Ear wax monitoring vs Hba1c

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LittleGreyCat

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Please see first part of over long post!

This is the second half of my post which broke the word/character count limit.

Rapidly losing the will to live here, but noting:

"Differences in the period covered by the baseline and the follow-up earwax sample may explain why the correlation between the baseline EGC and FSG (R = 0.71, p < 0.001) was much smaller than the association found between the follow-up EGC and PSG (R = 0.90, p < 0.001). This might be explained by the fact that only the amount of secreted earwax at the time of follow-up was standardized. Hence, the baseline period covered by the baseline EGC varied among participants and might have been affected by a range of factors. Aside from biological differences in fasting and postprandial glycemic levels, peaks of hyperglycemia, due to episodes of physical activity or stress before their inclusion in the study, might have affected baseline earwax measurements"

Which I read as saying that the baseline measurement of Earwax Glucose Concentration is not that good because of the indeterminate history of the original syringed sample. Only the sample taken one month later is known to cover a 4 week period.

All in all, as a one time scientist I am not impressed with this study.
It seems to be awash with axes to grind.
Not so much with test results.

It is interesting in showing that earwax includes glucose, and the concentration may well reflect the BG level when the wax was secreted.

However the study was so minor that it seems very wrong to draw any major conclusions.

Significant weaknesses:
  • Only 37 participants, all non-diabetic and generally healthy
  • Only one true test 4 weeks after ear syringed.
  • Lack of further testing to confirm the single result this is all based on (why not 3 * 4 week periods?) to confirm the singleton test result is accurate
  • Heavy reliance on a single FBG and a single PBG test to asses the accuracy of EGC and HbA1c testing. Again why no further testing?
  • Acknowledges that the accuracy of HbA1c tests is higher for diabetics than non diabetics (who were the test subjects)
  • Indirectly recognises the strength of CGM to overcome the original shortcomings of BG testing, but tried to bad mouth the technology
  • Acknowledges that cofounders (other influences) can affect the accuracy of HbA1c but does not make any effort to demonstrate that these do not affect EGM - just avoids them in the tests.
Anyway, the paper's summary:

"EGC using the novel device may be a harmless, economic, and suitable test for measuring long-term glucose concentrations."

I have highlighted the word "may" because it is doing a lot of heavy lifting here.

Summary (in my view):
  1. To be accurate, the subject required the ear to be syringed clean 4 weeks before the first test, and immediately after each test.
  2. The sample collected (either by syringing or the "novel device") has to go to a laboratory for analysis.
  3. This obviously requires a clinical visit, as is required now for blood samples for HbA1c.
  4. This study appears to ignore the fact that routine blood tests often also cover several other measurements such as kidney function and cholesterol, so will still be required.
  5. The cost of the analysis may be similar to that of HbA1c, or may be more expensive.
  6. The study is trivial on data and long on speculation. At best it is the foundation of a request for further study. No strong conclusions should be drawn on the basis of this paper.
  7. Conclusion: not impressed
 

LittleGreyCat

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Having just melted my brain ploughing through the paper, I will express some sympathy for those treating it in a jocular manner.

It may be unkind to treat it as a joke, but I am afraid that it isn't completely unjustified.

There isn't enough depth to draw any firm conclusions.
 

LittleGreyCat

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Serious indeed - they have developed a home test kit for it already. So, will the same meter take glucose strips, ketone strips, and earwax strips, I wonder?

No home test kit.
It needs to be done at the surgery.
 

LittleGreyCat

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Correct, They used serum blood samples to give FBG, pre and post-prandial measurements, and found the earwax tracked blood glucose better than the HbA1c.

As done to death in my main posts.
EGC may be more accurate - or it may not.
The amount of testing was so trivial that it is unsafe to base any firm conclusions on it.
 

Antje77

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I apologise if my jovial posts caused offence, just got carried away after reading some of the other posts. I did find it informative.
No offense at all, they made me smile, as did the other responses!
I just thought to remind everyone this one isn't in the jokes section to prevent the thread from becoming a joke thread only ;)
 
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TashT1

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As done to death in my main posts.
EGC may be more accurate - or it may not.
The amount of testing was so trivial that it is unsafe to base any firm conclusions on it.

Thanks for doing an in-depth review of the original paper, I got interrupted by the kids before I could look it up. It’s truly fascinating, whether the study holds up or not and a method I would never have thought was being investigated.
 

LittleGreyCat

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Thanks for doing an in-depth review of the original paper, I got interrupted by the kids before I could look it up. It’s truly fascinating, whether the study holds up or not and a method I would never have thought was being investigated.

I'm not saying that it is not interesting; it is a fascinating alternative method of measuring long term BG, and although it was not addressed in the paper (at least at the point when my brain melted) it does seem to potentially avoid the uncertainty with HbA1c where it is weighted to the last few weeks and is reliant on a normal replacement rate of red blood cells.

However we don't know if the glucose in the ear wax is denatured over time.
One of the strongest points is that if the ear is syringed then you know exactly how far back the reading goes.

One of the weakest points is that you still need a phlebotomist for all the other blood tests, and have to train someone to syringe the ear and then collect the wax sample as an additional exercise 4 weeks later.

HbA1c can be done every 6 months or a year with only one visit.
With ear wax you require 2 visits (syringe then collect 4 weeks later) or you need a much longer term study to test the effectiveness if the ear hasn't been syringed for 6 months or a year.
Also not good for initial diagnosis.

At first pass it looks as though they will have to demonstrate major clinical benefits to justify the extra training and work plus extra visits to syringe then test.

Edit: cynical me sees this as an attempt to flog the specialised collecting device for loads of money.
 

Oldvatr

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As one who wears ear insert hearing aids, I know to my cost that my ears suffer wax buildup more than normal, and I go for a decoke every 6 months or so. I wonder if that would skew the readings?