Abstract
BackgroundHydroquinone-containing creams cause false increases in capillary glycemia. However, the magnitude of this false increase, and the means to reverse it have not been investigated.ObjectiveTo evaluate the technical and clinical impact of hydroquinone-containing creams on capillary glycemia and investigate the efficacy of hand washing and other common practices, in reversing cream effects.MethodsWe included 91 participants in a quasi-experimental study in Buea, Cameroon. After determining the hydroquinone content of a cream, Caro Light, we used two glucometers with different enzymatic systems (Accu-Chek Active and OneTouch Ultra 2) to measure fasting glycemia after: initial hand washing (reference), application of 1 ml of hydroquinone-containing cream, finger swabbing with wet gauze, sanitizer application and a series of three hand washings following cream application. Reference glycemia was compared to those obtained after various interventions. Statistical significance was assessed by paired sample t-test, clinical significance by total error allowable (TEa), and clinical impact by Parke’s error grid analysis.ResultsThe mean differences in capillary glycemia (Intervention—reference) measured by Accu-Chek Active in mg/dl were 28, 27, 38, 16, 4, and -2 after cream application, finger swabbing, sanitizer application, one, two, and three hand washings respectively. Corresponding values for OneTouch Ultra2 were 41, 44, 64, 22, 5 and -5. These differences, except after two and three hand washings were both statistically (p < 0.0001) and clinically significant (TEa). After cream application, Accu-Check had 9.9% of values in Parke’s Zones C-E, while OneTouch had 18.7%.ConclusionHydroquinone-containing creams cause significant false increase in capillary glycemia irrespective of the enzymatic system of the glucometer used, and can lead to potentially wrong clinical decisions. A minimum of two hand washings is required prior to capillary glucose measurement.
Highlights
Point-of-care(POC) glucometers have widely been adopted as tools to provide timely feedback for diabetes management and monitoring, and for diabetes risk screening and diagnosis in resources-limited and remote settings [1,2]
After determining the hydroquinone content of a cream, Caro Light, we used two glucometers with different enzymatic systems (Accu-Chek Active and OneTouch Ultra 2) to measure fasting glycemia after: initial hand washing, application of 1 ml of hydroquinone-containing cream, finger swabbing with wet gauze, sanitizer application and a series of three hand washings following cream application
Statistical significance was assessed by paired sample t-test, clinical significance by total error allowable (TEa), and clinical impact by Parke’s error grid analysis
Summary
Point-of-care(POC) glucometers have widely been adopted as tools to provide timely feedback for diabetes management and monitoring, and for diabetes risk screening and diagnosis in resources-limited and remote settings [1,2]. Four main factors alter the accuracy of glucometers: strip factors, physical or environmental factors, pharmacological factors and patient factors [3] The latter includes incorrect hand washing or interfering substances such as hand lotions, alcohol, or dirt. Errors in blood glucose measurement due to extrinsic interfering substances continue to significantly plague the accuracy of results. This has major clinical impact especially with the indiscriminate use of over-the-counter creams for skin bleaching [4]. In a study involving 11 healthy volunteers in France, we showed that hydroquinone-containing creams caused a seeming mean increase in capillary glycaemia of 170 mg/dl [5]. The magnitude of this false increase, and the means to reverse it have not been investigated
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