Evaluation of Point-of-Care Blood Glucose Measurements in Patients with Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome Admitted to a Critical Care Unit

Corl, Dawn E.; Yin, Tom S.; Mills, Michelle; Spencer, Tina L.; Greenfield, Lucy; Beauchemin, Erin; Cochran, Jessica; Suhr, Louise D.; Thompson, Rachel; Wisse, Brent E.

doi:10.1177/193229681300700516

Cited by 4 publications

(4 citation statements)

References 16 publications

(33 reference statements)

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“…A recent study indicated that venous blood POC error was not considered clinically significant in patients with DKA/HHS. 27 The authors concluded that there is a low risk of causing hypoglycemia from excess insulin administration based on POC glucose error but stated that patient harm could occur by delaying correction of metabolic disturbances in patients with DKA/HHS. Therefore further investigation is required to determine if POC BHB methods affected by hematocrit will influence the management of ketonemia particularly in patients following a goal directed targeted treatment for DKA.…”

Section: Discussionmentioning

confidence: 99%

“…In the NICU study 37 abnormal levels of pH and electrolytes were also assessed and shown not to influence the accuracy of StatStrip. In a recent study it was reported that Accu-Chek POC glucose accuracy was influenced by acidemia, which can be present in DKA/HHS patients, 27 and as such further investigation into the role of fluctuating pH ranges on POC meter performance is required.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Performance Assessment of Point-of-Care Testing Devices for Measuring Glucose and Ketones at the Patient Bedside

Ceriotti

Kaczmarek

Guerra

et al. 2014

J Diabetes Sci Technol

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Point-of-care (POC) testing devices for monitoring glucose and ketones can play a key role in the management of dysglycemia in hospitalized diabetes patients. The accuracy of glucose devices can be influenced by biochemical changes that commonly occur in critically ill hospital patients and by the medication prescribed. Little is known about the influence of these factors on ketone POC measurements. The aim of this study was to assess the analytical performance of POC hospital whole-blood glucose and ketone meters and the extent of glucose interference factors on the design and accuracy of ketone results. StatStrip glucose/ketone, Optium FreeStyle glucose/ketone, and Accu-Chek Performa glucose were also assessed and results compared to a central laboratory reference method. The analytical evaluation was performed according to Clinical and Laboratory Standards Institute (CLSI) protocols for precision, linearity, method comparison, and interference. The interferences assessed included acetoacetate, acetaminophen, ascorbic acid, galactose, maltose, uric acid, and sodium. The accuracies of both Optium ketone and glucose measurements were significantly influenced by varying levels of hematocrit and ascorbic acid. StatStrip ketone and glucose measurements were unaffected by the interferences tested with exception of ascorbic acid, which reduced the higher level ketone value. The accuracy of Accu-Chek glucose measurements was affected by hematocrit, by ascorbic acid, and significantly by galactose. The method correlation assessment indicated differences between the meters in compliance to ISO 15197 and CLSI 12-A3 performance criteria. Combined POC glucose/ketone methods are now available. The use of these devices in a hospital setting requires careful consideration with regard to the selection of instruments not sensitive to hematocrit variation and presence of interfering substances.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative Performance Assessment of Point-of-Care Testing Devices for Measuring Glucose and Ketones at the Patient Bedside

Ceriotti

Kaczmarek

Guerra

et al. 2014

J Diabetes Sci Technol

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show abstract

“…Preanalytical variables, common in the ICU, fall into three core groupings: the user interface-including the user skills, device-specific, and technique used for specimen collection; patient/therapy factors-such as interfering medication or endogenous substances; and physiologic, reflecting glucose metabolism, capillaryto-plasma glucose gradients, insulin kinetics, and more. Further inaccuracy may result from slow glucose equilibration during hypotension or shock (124), with vasopressors (125), or other states of impaired microcirculation, edema, acidosis, dehydration, and extremes of glucose values (126)(127)(128)(129).…”

