control when basal insulin (glargine once
more than 102 cm for men and more than
                                                         using an ANCOVA model, which included                   daily or detemir twice daily) was added and
88 cm in women were used.
                                                         randomised treatment effect, use of AH                  sulphonylureas and glinides were retained/
    The eight-year incidence of type 2 diabe-
                                                         therapy at 26 weeks and interaction with                stopped.
tes was 32% in patients defined according
                                                         liraglutide/placebo at 26 weeks.                            Glucose control was not statistically
to these criteria, compared to 15% using
                                                                                                                 significantly different but patients who
the smaller waist circumference measure.                 Source: Abstract 0296-OR. Fonseca V, Plutzky J,
                                                         Montanya E, et al. Liraglutide, a once-daily human
                                                                                                                 continued with sulphonylureas had more
Source: Abstract 0381-OR. Saely CH, Vonbank A,           GLP-1 analog, lowers systolic blood pressure (SBP)      hypoglycaemia (40 vs 24.5%) and gained
Rein P, et al. Prediction of type 2 diabetes with the    independently or concomitant antihypertensive treat-    significantly more weight (1.5 vs 0.4 kg).
novel metabolic syndrome consensus definition: The       ment.                                                   End-of study daily insulin doses were how-
importance of waist circumference.
                                                                                                                 ever significantly lower in patients continu-
                                                                                                                 ing secretagogues than in those stopping
                                                         dietaryomega-3polyunsaturated                        these agents (0.6 vs 0.8 units/kg/day).
diaBetestHerapy                                        fattyacid(fishoilcapsules)reduced
                                                         atherosclerosisprogressionintype                    Source: Abstract 0037-OR. Swinnen SG, Dain MP,
                                                                                                                 Mauricio D, et al. Continuation versus discontinuation
Metforminprotectsagainstanti-                         2diabetes                                              of insulin sceretagogues when initiating insulin in type
depressantdiabetesrisk?                                This one-year study of 300 patients with                2 diabetes.
Continuous use of antidepressant medi-                   type 2 diabetes showed that carotid
cation increased the risk of developing                  intima–media thickness did not progress

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reduCingCOMpliCatiOnsOF                                    diabetic ketoacidosis at emergency department triage:      encouragingandeducatingphysi-
                                                              beta hydroxybutyrate vs urine dip.
diaBetes                                                                                                                cianscanresultinearlierinsulin
infliximabtreatmentimproves                                rotatingglucometerusageafter
visualacuityindiabeticmacular                            achievingglucosecontrolinthe
                                                              firstpatientimprovesHBa1clevels                       Using the updated ADA/EASD consen-
oedemathatdoesnotrespondto                                                                                         sus statement, which includes earlier use
laserphotocoagulation                                        inresource-constrainedsettingsin
                                                                                                                         of insulin in patients not achieving HbA1c
This small phase III study suggested that                                                                                goals on metformin and lifestyle, this cer-
larger and long-term trials should be under-                  A home glucose-monitoring programme                        tified diabetes educator (CDE) programme
taken to assess the efficacy of the systemic                  for Kenyan patients with an HbA1c above                    increased insulin use rates from 25 to 39%.
or intravitreal anti-TNF monoclonal anti-                     10% and a cell phone has shown a mean                      Patient HbA1c values improved with the
body, infliximab, to improve the vision of                    drop in HbA1c of 3% in a remotely managed                  proportion of diabetics with HbA1c > 8.5%
patients with diabetic macular oedema                         cost-effective process of diabetes care.                   dropping from 36 to 24%.
refractory to laser therapy.                                      Patients are given a glucometer and pro-                   The intervention was not too labour
   This single-centre, double-blind, ran-                     vided with glucose testing strips. They are                intensive, and was conducted over six
domised, placebo-controlled, crossover                        called weekly by community workers, who                    months and included three main compo-
study in 11 patients showed that intrave-                     record their results and relay the informa-                nents: office-based education, print and
nous infliximab (5 mg/kg) at weeks zero,                      tion to clinicians, who then adjust the insu-              monthly e-mail reminders.
two, six and 14, followed by placebo to                       lin dose based on a standardised protocol.
