Analytic Evaluation of a New Glucose Meter System in 15 Different Critical Care Settings

Abstract

Background: Maintaining appropriate glycemic control in critically ill patients reduces morbidity and mortality. The use of point-of-care (POC) glucose devices is necessary to obtain rapid results at the patient's bedside. However, the devices should be thoroughly tested in the intended population before implementation. The use of POC glucose meters in critically ill patients has been questioned both in the literature and by regulatory agencies. The aim of this study was to determine if the ACCU-CHEK ® Inform II system (Roche Diagnostics) POC glucose meter demonstrated the desired accuracy and precision, as defined by Clinical and Laboratory Standards Institute guideline POCT12-A3, in a large number of critically ill patients from multiple intensive care settings at two academic medical centers. Methods: A total of 1200 whole blood meter results from 600 patients were compared with central laboratory plasma values. Whole blood aliquots from venous samples were used to obtain duplicate meter results with the remaining sample being processed to obtain plasma for central laboratory testing within 5 min of meter testing. Results: A total of 1185 (98.8%) of the new meter's glucose values were within ±12.5% (±12 mg/dl for values ≥100 mg/dl) of the comparative laboratory glucose values, and 1198 (99.8%) were within ±20% (±20 mg/dl for values <100 mg/dl). Conclusions: Considering the large number of patients from numerous critical care units examined, the new glucose meter system appears to have sufficient analytic accuracy for use in critically ill patients.

Performance of strip-based glucose meters and cassette-based blood gas analyzer for monitoring glucose levels in a surgical intensive care setting

“…Overall our results confirm previous reports [16][17][18][19][20][21]. Using the 10% criterion recently set forward by the FDA [12], only for the BGA all results fell within these boundaries.…”

“…Previous studies tested meters in populations not limited to critically ill patients [16][17][18][19][20][21] or in neonatal populations focusing on detection of hypoglycemia [17,18,20], and weighted results not [16,19,20] or per less stringent CLSI or ISO 15197 criteria [17,18,21], or used the glucose oxidase method [18,20,21] instead of the more definitive [22] coupled hexokinase -glucose-6-phosphate dehydrogenase (HK/G6PD) method [16,17,19]. In the present study we compared three hospital-type handheld strip-based systems on whole blood samples of our surgical intensive care unit (ICU), with our blood gas analyzer (BGA) and with the central laboratory HK/G6PD method.…”

Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room

“…Newer meter technologies may provide more accurate glucose measurement 12–14 when used on critically ill patients, though studies have not specifically addressed capillary sampling or use of meters intraoperatively. One previous study 33 specifically examined glucose measurements in the OR, although few patients were under anesthesia at the time of sample collection.…”

“…Though newer technologies may provide more accuracy 12–14 , there is still concern about the use of meters in the critically ill 15,16 . Studies have demonstrated potentially dangerous discrepancies in capillary glucose measurement in patients on vasopressor therapy 10,17 , patients in shock 18 or with poor tissue perfusion 19 , and in other critically ill patient populations 20 .…”

Glycemic Management After Resuscitation: Is Glucose The Best Alternative?

“…To date serum glucose tight control is recommended to avoid both hypo-and hyper-glycaemia, according to the NICE-SUGAR trial, the best study on glycemic control strategies among ICU patients (10). There is now general consensus about glycemic management of criticallyill patients; guidelines recommend to maintaining blood glucose lower than 180 mg/dL (11).…”