Bedside Glucometer Research Articles

Pancreatic cyst fluid glucose: a rapid on-site diagnostic test for mucinous cysts

Pancreatic cystic fluid (PCF) analysis is frequently used for cyst diagnosis with carcinoembryonic antigen (CEA) being the most accepted biomarker. Low glucose levels in PCF were previously suggested as a marker for mucinous cysts. A bed-side glucometer is a point-of care, immediate, simple, and cheap method which requires a small volume of PCF. The aim of our study was to identify the optimal glucose cut-off level for identifying mucinous cysts, evaluate the diagnostic accuracy of glucose compared to CEA, and validate glucometry against reference laboratory biochemical analysis. A single-center prospective cohort study. Consecutive patients aged 18 and older, who underwent pancreatic cyst evaluation, at the Tel Aviv Medical Center between 2016 and 2021 were analyzed. Cyst type was defined based on clinical, laboratory, and radiologic findings. Glucose was measured using laboratory biochemical analysis and two glucometers. Receiver operating characteristic analysis derived sensitivity, specificity, and accuracy were calculated and McNemar test was used to compare between methods. One hundred and one PCF samples were evaluated. The areas under the receiver operating characteristics curve for identifying mucinous cysts using glucometer, glucose laboratory, and their combination were 0.88 (p < 0.001), 0.92 (p < 0.001), and 0.93 (p < 0.001), respectively. A glucose level of 87 mg/dL was identified as the optimal laboratory glucose threshold value to detect mucinous cyst with a sensitivity of 90.9%, specificity of 83.3%, and accuracy of 89.3, higher in comparison to cyst fluid CEA. Furthermore, PCF glucose levels had the strongest association with mucinous cysts. Our findings suggest that PCF glucose level is more accurate than CEA for the diagnosis of mucinous cysts. Glucometry glucose level assessment demonstrated an excellent correlation with laboratory glucose measurements and may become a useful diagnostic test.

Rapid detection of bacterial meningitis using a point-of-care glucometer.

In case of acute bacterial meningitis, a decision on the need for intensive care admission should be made within the first hour. The aim of this study was to assess the ability of a point-of-care glucometer to determine abnormal cerebrospinal fluid (CSF) glucose concentration at the bedside that contributes toward bacterial meningitis diagnosis. We carried out a prospective study and simultaneously measured the glucose concentrations in CSF and blood using a central laboratory and a point-of-care glucometer. We compared CSF/blood glucose ratios obtained at the bedside with a glucometer versus those obtained by the central laboratory. We determined the performance characteristics of the CSF/blood glucose ratio provided by a glucometer to detect bacterial infection in the CSF immediately after CSF sampling. We screened 201 CSF collection procedures during the study period and included 172 samples for analysis. Acute bacterial meningitis was diagnosed in 17/172 (9.9%) of CSF samples. The median turnaround time for a point-of-care glucometer analysis was 5 (interquartile range 2-10) min versus 112 (interquartile range 86-154) min for the central laboratory (P<0.0001). The optimal cut-off of the CSF/blood glucose ratio calculated from a bedside glucometer was 0.46, with a sensitivity of 94.1% (95% confidence interval: 71.3-99.9%), a specificity of 91% (95% confidence interval: 85.3-95%), and a positive likelihood ratio of 10. A glucometer accurately detects an abnormal CSF/blood glucose ratio immediately after the lumbar puncture. This cheap point-of-care method has the potential to speed up the diagnostic process of patients with bacterial meningitis.