Section: Adult and Pediatric Glucose Monitoring Devicesmentioning

confidence: 99%

Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024

Honarmand,

Sirimaturos,

Hirshberg

et al. 2024

Critical Care Medicine

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Rationale: Maintaining glycemic control of critically ill patients may impact outcomes such as survival, infection, and neuromuscular recovery, but there is equipoise on the target blood levels, monitoring frequency, and methods. Objectives: The purpose was to update the 2012 Society of Critical Care Medicine and American College of Critical Care Medicine (ACCM) guidelines with a new systematic review of the literature and provide actionable guidance for clinicians. Panel Design: The total multiprofessional task force of 22, consisting of clinicians and patient/family advocates, and a methodologist applied the processes described in the ACCM guidelines standard operating procedure manual to develop evidence-based recommendations in alignment with the Grading of Recommendations Assessment, Development, and Evaluation Approach (GRADE) methodology. Conflict of interest policies were strictly followed in all phases of the guidelines, including panel selection and voting. Methods: We conducted a systematic review for each Population, Intervention, Comparator, and Outcomes question related to glycemic management in critically ill children (≥ 42 wk old adjusted gestational age to 18 yr old) and adults, including triggers for initiation of insulin therapy, route of administration, monitoring frequency, role of an explicit decision support tool for protocol maintenance, and methodology for glucose testing. We identified the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as a good practice statement. In addition, “In our practice” statements were included when the available evidence was insufficient to support a recommendation, but the panel felt that describing their practice patterns may be appropriate. Additional topics were identified for future research. Results: This guideline is an update of the guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. It is intended for adult and pediatric practitioners to reassess current practices and direct research into areas with inadequate literature. The panel issued seven statements related to glycemic control in unselected adults (two good practice statements, four conditional recommendations, one research statement) and seven statements for pediatric patients (two good practice statements, one strong recommendation, one conditional recommendation, two “In our practice” statements, and one research statement), with additional detail on specific subset populations where available. Conclusions: The guidelines panel achieved consensus for adults and children regarding a preference for an insulin infusion for the acute management of hyperglycemia with titration guided by an explicit clinical decision support tool and frequent (≤ 1 hr) monitoring intervals during glycemic instability to minimize hypoglycemia and against targeting intensive glucose levels. These recommendations are intended for consideration within the framework of the patient’s existing clinical status. Further research is required to evaluate the role of individualized glycemic targets, continuous glucose monitoring systems, explicit decision support tools, and standardized glycemic control metrics.

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“…Volume status (including fluid intake and output), vital signs, neurological status, plasma concentrations of electrolytes, anion gap, osmolality and glucose need to be monitored closely, initially as often as every 2 hours (1,31,32). Capillary blood glucose (CBG) measurements are unreliable in the setting of severe acidosis (46). Precipitating factors must be diagnosed and treated (1,31,32).…”

Section: Managementmentioning

confidence: 99%

Hyperglycemic Emergencies in Adults

Goguen¹,

Gilbert²

2018

Canadian Journal of Diabetes

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KEY MESSAGES • Diabetic ketoacidosis and hyperosmolar hyperglycemic state should be suspected in people who have diabetes and are ill. If either diabetic ketoacidosis or hyperosmolar hyperglycemic state is diagnosed, precipitating factors must be sought and treated. • Diabetic ketoacidosis and hyperosmolar hyperglycemic state are medical emergencies that require treatment and monitoring for multiple metabolic abnormalities and vigilance for complications. • A normal or mildly elevated blood glucose level does not rule out diabetic ketoacidosis in certain conditions, such as pregnancy or with SGLT2 inhibitor use. • Diabetic ketoacidosis requires intravenous insulin administration (0.1 units/ kg/h) for resolution. Bicarbonate therapy may be considered only for extreme acidosis (pH ≤7.0). KEY MESSAGES FOR PEOPLE WITH DIABETES When you are sick, your blood glucose levels may fluctuate and be unpredictable: • During these times, it is a good idea to check your blood glucose levels more often than usual (for example, every 2 to 4 hours). • Drink plenty of sugar-free fluids or water. • If you have type 1 diabetes with blood glucose levels remaining over 14 mmol/L before meals, or if you have symptoms of diabetic ketoacidosis (see Table 1), check for ketones by performing a urine ketone test or blood ketone test. Blood ketone testing is preferred over urine testing. • Develop a sick-day plan with your diabetes health-care team. This should include information on: • Which diabetes medications you should continue and which ones you should temporarily stop • Guidelines for insulin adjustment if you are on insulin • Advice on when to contact your health-care provider or go to the emergency room. Note: Although the diagnosis and treatment of diabetic ketoacidosis (DKA) in adults and in children share general principles, there are significant differences in their application, largely related to the increased risk of lifethreatening cerebral edema with DKA in children and adolescents. The specific issues related to treatment of DKA in children and adolescents are addressed in the Type 1 Diabetes in Children and Adolescents chapter, p. S234. Symptoms Signs Hyperglycemia Polyuria, polydipsia, weakness ECFV contraction Acidosis Air hunger, nausea, vomiting and abdominal pain Altered sensorium Kussmaul respiration, acetone-odoured breath Altered sensorium Precipitating condition See list of conditions in Table 2 Can J Diabetes 42 (2018) S109-S114 Contents lists available at ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d i a n j o u r n a l o f d i a b e t e s. c o m

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Evaluation of Point-of-Care Blood Glucose Measurements in Patients with Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome Admitted to a Critical Care Unit

Cited by 4 publications

References 16 publications

Comparative Performance Assessment of Point-of-Care Testing Devices for Measuring Glucose and Ketones at the Patient Bedside

Comparative Performance Assessment of Point-of-Care Testing Devices for Measuring Glucose and Ketones at the Patient Bedside

Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024

Hyperglycemic Emergencies in Adults

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