Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review

Abstract

IntroductionGlucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit. Arterial blood gas analyzers and glucose meters are commonly used to measure blood-glucose concentration in an intensive care unit; however, their accuracies are still unclear.MethodsWe performed a systematic literature search (January 1, 2001, to August 31, 2012) to find clinical studies comparing blood-glucose values measured with glucose meters and/or arterial blood gas analyzers with those simultaneously measured with a central laboratory machine in critically ill adult patients.ResultsWe reviewed 879 articles and found 21 studies in which the accuracy of blood-glucose monitoring by arterial blood gas analyzers and/or glucometers by using central laboratory methods as references was assessed in critically ill adult patients. Of those 21 studies, 11 studies in which International Organization for Standardization criteria, error-grid method, or percentage of values within 20% of the error of a reference were used were selected for evaluation. The accuracy of blood-glucose measurements by arterial blood gas analyzers and glucose meters by using arterial blood was significantly higher than that of measurements with glucose meters by using capillary blood (odds ratios for error: 0.04, P < 0.001; and 0.36, P < 0.001). The accuracy of blood-glucose measurements with arterial blood gas analyzers tended to be higher than that of measurements with glucose meters by using arterial blood (P = 0.20). In the hypoglycemic range (defined as < 81 mg/dl), the incidence of errors using these devices was higher than that in the nonhypoglycemic range (odds ratios for error: arterial blood gas analyzers, 1.86, P = 0.15; glucose meters with capillary blood, 1.84, P = 0.03; glucose meters with arterial blood, 2.33, P = 0.02). Unstable hemodynamics (edema and use of a vasopressor) and use of insulin were associated with increased error of blood glucose monitoring with glucose meters.ConclusionsOur literature review showed that the accuracy of blood-glucose measurements with arterial blood gas analyzers was significantly higher than that of measurements with glucose meters by using capillary blood and tended to be higher than that of measurements with glucose meters by using arterial blood. These results should be interpreted with caution because of the large variation of accuracy among devices. Because blood-glucose monitoring was less accurate within or near the hypoglycemic range, especially in patients with unstable hemodynamics or receiving insulin infusion, we should be aware that current blood glucose-monitoring technology has not reached a high enough degree of accuracy and reliability to lead to appropriate glucose control in critically ill patients.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Plasma glucose values by capillary point-of-care testing have been found to be potentially inaccurate, with frequent false elevations [479][480][481] over the range of glucose levels, but especially in the hypoglycemic and hyperglycemic ranges [482] and in shock patients (receiving vasopressors) [478,480]. A review of studies found the accuracy of glucose measurements by arterial blood gas analyzers and glucose meters by using arterial blood significantly higher than measurements with glucose meters using capillary blood [480].…”

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

“…The recommendation presented for this CQ was based on the results of a systematic review conducted by Inoue et al 336. In a comparison of measurements taken using a glucometer with capillary blood or a blood gas analyzer using arterial blood, measurements taken using the arterial blood gas analyzer were less likely to include measurement errors falling significantly outside the acceptable range (odds ratio: 0.04; 95% confidence interval [CI]: 0.01–0.14) 336.…”

“…In a comparison of measurements taken using a glucometer with capillary blood or a blood gas analyzer using arterial blood, measurements taken using the arterial blood gas analyzer were less likely to include measurement errors falling significantly outside the acceptable range (odds ratio: 0.04; 95% confidence interval [CI]: 0.01–0.14) 336. In addition, in a comparison of glucometer measurements using capillary blood or arterial blood, the risk of measurement error was significantly lower when arterial blood was used (odds ratio: 0.36; 95% CI: 0.25–0.52).…”

Give me less sugar: how to manage glucose levels in post-anoxic injury?

“…Third, Daviaud et al measured glucose levels using capillary glucometers; however, these devices have been shown to have a low accuracy in critically ill patients when compared to glucose measurements performed on venous/arterial blood. In particular, mean differences with the blood values may vary from 0.2 to 1.4 mmol/L (limits of agreement from 1.7 to 2.5 mmol/L), especially within the hypoglycaemic range [16]. Also, the use of vasopressors and the presence of oedema, both of which are common after CA, were important determinants of inaccuracy and might increase the risk of errors of capillary glucometers in this setting.…”