Comparison of Capillary and Venous Glucose in Diabetic Patient in a Peripheral Hospital

Introduction: This study was done to determine the mean difference and correlation between fasting capillary and venous glucose estimation.&#x0D; Methods: This was cross-sectional analytic study done in United Mission Hospital, Palpa, Tansen. Calculated sample size was 92, convenience sampling technique was used. During 5 month of duration in 92 diabetic patients, where fasting capillary and venous glucose were performed consecutively. Confounding was ruled out with matching approach, adjustment tests were also used like X2 Mantel -Haenszel and logistic regression. Reporting guideline of this observational study was done with the help of SROBE guidelines.&#x0D; Results: The mean venous blood glucose was 9.52% higher than the Mean capillary glucose. A strong correlation was observed between venous and capillary blood glucose, with Pearson correlation coefficient of 0.94.&#x0D; Conclusions: There is a significant difference in the blood glucose results analyzed on a bedside glucometer when the samples are taken from capillary or venous sources. Although good correlation is between venous and capillary derived samples, caution must be exercised in accepting the results as equivalent or using either as substitutes for a laboratory blood glucose result.

Bedside Blood Glucose Monitoring in Critically Ill Patients: Comparison Between Arterial and Capillary Glucose

BackgroundCritically ill patients are at high risk of hypoglycemia and are particularly vulnerable to unrecognized hypoglycemia. Close blood glucose monitoring is therefore crucial. There are several options to conduct frequent blood glucose measurement and a number of conditions in intensive care unit patients may affect the accuracy of blood glucose measurement. The aim of the study was to compare the accuracy of capillary glucose by bedside glucometer with arterial samples by bedside glucometer and arterial samples by blood gas analyzer in critically ill patients through a prospective case-control study. Materials and MethodsArterial and capillary samples from 60 patients were taken simultaneously and were tested immediately at the bedside. Results of the paired measurements were compared and expressed as a correlation coefficient. ResultsCapillary glucose in the study group and control group were 9.73 ± 2.28mmol/L and 8.9 ± 1.86mmol/L, respectively; mean arterial glucose measured by glucometer in the study group and control group were 9.25 ± 2.05mmol/L and 8.4 ± 1.89mmol/L, respectively; and mean arterial glucose measured by blood gas analyzer in the study group and control group were 8.41 ± 1.9mmol/L and 8.24 ± 1.5mmol/L, respectively. Correlation between capillary values and arterial values measured by glucometer was less in the study group (r = 0.936, P < 0.001 and r = 0.973, P < 0.001). Correlation between capillary values measured by glucometer and arterial values measured by blood gas analyzer was also less in the study group (r = 0.897, P = 0.001 and r = 0.964, P < 0.001). ConclusionsCapillary blood glucose monitoring is reliable only in a selected group of critically ill patients.

Clinical Use of Continuous Glucose Monitoring in Pediatrics.

The first reported clinical use of a continuous glucose monitoring (CGM) system in children was by Coss-Buet al. in 1999.1 They investigated a bedside VIA 1-01G Blood Chemistry monitor for measuring glucose in the pediatric intensive care unit (PICU). The monitor was programmed to draw venous blood, analyze, and record blood glucose samples automatically at predetermined intervals. This system was large, difficult to move, required intravenous access, and took 20 min to set up. Nonetheless, the data provided were comparable to measures by a laboratory glucose analyzer and bedside glucometer and could be used to inform clinical decision-making. Many advances have occurred since that time to benefit pediatric patients with diabetes. Most recently, the FDA has approved the Dexcom G5 CGM system for use in insulin dosing decisions (nonadjunctive use),2 the MiniMed 670G hybrid closed-loop system which alters insulin delivery based on CGM data for children ≥14 years of age,3 and the Abbott FreeStyle Libre Pro for use by healthcare providers in tracking glucose data for those 18 years and over.4 In this chapter, published Pediatric data on CGM use will be reviewed in the following areas: type 1 and 2 diabetes mellitus, prediabetes, cystic fibrosis, neonatology, adrenal insufficiency, glycogen storage disease, and critical illness. Data were obtained through review of published works from a PubMed search of “pediatric continuous glucose monitor.” We also review pediatric CGM data from artificial pancreas studies, a rapidly evolving field with great promise to reduce burden and improve glucose control in pediatric patients.

