Point of care glucose testing—Need for a better mousetrap or time to rethink the hunt?*

Juneja, Rattan; Zito, Denise R.

doi:10.1097/ccm.0b013e318187b7d8

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…This system presents some limitations; data suggest that fingerstick and point-of-care glucose measurements are inaccurate and tend to overestimate the actual, blood glucose levels in critically ill ICU patients 22,23 . However, although it is not considered the gold standard, it was the most practical and rapid approach that was available 24 .…”

Section: Discussionmentioning

confidence: 99%

Tight Glucose Control versus Intermediate Glucose Control: A Quasi-Experimental Study

Durão

Marra

Moura

et al. 2010

Anaesth Intensive Care

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Intensive insulin treatment is associated with an increased risk of hypoglycaemia. The purpose of this study was to evaluate two different strategies: tight glucose control (TGC) versus intermediate glucose control (IGC). In this quasi-experimental study, 130 critically ill patients were assigned to receive either the TGC protocol (n=65), according to which blood glucose levels were maintained between 4.4 and 6.1 mmol/l, or the IGC protocol (n=65), according to which blood glucose levels were maintained between 4.4 and 8.0 mmol/l. A total of 52 subjects (40%) were diabetic and 63 (49%) were septic. In the IGC group, glucose levels were stabilised in the target range for a longer period of time when compared to the TGC group (63 vs 41%, P <0.001). The median capillary blood glucose level was 6.7 mmol/l in the TGC group (6.2 to 7.2) and 7.9 mmol/l (7.0 to 8.5) in the IGC group (P <0.001). The incidence of hypoglyacemia less than 2.2 mmol/l was 21.5% in the TGC group and 1.5% in the IGC group (P <0.001), and the incidence of hypoglycaemia less than 3.3 mmol/l was 67.7 and 26.2% (P <0.001) in the two groups, respectively. Diabetes (odds ratio 2.88, CI 1.22 to 6.84) and the TGC protocol (odds ratio 7.39, CI 3.15 to 17.35) were identified as independent risk factors for hypoglycaemia less than 3.3 mmol/l. Mechanical ventilation (odds ratio 4.33, CI 1.16 to 16.13), medical illness (odds ratio 2.88, CI 1.20 to 6.99) and hypoglycaemia (<3.3 mmol/l) (odds ratio 2.99, CI 1.21 to 7.41) were independent factors associated with mortality. TGC is difficult to accomplish in routine intensive care unit settings and is associated with a significant increase in the incidence of hypoglycaemia. Hypoglycaemia <3.3 mmol/l is an independent risk factor for in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Tight Glucose Control versus Intermediate Glucose Control: A Quasi-Experimental Study

Durão

Marra

Moura

et al. 2010

Anaesth Intensive Care

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“…Hospitals perform millions of blood glucose (BG) determinations annually (Cook et al., ) due to an increased prevalence of patients with diabetes mellitus (National Diabetes Information Clearing House, ) and heightened awareness of the importance of inpatient glycemic control (Cook et al., ). Point‐of‐care (POC) testing is a rapid and convenient (Juneja & Zito, ) measure of capillary BG, but is less precise and accurate than laboratory venous BG (Floré, Fiers, & Delanghe, ). Recognition of patient hypoglycemia, as well as insulin ordering and administration decisions are frequently based on POC BG results.…”

mentioning

confidence: 99%

The Impact of Inpatient Point-Of-Care Blood Glucose Quality Control Testing

Corl

Yin²,

Hoofnagle³

et al. 2012

Journal for Healthcare Quality

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Analyze the effectiveness of mandated point-of-care (POC) blood glucose (BG) meter quality control (QC) testing. All POC BG QC tests were analyzed to evaluate operator and strip/meter error rates and institutional cost. POC BG QC test failure (17/103,580 over 24 months) was low and no meters failed subsequent linearity testing. Examining individual QC measures shows that operator error occurs frequently and total error rate is related to QC familiarity (>50 QC tests/month, 2.4%; <50 QC tests/month, 3.8%, p < .001). Even among the most competent operators, strip/meter error (1.2 ± 0.3%) accounted for 50% of total error. Compared with manufacturer-recommended QC testing, Joint Commission mandated POC BG QC testing during 2008/2009 incurred excess costs of approximately US$127,000. POC BG meter failure within current guidelines is rare and does not justify the cost of daily QC testing. Frequent QC testing can identify operators needing retraining in POC testing. Strip/meter QC errors are common, are not prevented by current QC testing standards, and may contribute to clinical errors.

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