Liquid citrate acidification introduces significant glucose bias and leads to misclassification of patients with diabetes

Juričić, Gordana; Kopcinovic, Lara Milevoj; Saračević, Andrea; Bakliza, Ana; Šimundić, Ana-Maria

doi:10.1515/cclm-2015-0358

Cited by 17 publications

(3 citation statements)

References 27 publications

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“…Citrate is an important intermediate product in the TCA cycle and is also the terminal metabolic pathway and metabolic linkage of lipid biosynthesis. Previous studies found that citrate was significantly increased in the DM rats and liquid citrate acidification can most effectively inhibit glycolysis [38,39], which are consistent with our finding that the level of citric acid increased in the model group and decreased in the HD group. Citric acid can reversibly produce isocitrate under the action of aconitase, and the isocitrate dehydrogenase (ICD) is a key rate-limiting enzyme in the TCA cycle.…”

Section: Energy Metabolismsupporting

confidence: 92%

Urinary Metabolomics Study of the Intervention Effect of Hypoglycemic Decoction on Type 2 Diabetes Mellitus Rats Model

Pan

Sun

Liu

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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The hypoglycemic decoction (HD) is a traditional Chinese medicine (TCM) preparation for the treatment of diabetes mellitus (DM), with a remarkable therapeutic effect. However, its mechanism of action is still unclear at the metabolic level. In this study, the biochemical markers from type 2 DM (T2DM) rats, induced by a high-sugar and high-fat diet combined with streptozotocin (STZ), were detected. The metabolomics-based analysis using high-performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS) was conducted to evaluate urine samples from control, model, metformin, and HD groups. After oral administration of HD for 28 days, the general state, weight, fasting blood glucose (FBG), blood lipid level, oral glucose tolerance test (OGTT), fasting insulin (FINS), insulin sensitivity index (ISI), and homeostasis model assessment of insulin resistance (HOMA-IR) were significantly improved (P<0.01). The western blotting showed that HD can enhance the protein expression of glucose transporter 4 (GLUT4) and adenosine monophosphate-activated protein kinase (AMPK). The metabolomics results revealed that after treatment with HD, the levels of L-carnitine, 1-methyladenosine, 1-methylhistamine, and 3-indoleacrylic acid were upregulated and the levels of riboflavin, phenylalanine, atrolactic acid, 2-oxoglutarate, citrate, isocitrate, cortisol, and glucose were downregulated. The main mechanism may be closely related to the regulation of the tricarboxylic acid (TCA) cycle, phenylalanine metabolism, glyoxylate metabolism, and dicarboxylate metabolism. Additionally, it was also found that HD can regulate the protein expression of GLUT4 and AMPK to interfere with TCA cycle and carbohydrate metabolism to treat T2DM.

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Section: Energy Metabolismsupporting

confidence: 92%

Urinary Metabolomics Study of the Intervention Effect of Hypoglycemic Decoction on Type 2 Diabetes Mellitus Rats Model

Pan

Sun

Liu

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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“…The first lyophilized citric-citrate buffer additive was replaced by a liquid additive that required the use of a controversial dilution factor ( 17 - 19 ). But, since 2017, it has been replaced by a validated lyophilized additive ( 16 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Preanalytical issues related to routine and diagnostic glucose tests: Results from a survey in Spain

García-del-Pino¹,

Bauça

Gómez³

et al. 2020

Biochem. med. (Online)

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IntroductionDiabetes mellitus (DM) is one of the most prevalent diseases worldwide. The objective of this study was to find out under what preanalytical conditions routine and diagnostic glucose tests are performed across Spanish laboratories; and also what criteria are used for DM diagnosis.Materials and methodsAn online survey was performed by the Commission on Quality Assurance in the Extra-Analytical Phase of the Spanish Society of Laboratory Medicine (SEQC-ML). Access to the questionnaire was available on the home page of the SEQC-ML website during the period April-July 2018. Data analysis was conducted with the IBM SPSS© Statistics (version 20.0) program.ResultsA total of 96 valid surveys were obtained. Most laboratories were in public ownership, serving hospital and primary care patients, with high and medium workloads, and a predominance of mixed routine-urgent glucose testing. Serum tubes were the most used for routine glucose analysis (92%) and DM diagnosis (54%); followed by lithium-heparin plasma tubes (62%), intended primarily for urgent glucose testing; point-of-care testing devices were used by 37%; and plasma tubes with a glycolysis inhibitor, mainly sodium fluoride, by 19%. Laboratories used the cut-off values and criteria recognized worldwide for DM diagnosis in adults and glucose-impaired tolerance, but diverged in terms of fasting plasma glucose and gestational DM criteria.ConclusionPreanalytical processing of routine and DM diagnostic glucose testing in Spain does not allow a significant, non-quantified influence of glycolysis on the results to be ruled out. Possible adverse consequences include a delay in diagnosis and possible under-treatment.

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“…The highest drop of glucose concentration was observed in the serum tube, then in NaF/KOx followed by lithium-heparin tube sampled on ice. Liquid citrate tube preserved glucose concentration the best ( 25 ). These results underline the risks associated with usage of serum tube for glucose concentration measurement: misdiagnosis of diabetes patients and falsely decreased glucose concentration.…”

Section: Discussionmentioning

confidence: 99%

Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

2017

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IntroductionThe aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia.Materials and methodsThis paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100).ResultsIn investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96).ConclusionFirst two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.

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Liquid citrate acidification introduces significant glucose bias and leads to misclassification of patients with diabetes

Cited by 17 publications

References 27 publications

Urinary Metabolomics Study of the Intervention Effect of Hypoglycemic Decoction on Type 2 Diabetes Mellitus Rats Model

Urinary Metabolomics Study of the Intervention Effect of Hypoglycemic Decoction on Type 2 Diabetes Mellitus Rats Model

Preanalytical issues related to routine and diagnostic glucose tests: Results from a survey in Spain

Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

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