Evaluating the Relationship of Fasting Capillary and Venous Blood Sugar Level in Self-Glucose Monitoring Device, Fasting Plasma Glucose Level and Glycosylated Hemoglobin (HbA1C)

Establishing the accuracy of glucose meters however is challenging. A Quantitative Survey research approach was employed in this study under 254 samples, those who are advised for HbA1C test. Baseline data were collected with the help of interview schedule and clinical data of the subjects by a self structured Questionnaire. Subjects were selected by the help of Non-probability purposive sampling technique. Four different parameters were fasting capillary blood sugar value, fasting venous blood sugar value, which were measured through self-glucose monitoring device, fasting plasma glucose level and the HbA1C value of that same sample collected from lab. There is a small but significant difference in the blood glucose results analyzed. So in clinical practice, bedside blood glucose measurements through glucometer may be used by capillary derived specimens and a degree of caution should be worked out in the interpretation of bedside glucometer measurements as they may not be sufficiently accurate to replace laboratory blood glucose results.

Diabetes management patterns in a palliative care unit in Saudi Arabia

Background: The terminally ill diabetic inpatients who had blood glucose monitoring continued until the day of death ranged from 32% to 76% according to previous studies. Researches regarding the management of diabetes in palliative care services in Saudi Arabia are insufficient, although it is of high prevalence. Balancing the goals of avoiding symptoms of hyperglycaemia and hypoglycaemia as well as minimising the burden of blood glucose monitoring and treatment have become a struggle to palliative care physicians due to limited evidence-based resources. This intensifies the complexity of managing diabetes during a terminal illness. Objective: The purpose of this study was to describe the management of diabetes among patients who were admitted to hospital-based palliative care unit (PCU) at King Fahad Medical City, Riyadh, Saudi Arabia. Methods: A retrospective chart review, cohort study for all PCU inpatients was done. The study was conducted on the charts of 12 months from January to December 2013. Measures included diabetes prevalence, monitoring of blood glucose by laboratory and/or bedside testing and diabetes treatment with the use of oral hypoglycaemic agents and insulin. Prevalence of diabetes associated comorbidities, hypertension and dyslipedemia were also measured along with their treatment. A descriptive analysis of collected data was carried out. Results: Eighteen adult diabetic patients (15.25%) out of the whole 118 patients admitted to PCU over the 12 months' study period were reported. Ten (55.6%) were males, and 8 (44.4%) were females, with a mean age of 59.26 years. Blood glucose monitoring in the diabetic patients was done for ten patients; bedside glucometer utilized for 9 patients (50%), glucometer + serum glucose measurement done in one patient (5.6%), and no glucose monitoring was done in eight patients (44.4%). The majority of the patients 11/18 (61%) stayed at the hospital until death while 7/18 (39%) did well and were discharged. The monitoring of blood sugar was continued for six patients until the last week of life. Blood glucose management dropped to 33% at the end of life. Initially, half of the patients (50%) had their blood glucose managed with hypoglycaemic medications with or without insulin. This dropped during the last week of life to 33%. In the comorbidity group, 72% were using antihypertensive or lipid lowering agents, as a result of which it dropped to 50% during the last week of life. Conclusion: Diabetes management varied among PCU patients. There is a real need for evidence-based guidelines for diabetes management among patients at the end of life. These guidelines should be tailored to patients' individual preferences in goals of care. Advance care planning should include discussion about patient preferences for management of diabetes at the end of life.

Comparison of glucometers used in hospitals and in outpatient settings with the laboratory reference method in a tertiary care hospital in Mumbai.

Background:Glucometers allow self-monitoring of blood glucose in a convenient manner. With the availability of various glucometers, there is a persistent attempt to improve the accuracy and the precision of these glucometer readings, so as to match the laboratory values of blood glucose.Objective:We compared the glucometers used in hospital and out-patient settings with the laboratory reference method.Materials and Methods:We analyzed a total of 105 blood samples collected from in-patient and out-patient from our tertiary care hospital. Venous blood samples were collected and checked on six glucometers and the same blood sample was sent to the laboratory for glucose estimation. The laboratory value was used as a reference for comparison. The accuracy was evaluated by the ISO criteria. The results were evaluated by Bland Altman graphs, correlation coefficients, scatter plots and Clarke's error grid analysis.Results:We observed good correlation between bed side glucometer and laboratory automated analyzer. Among the in-patient glucometers Breeze 2, Performa and SureStep, the correlation coefficient was 0.97, 0.96 and 0.88 respectively. Among the outpatient glucometers One touch ultra 2, Active and Contour, the correlation coefficient was 0.97, 0.97 and 0.95 respectively.Conclusions:There is a good correlation between different glucometers and laboratory values especially in the out-patient settings. Among all in-patient glucometers, SureStep by Johnson and Johnson had least correlation coefficient, whereas all three out-patient glucometers correlated well with the laboratory values.

