Capillary Glucose Monitoring Research Articles

Toxic Levels of Acetaminophen Produce a Major Positive Interference on Glucometer Elite and Accu-chek Advantage Glucose Meters

Bedside capillary glucose monitoring has become widespread in most hospitals. Glucose meters have been shown to provide a reasonably acceptable degree of accuracy compared with laboratory instruments when proper quality control is in place (1). However, a recent clinical case shows that such systems have limitations in hospital settings. A 55 years-old woman was admitted to the emergency room with suspected acetaminophen overdose. She had been found lying on the floor of her apartment in an altered level of consciousness, and a bottle of acetaminophen was discovered beside her. The patient had recently been hospitalized for a period of three months for depression. She had no history of diabetes. Capillary blood glucose as measured with the Glucometer Elite (Bayer) at the emergency room showed values of 8.4, 12.8, and 9.4 mmol/L (samples taken within 2.5 h of arrival). Serum analysis in the laboratory …

Diabetes in the elderly.

Diabetes affects at least 20% of the population over the age of 65. Half of these patients are unaware that they have the disease. Diabetes in middle-aged subjects is characterized by an impairment in glucose induced insulin release, increased fasting hepatic glucose output and resistance to insulin mediated glucose disposal. In contrast, diabetes in the elderly is primarily associated with insulin deficiency. The presentation of diabetes in the aged is often non-specific. The elderly have an increased frequency of complications from diabetes. They are particularly susceptible to hypoglycaemia, because of reduced awareness of hypoglycaemic warning symptoms and altered release of counterregulatory hormones. Although no data are yet available from randomized controlled trials, there is abundant epidemiological evidence to suggest that adequate control of blood glucose can be expected to reduce the risk of long-term complications. A team approach is ideal for the management of the elderly patient with diabetes. Little data is available on which to base a diet and exercise prescription for elderly patients. Gliclazide appears to be the sulphonylurea of choice in the aged because it is associated with a lower frequency of hypoglycaemic reactions. Urine glucose testing is unreliable, and capillary glucose monitoring is preferred. Fructosamine may prove to be superior to haemoglobin A1C for monitoring long-term control.

Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing

purpose: To study the implementation of bedside capillary glucose monitoring using a hospital-wide quality control (QC) program. methods: A prospective study of QC performance in 7 outpatient and 39 inpatient treatment units was performed in a large teaching hospital over a 2-year period. Approximately 800 nurses were trained to perform bedside capillary glucose monitoring (Accu-Chek II, Boehringer-Mannheim, Indianapolis, IN). An eight-point QC program was instituted including proficiency testing, instrument maintenance, performance of daily controls, storage of reagent strips and supplies, instrument calibration, and documentation procedures. results: Comparison of laboratory and bedside test results (split-sample proficiency testing) revealed Y = 1.004X + 7.26, r = 0.95, with a mean percent difference of −4.2% (p <0.001). Less than 7% of results fell outside ± 20% of the laboratory results. QC scores (0 = worst to 4 = best), based on adherence to the QC program, improved from 0 on the first inspection to 3.7 ± 0.17 by the 11th inspection. The most common QC deficiencies were failure to perform split-sample testing (41.4%) and failure to perform instrument maintenance (30.2%). Significant differences were noted in the QC performance of different types of medical services. During the 2-year study period, the total number of glucose assays performed in the clinical laboratories decreased by 22.2% concurrent with initiation of bedside testing. The number of instruments in the hospital increased from 10 to 46. conclusions: Bedside capillary glucose assays can be widely implemented in large hospitals with an acceptable degree of accuracy. QC programs with frequent inspections are necessary to identify units that function inadequately, and a formal disciplinary policy is required to ensure compliance with the program.

Pyoderma gangrenosum and finger‐tip ulceration in a diabetic patient

AbstractWe report details of a diabetic patient who developed pyoderma gangrenosum following cholecystectomy, and subsequently developed ulceration of the thumb at the site of finger‐prick for capillary glucose monitoring. Although the latter was thought to be due to viral infection, pyoderma gangrenosum may also have been involved as it is associated with impaired immunological function and abnormal cutaneous response to minor trauma. The possible relationship between pyoderma gangrenosum and diabetes is discussed, and also the implications for therapy of the two disorders. The pyoderma gangrenosum resolved with steroid therapy.

A complication of capillary glucose monitoring

A complication of capillary glucose monitoring

A complication of capillary glucose monitoring

A complication of capillary glucose monitoring

Bedside capillary glucose measurement by staff nurses in a general hospital

The accuracy of capillary blood glucose monitoring has been well demonstrated when applied by patients in the outpatient setting or by specially trained nurses on inpatient diabetes units. In order to determine the applicability of this technique in the more general hospital setting, a program was initiated for instructing general staff nurses in the use of Chemstrips bG strips and the Accu-Chek bG meter. As a pilot study, nurses on four general medical and surgical hospital floors performed capillary glucose determinations within 15 minutes of the drawing of venous blood samples for determination of plasma glucose in the hospital's Chemistry Laboratory. Two hundred ten paired measurements were made by 31 nurses. Linear regression analysis yielded a Pearson correlation coefficient of 0.96 between bedside and laboratory glucose measurements. The mean percent deviation between the two values was 7.9 percent. Acceptance by both nurses and patients was high. Properly supervised capillary glucose monitoring can provide a valuable adjunct to the care of hospitalized patients with diabetes.

Bedside Capillary Glucose Monitoring in the General Hospital

We assessed the accuracy and reliability of capillary glucose monitoring (CGM) for 20 hospitalized patients as an alternative to repeated venipunctures for laboratory blood glucose (LBG) determination. A total of 330 pairs of observations was obtained. Pearson correlation between patient estimates using Chemstrip bG and the laboratory glucose-oxidase method was 0.87. The mean LBG determination was 197 +/- 5 mg/dl compared with 176.4 +/- 4.3 mg/dl for patient CGM estimates. The mean deviation was 17.6 +/- 2.9 mg/dl or 8.9%, which is well within the 20% range that is generally accepted as sufficiently accurate. Certain individual patients may require relatively more instruction and supervision to reliably carry out these measurements. These patients may represent 10-25% of all diabetic patients. Neither age nor years of schooling is a useful index to identify these patients. Therefore, we suggest as a routine that 10 or more CGM be checked against simultaneous LBG to confirm accuracy before relying on bedside CGM estimates alone in managing the hospitalized patient. Patients who can carry out CGM accurately may be managed with CGM alone.