Estimates of Total Analytical Error in Consumer and Hospital Glucose Meters Contributed by Hematocrit, Maltose, and Ascorbate

Lyon, Martha E.; DuBois, Jeffrey A.; Fick, Gordon H.; Lyon, Andrew W.

doi:10.1177/193229681000400624

Cited by 22 publications

(24 citation statements)

References 18 publications

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“…Lyon, et al15 reported that ascorbic acid produced statistically significant analytical errors with SMBG devices. These interferences may mask true hypoglycemia or hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

Spurious Elevation of Glucose Concentration during Administration of High Dose of Ascorbic Acid in a Patient with Type 2 Diabetes on Hemodialysis

et al. 2013

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We describe herein a case of life-threatening hypoglycemia due to spurious elevation of glucose concentration during the administration of ascorbic acid in a type 2 diabetic patient. A 31-year-old female was admitted for proliferative diabetic retinopathy treatment and prescribed high dose ascorbic acid. During hospitalization, she suddenly lost her consciousness and her glucose concentration was 291 mg/dL, measured using self-monitoring blood glucose (SMBG) device, while venous blood glucose concentration was 12 mg/dL. After intravenous injection of 50% glucose solution, the patient became alert. We reasoned that glucose measurement by SMBG device was interfered by ascorbic acid. Physicians should be aware of this interference; high dose ascorbic acid may cause spurious elevation of glucose concentration when measuring with SMBG devices.

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“…Lyon, et al15 reported that ascorbic acid produced statistically significant analytical errors with SMBG devices. These interferences may mask true hypoglycemia or hyperglycemia.…”

Section: Discussionmentioning

confidence: 99%

Spurious Elevation of Glucose Concentration during Administration of High Dose of Ascorbic Acid in a Patient with Type 2 Diabetes on Hemodialysis

et al. 2013

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“…The accuracy of these handheld blood glucose meters in critically ill patients has recently been questioned [21]. Many drugs, depending on the enzymatic reaction, may interfere with the blood glucose measurement (eg, ascorbic acid, acetaminophen, icodextrin) [22]. The main culprit in the accuracy of the blood glucose meters during critical illness appears to be anemia [23], which is widely tolerated in critically ill patients due to restrictive transfusion policies [24,25].…”

Section: Is Nice-sugar Evidence Against Blood Glucose Control?mentioning

confidence: 99%

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Mesotten

Berghe

2011

Curr Diab Rep

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Hyperglycemia during critical illness is associated with adverse outcome. The proof-of-concept Leuven studies assessed causality, and revealed that targeting strict normoglycemia (80-110 mg/dL) with insulin improved outcome compared with tolerating hyperglycemia to the renal threshold (215 mg/dL). A large multicenter trial (NICE-SUGAR [Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation]) found an intermediate blood glucose target (140-180 mg/dL) safer than targeting normoglycemia. Differences in design and in execution of glycemic control at the bedside may have contributed to these results. In NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation), the blood-glucose target range in the control group was lower, there were problems to reach and maintain normoglycemia in the intervention group, and inaccurate handheld blood glucose meters and variable blood sampling sites were allowed. Inaccurate tools led to insulin-dosing errors with consequently (undetected) hypoglycemia and unacceptable blood glucose variability. Also, the studies were done superimposed upon different nutritional strategies. Thus, such differences do not allow simple, evidence-based recommendations for daily practice, but an intermediate blood glucose target may be preferable while awaiting better tools to facilitate safely reaching normoglycemia.

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“…Fundamental assumptions of this methodologic approach are that the measured value for blood [gluc] is minimally affected by changes in hematocrit (Hct) and sample temperature. Changes in Hct have been widely documented to influence the measured value for blood [gluc] when used to analyze human blood . It has been known for more than 100 years that intra‐erythrocyte [gluc] is lower than plasma [gluc] in cattle, horses, pigs, and dogs, but not in humans and other primates .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an Electrochemical Point‐of‐Care Meter for Measuring Glucose Concentration in Blood from Periparturient Dairy Cattle

Megahed

Hiew

Townsend

et al. 2015

Veterinary Internal Medicne

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BackgroundThe Precision Xtra® meter is a promising low cost electrochemical point‐of‐care unit for measuring blood glucose concentration ([gluc]) in cattle blood. The meter uses an algorithm that assumes the intra‐erythrocyte [gluc] equals the plasma [gluc] on a molal basis, and that the hematocrit is similar in humans and cattle.ObjectivesThe primary objective was to determine the accuracy of the meter for measuring plasma [gluc] in dairy cattle. Secondary objectives were to characterize the influence of hematocrit and sample temperature on the measured value for [gluc].AnimalsA total of 106 periparturient Holstein‐Friesian cattle.MethodsBlood and plasma samples (1,109) were obtained and Deming regression and Bland–Altman plots were used to determine the accuracy of the meter against the reference method (plasma hexokinase assay). Multivariable regression and linear regression were used to determine the effect of hematocrit and sample temperature on the plasma [gluc] measured by the meter.ResultsIntra‐erythrocyte [gluc] was 18% of plasma [gluc] on a molar basis. Sample temperature had a significant linear effect on plasma [gluc] as measured by the meter for 3/5 plasma samples when measured [gluc] > 160 mg/dL.Conclusions and clinical importanceThe meter utilizes an algorithm that is optimized for human blood and is inaccurate when applied to bovine blood. Until a cattle‐specific algorithm is developed, we recommend using plasma as the analyte instead of blood and calculating plasma [gluc] using the equation: [gluc] = 0.66 × [gluc]p‐meter + 15, where [gluc]p‐meter is the value reported by the meter. If blood is measured, then we recommend using the equation: [gluc] = 0.90 × [gluc]b‐meter + 15.

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Estimates of Total Analytical Error in Consumer and Hospital Glucose Meters Contributed by Hematocrit, Maltose, and Ascorbate

Abstract: Background:

Cited by 22 publications

References 18 publications

Spurious Elevation of Glucose Concentration during Administration of High Dose of Ascorbic Acid in a Patient with Type 2 Diabetes on Hemodialysis

Spurious Elevation of Glucose Concentration during Administration of High Dose of Ascorbic Acid in a Patient with Type 2 Diabetes on Hemodialysis

Glycemic Targets and Approaches to Management of the Patient with Critical Illness

Evaluation of an Electrochemical Point‐of‐Care Meter for Measuring Glucose Concentration in Blood from Periparturient Dairy Cattle

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