A comparison of epidural and cerebrospinal fluid glucose in parturients at term: an observational study

BackgroundDetecting inadvertent dural puncture during labour epidural insertion can be difficult when using a loss of resistance to saline technique. Testing fluid for glucose that leaks from a Tuohy needle may confirm the presence of cerebrospinal fluid and infer inadvertent dural puncture. This study compared the glucose content of intrathecal fluid obtained during spinal anaesthesia for elective caesarean delivery with that of fluid from a Tuohy needle or epidural catheter when establishing epidural analgesia for labour. MethodsWomen aged ⩾18 years undergoing elective caesarean delivery and labouring parturients who requested epidural analgesia were recruited prospectively in a tertiary referral centre over a three-month period. Fluid was collected into a sterile container either during spinal anaesthesia or from a labour epidural needle. Glucose content was evaluated using a bedside blood glucometer and laboratory colorimetric analyzer. ResultsOf the 118 women approached, 115 participated. All 40 women having spinal anaesthesia and 2/75 (2.7%) women having epidural analgesia, in whom inadvertent dural puncture was subsequently confirmed, had fluid samples testing positive for glucose. Median [range] laboratory glucose readings were 2.9 [1.3–5.1] mmol/L for cerebrospinal fluid and <0.3mmol/L in fluid that leaked from a Tuohy needle (P=0.0001). ConclusionWhen using a loss of resistance to saline technique for epidural catheter placement, bedside glucometer testing of fluid leaking from the epidural needle may be of value in the early detection of inadvertent dural puncture.

Comparison of bedside and laboratory blood glucose estimations in critically ill children with shock

Bedside glucometers are often used for frequent glucose measurements on capillary blood in critically ill children. However, there are concerns that capillary blood glucose estimations may not be accurate in children with shock and peripheral edema. The objective of this study was to compare simultaneously obtained laboratory values of arterial or central venous blood glucose with capillary blood glucose estimation using a glucometer in children with shock. Prospective observational study. Tertiary pediatric intensive care unit in a children's hospital in Chennai. All children admitted between July 2007 and September 2008 with shock as defined by the American College of Critical Care Medicine criteria were eligible for inclusion. None. Three hundred thirty-seven sets of simultaneous measurements were obtained from 52 children (age range, 3 months to 18 yrs; average Pediatric Risk of Mortality III score 9.6). The mean blood glucose measurement using capillary blood on a bedside glucometer was 135 ± 67 mg/dL (7.5 ± 3.7 mmol/L). The mean laboratory glucose was 130 ± 67 mg/dL (7.2 ± 3.7 mmol/L). The correlation coefficient between the measurements was 0.94. There were no differences between those with and without peripheral edema. Using Bland-Altman plots, the mean difference between capillary samples vs. laboratory glucose was 6 mg/dL (0.3 mmol/L). The spread was wider at the higher ends of blood glucose values. Capillary blood glucose estimation in children with shock was similar to the laboratory measurement in the midranges of glucose values.

Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Intensive insulin treatment is associated with an increased risk of hypoglycemia, so strict glycemic monitoring is essential. The best type of sample for identifying hypoglycemia remains under debate. To establish the number of hypoglycemic events in intensive care patients relative to insulin administration method and the method used to collect the blood sample. Retrospective descriptive study lasting 6 months. Hypoglycemia was defined as a blood glucose level less than 80 mg/dL (mild: 50-79 mg/dL, severe: <50 mg/dL), measured with a bedside glucometer and blood from the arterial catheter or fingerstick, in critically ill patients who require insulin administered subcutaneously (with sliding scales) or via continuous intravenous perfusion (intense infusion protocol with a nurse-managed insulin therapy algorithm). Analysis of the 6636 samples from 144 critically ill patients revealed 188 mildly hypoglycemic samples (2.8%) and 3 severely hypoglycemic samples (0.04%). The prevalence of mild hypoglycemia was greater when insulin was administered intravenously (3.2%) rather than subcutaneously (2.3%; P = .04). Among patients receiving insulin intravenously, hypoglycemia was found more often in arterial (4.5%) than in capillary (2.8%) blood (P = .01). The prevalence of hypoglycemia in capillary blood samples did not differ significantly between subcutaneous (2.3%) and intravenous (2.8%) insulin therapies (P = .21). With a target blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected in critically ill patients, regardless of whether insulin is administered intravenously or subcutaneously. Analysis of solely arterial samples may yield a higher prevalence of hypoglycemia than otherwise.

The pitfalls of bedside glucometers

We felt it was important to highlight a problem that we encountered with a bedside glucometer and a patient with end stage renal failure on continuous ambulatory peritoneal dialysis. Vast discrepancies between true venous glucose levels and those estimated by certain glucometers in this situation can be problematic and dangerous. Not all glucometers are the same: they differ in their ability to estimate glucose levels. The Advantage (Roche) and Accutrend Sensor (Boehringer MannHeim) glucometers both use the glucose dehydrogenase enzyme reaction to estimate glucose levels. Certain dialysates, including Extraneal (Icodextrin), contain significant amounts of long-chain non-glucose-reducing substances. Such substances are metabolized by glucose dehydrogenase and lead to falsely elevated glucose readings. Precision Q.I.D (Medisense) and Glucocard (Merarini Diagnostics) glucometers analyse glucose levels using a different enzyme, glucose oxidase. Long-chain non-glucose-reducing substances do not interfere with glucose calculations based on this enzyme. We encountered a young patient on continuous ambulatory peritoneal dialysis in our hospital who was using a Roche glucometer at home. Compliance with treatment seemed poor. The patient had been admitted with severe hypertension and hyperglycaemia. His Extraneal dialysate solutions were adjusted appropriately and a insulin sliding scale was commenced. At this time he had a hypoglycaemic coma that was not diagnosed until after the venous glucose had returned from the laboratory. During this delay he had failed to respond to naloxone and also had a brain CT, which was normal. The Consultant Physician, Nephrology Team and myself were all perplexed by his sudden deterioration. The glucometer read 11 mmol/L. The nursing staff reported that the glucometer had been calibrated by our Biochemistry department and it was the same type used by the patient at home, and that they had also repeated the glucometer reading. Discrepancies have been reported a couple of times in the medical literature, however it seems that a knowledge of this problem is not widespread. This near-miss led to a policy change in our hospital, and the episode emphases the importance of not taking a glucometer reading on face value. Dehydration, vomiting, diarrhoea, diuretics, peripheral vascular disease, hyperuricaemia, significant paracetamol overdose and severe jaundice can also lead to unreliable results.

In One Ear and Out the Other: Communication Barriers as a Risk Factor for Critical Incidents

In One Ear and Out the Other: Communication Barriers as a Risk Factor for Critical Incidents

Networking Experience of Point-of-Care Test Glucometer

Clinical laboratories are selecting total solutions to point-of-care test (POCT) by handling all aspects of information management ranging from the ordering of the test to the reporting of verified results. Today, many POCT devices can be directly connected to the laboratory information system (LIS) via data management system (DMS). We report here our experience with the networking of POCT glucometers. We set up computerization of POCT glucometer (Precision PCx, Abbott, USA) in August, 2004 and established a quality control (QC) system for the portable glucometers on 16 wards in Chung-Ang University Hospital. Precision of the glucometers was assessed by performing 28 replicate tests using quality control specimens containing 5 different glucose concentrations. Turnaround time (TAT) was calculated from the data of 17,796 glucose tests performed during a 5-month period in 2004 before computerization of the glucometers and 31,513 tests performed during the same 5-month period of 2005 after computerization. In the precision study, within-run and total-run CVs were within 10%. With the networking of POCT glucometers, the TAT from the collection of specimen to the specimen receipt to the LIS was 28.5+/-17.2 min compared to 43.6+/-17.5 without the networking (P<0.0001). A staff satisfaction survey received a high score (88%) for an overall satisfaction. This device significantly expands the data management and networking capabilities of the bedside glucometer. Networking technology should allow for a centralized quality control management.

