Capillary Glucose Testing Research Articles

Process improvement for bedside capillary glucose testing in a large academic medical center: the impact of new technology on point-of-care testing

Point-of-care testing (POCT) for the management of patients with diabetes has become a standard of care. Originally, diabetic monitoring was accomplished by manual urine dipsticks. The development of hand-held, battery-operated capillary glucose monitors radically improved the ability of physicians and nurses to monitor diabetic patients during their hospital stay. Capillary glucose meters have been shown to provide accurate results under controlled conditions, but a number of early meters had issues with the quality of testing when used by non-laboratory personnel. Bedside capillary glucose testing was first initiated in our hospital in 1990, using a first-generation glucose meter that could measure a glucose value within 2 min. Operator errors were common because the glucose strips required wiping and the testing required timing. Furthermore, these early meters had no data storage or data management capabilities. In 1995, we transitioned to a second-generation meter with a rudimentary data management and storage capability that could be downloaded to a portable laptop. A log of quality control (QC) data could be derived from the download. A major problem with this device was the need to bring the instruments and laptop together, which was labor intensive and difficult to sustain over long periods of time in a large institution. We recently implemented a third-generation instrument (the Abbott Precision PCx) with a data management system (Precision NET). This device significantly expands the data management and networking capabilities of the bedside glucose meter, as shown in Table 5. Glucose values can now be performed in a fraction of the time of the first-generation meters, the need to wipe the glucose strips has been eliminated, and only certified operators can use the instrument. Networking technology allows for centralized quality control management, and the ability to network with other point-of-care technologies using intranet and in the near future internet applications. Collectively, these developments have radically improved the efficiency and quality of bedside capillary glucose testing, and have significantly enhanced the ability to manage this important technology.

Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital: Implications for managing point of care testing

purpose: To study the use and cost of bedside capillary glucose testing in a large teaching hospital. patients and methods: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, time, operator, and results of patient and quality control tests. Cost analysis was performed using data from time studies, test tallies in logbooks, and hospital administration records. results: The number of glucose meters in the hospital increased from 10 to 54 over a 2-year period. In 1992, 67,596 tests were performed by the bedside method, representing 30.7% of all glucose measurements performed in the institution. The majority of tests (94.7%) were performed on inpatients, and 10.2% of all hospital admissions underwent bedside glucose testing. The impact on the number of glucose tests performed in the clinical laboratories was minimal, indicating that bedside glucose testing was added as an extra test rather than as a substitute for laboratory-based glucose measurements. The cost of bedside glucose testing was $4.19 per test compared with $3.84 in the clinical laboratory. The cost varied from one unit to another (median $5.52, range $3.08 to $48.16), an effect largely attributed to the difference in the volume of tests performed by different units. In seven high-volume units the cost per test was lower than the corresponding value in the laboratory. The cost of bedside glucose testing included labor (80.2%) and supplies (19.8%). The percent of costs attributed directly to patient testing was 57.7%, whereas the costs for all other related activities (training, quality control, and quality assurance) was 42.3%. conclusions: Bedside capillary glucose testing is a rapidly expanding technology and is performed on a significant percentage of hospital admissions. Bedside glucose testing is not inherently more expensive than centralized laboratory measurements but implementation on inefficient care units with low utilization can add substantially to the cost. Much of the excess cost of the bedside method can be attributed to the high costs of quality control and quality assurance, training, and documentation.

Diagnosis of gestational diabetes by capillary blood samples and a portable reflectance meter: Derivation of threshold values and prospective validation

Paired capillary-venous samples were obtained from 255 women undergoing a glucose challenge test and 116 women undergoing an oral glucose tolerance test. The capillary equivalents for the venous threshold values were calculated by regression analysis. The glucose challenge test predictions of either normal or abnormal agreed in 82%. The sensitivity, specificity, and positive and negative predictive values for the capillary oral glucose tolerance test were 89%, 90%, 62%, and 98%, respectively. These capillary equivaients were then applied prospectively to 147 women undergoing a glucose challenge test and 141 women undergoing an oral glucose tolerance test. The concurrence rate of the glucose challenge test in the prcspective group was 90%. The sensitivity, specificity, and positive and negative predictive values for the capillary oral glucose tolerance test were 64%, 95%, 75%, and 92%. When the venous threshold recommendations of the American Diabetes Association were used instead of those standard at our institution, these values increased to 75%, 98%, 83%, and 96%, respectively. The recommended capillary values of the American Diabetes Association were 100% sensitive but had a positive predictive value of only 20%. Based on the prospective group, the cost per case of gestational diabetes identified would decline 63% if both a capillary glucose challenge test and an oral glucose tolerance test were used and 25% if the capillary glucose challenge test and venous oral glucose tolerance test were used. Combining the data set for new regression equations, the following venous-capillary threshold sets emerged: glucose challenge test, 140 mg/dl/150 mg/dl; fasting oral glucose tolerance test, 105 mg/dl/114 mg/dl; 1 hour, 190 mg/dl/211 mg/dl; 2 hours, 165 mg/dl/183 mg/dl; 3 hours, 145 mg/dl/157 mg/dl. The sensitivity, specificity, and negative predictive values for the capillary oral glucose tolerance test with these thresholds were 80%, 97%, 80%, and 97%. In conclusion, capillary glucose testing for diabetes during pregnancy is feasible and cost-effective.