                                                                  Once a patient achieves good control,                  Source: Abstract 0108-OR. Endsley S, Leal S, Choi J,
32 weeks, improved visual acuity by 24%                                                                                  Martinez AN. An office-based physician education
compared to placebo-treated eyes.                             he/she returns the glucometer, which is                    program to enhance the earlier initiation of insulin: An
                                                              then given to another patient. The research-               evaluation of an academic detailing intervention in the
Source: Presidents Poster 0416-PP. Tentolouris IV,            ers plan to extend this model to rural areas               US.
Grigcropoulos V, Emfietzoglou I, et al. Infliximab for        of Kenya.
diabetic macular edema refractory to laser photo-
coagulation.                                                  Source: Presidents Poster, Abstract No 0432-PP. Ouma
                                                              MN and Pastakia SK. A comprehensive collaborative          Cardiovascularoutcomestrialiniti-
point-of-caretestingofdiabetic                            enhanced diabetes care program in the rural resource       atedforliraglutide
                                                              constrained setting of Eldoret (western) Kenya.
keto-acidosisavoidsunnecessary                                                                                        Novo Nordisk announced at the ADA meet-
dKawork-upsinhyperglycaemic                                                                                          ing details of the company’s cardiovascular
patientspresentingatemergency                             poorglycaemiccontrolslows                              outcomes trial for liraglutide, which is set
departments                                                   woundhealing                                              to start in the autumn of 2010.
                                                                                                                            The LEADER™ trial (Liraglutide Effect and
The poor specificity of urine dipstick tests                  This evaluation of raw data from several                   Action in Diabetes: Evaluation of cardiovas-
for diabetic ketones resulted in a high false-                multi-centre, randomised, FDA-approved                     cular outcome Results) aims to assess and
positive rate with increased hospital costs.                  clinical trials among similar populations                  confirm the cardiovascular safety of the
This study used the point-of-care (POC)                       incorporated 411 diabetic patients with                    company’s new once-daily human GLP-1
capillary beta-hydroxybutyrate test (the                      neuropathic foot ulcerations and evaluated                 analogue and potentially show its ability to
Precision Xtra meter, Abbott Laboratories)                    the clinical and laboratory data during a                  improve cardiovascular outcomes. The trial
to obviate these additional costs.                            12-week period of wound healing.                           also satisfies the new FDA guideline for
    Five hundred hyperglycaemic patients                          The relationship between HbA1c and                     type 2 diabetes treatments.
admitted to the emergency department                          successful wound healing over 12 weeks                        The protocol has been designed in close
were enrolled in the study and 53 met all                     of standardised treatment was then evalu-                  collaboration with an international expert
ADA criteria for DKA. The urine dipstick                      ated. After adjusting for covariates (dura-                steering committee as well as US and EU
had a sensitivity of 98%, but a specificity                   tion of diabetes, age, gender, race, etc),                 regulatory authorities, and with assistance
of 40%, whereas use of the Precision Xtra                     the evaluation showed that the odds of                     from the Population Health Research Insti-
meter had an equal sensitivity but a specifi-                 healing decreased by 15% for every 1%                      tute (PHRI) at McMaster University, Canada.
city of 80%, thereby significantly reducing                   increase in HbA1c during the preceding 12                  Furthermore, an independent data-moni-
unnecessary DKA work-ups in hyperglycae-                      weeks of wound care.                                       toring committee will monitor progress of
mic patients.
                                                              Source: Abstract 0189-OR. Cook EA, Cook JJ, Henao          the trial and ensure that it meets the high-
Source: Presidents Poster 0386-PP. Arora S, Peters AL,        M, et al. The importance of sustained glycaemic control    est standards of ethics and patient safety.
Long T, et al. Utilising point-of-care testing to identifiy   during wound healing.


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