Introducing intensive insulin therapy: the nursing perspective

Intensive insulin therapy (IIT) for the management of high blood glucose can reduce mortality and morbidity in the critically ill. However, there is little published literature on how to implement it successfully. The aim of this study is to chronicle the development and difficulties encountered in implementing an IIT protocol in a critical care unit in a district general hospital. A nurse-led protocol was developed. Qualitative audit was undertaken during development and implementation to identify potential problems with using the Bath Insulin Protocol. Regular feedback sessions were introduced to encourage change and further identify problem issues. Qualitative audit led to changes in practice for individual nurses and changes to other unit protocols. The main change for individual nurses was to measure blood glucose hourly using a bedside glucometer. The unit's feeding and drug dilution policies were identified as a potential cause of glucose instability and were modified. To implement IIT successfully, it is necessary to consider changing working practices and to identify other unit protocols which can cause glucose instability. The additional nursing workload must be considered and appropriate means of supporting staff identified.

ACCURACY OF GLUCOSE MEASUREMENT IN CRITICALLY ILL PATIENTS IN SHOCK

PURPOSE: Strict normalization of blood glucose level improves outcome in critically ill patients. Accurate glucose measurement is an essential aspect of intensive insulin therapy. The various methods of testing (glucometer, blood gas analyzer and conventional laboratory analyzer) have not been studied simultaneously in patients in shock. This study is designed to prospectively evaluate different methods of glucose monitoring in critically ill patients. The specific aim is to evaluate the accuracy of bedside glucometer and blood gas analyzer in comparison with the clinical laboratory colorimetric method (gold standard).

Capillary versus venous bedside blood glucose estimations

Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients. Methods: Blood glucose...

Blood Glucose Concentration Measured Using a Glucose Oxidase Method is more Accurate in Venous Blood than Oxygenated Arterial Blood

Background: Portable glucometers are often utilized at the patient's bedside in the ICU or operating room for frequent measurements of the blood glucose concentration. Many of these devices are based on a glucose oxidase method that may be influenced by . The aim of this study was to evaluate the influence of a high of arterial blood on measured glucose values compared with venous blood. Methods: Forty adult patients who underwent surgery with general anesthesia were included in this study. Each patient had a cannula inserted into the radial artery and a central venous catheter through the right internal jugular vein. Two hours after the induction of anesthesia, we drew arterial and venous blood and measured the blood glucose concentration using both a bedside glucometer based on a glucose oxidase method and a laboratory glucometer based on a hexokinase method. We also measured blood gas, electrolyte, and hematocrit values. Statistical analyses were performed with repeated measure ANOVA, multiple linear regression, and Bland-Altman's analysis. Data is expressed as mean . SD. Results: The arterial blood glucose concentration measured by the glucose oxidase method (119.5 25.0 mg/dl) was significantly lower than the venous blood (133.5 24.8 mg/dl) and hexokinase method (134.2 27.1 mg/dl). There was no significant difference between the venous blood glucose concentration by the glucose oxidase method and hexokinase method. When we used the correction formula: corrected glucose value = arterial glucose value by glucose oxidase method + 0.1053 - 5.414, the bias improved from - 14.6 mg/dl to 1.0 mg/dl. Conclusions: The blood glucose concentration measured by the glucose oxidase method is more accurate in venous blood than oxygenated arterial blood. When we measure the blood glucose level using the glucose oxidase method, we should consider the influence of high oxygen tension.