{"id":264,"date":"2024-10-30T20:15:08","date_gmt":"2024-10-30T20:15:08","guid":{"rendered":"https:\/\/iims.uthscsa.edu\/isrn\/?page_id=264"},"modified":"2024-11-07T16:32:46","modified_gmt":"2024-11-07T16:32:46","slug":"glucometer-error-in-the-anemic-patient-abstract","status":"publish","type":"page","link":"https:\/\/iims.uthscsa.edu\/isrn\/resources\/ereading-room\/abstracts\/glucometer-error-in-the-anemic-patient-abstract\/","title":{"rendered":"Glucometer Error in the Anemic Patient"},"content":{"rendered":"

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Principal Investigator:<\/td>\nElizabeth A. Mann, RN, MS, CCRN, CCNS<\/td>\n<\/tr>\n
Organization:<\/td>\nUS Army Institute of Surgical Research<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Abstract<\/h2>\n

Problem<\/h3>\n

Traditional single-channel point-of-care (POC) glucometers overestimate true glucose values in anemic patients, creating a dilemma for providers who simultaneously implement tight glucose control and restrictive transfusion strategies\u00a01, 2<\/sup>.<\/p>\n

Evidence<\/h3>\n

We previously demonstrated that a mathematical formula successfully corrects for the effect of hematocrit (HCT) alone, improving glycemic regulation\u00a03<\/sup>. Studies suggest multiple biologic parameters such as oxygen tension, acid base balance, and various pharmacological agents also affect the accuracy of handheld glucometers\u00a04, 5<\/sup>. A newly released 4-channel POC analyzer measures and eliminates the majority of these interfering substances.<\/p>\n

Strategy<\/h3>\n

A 4-channel glucometer was compared to a single channel glucometer with mathematical hematocrit correction to determine which method provided a better approximation of laboratory glucose measurement.<\/p>\n

Practice Change<\/h3>\n

As a result of our study, our institution has initiated conversion of all POC glucometers to the 4-channel Nova, Biomedical glucometer.<\/p>\n

Evaluation<\/h3>\n

Whole blood samples (n=99) were prospectively gathered from 42 critically ill patients in the surgical, trauma, medical and burn ICU. Samples were tested on the single-channel (SureStep Flexx\u2122<\/sup>, LifeScan) and 4-channel (StatStrip\u2122<\/sup>, Nova Biomedical) glucometers, and in the central chemistry laboratory (Vitros Fusion, Ortho Clinical Diagnostics). Error rates were calculated based on differences from laboratory reference values.<\/p>\n

Results<\/h3>\n

Mean HCT for samples was 26.6% (SD 5.2%, range 18.5 \u2014 43.1%). Mean error for uncorrected single channel glucose measurement was 22% (SD 9.4%, range -42.4 \u2014 3.6%), decreasing to -4.36% (SD 5.6%, range -14.7 \u2014 14.6%) after correction. Mean error for 4-channel measurement was -4.25% (SD 5.3%, range -30.3 \u2014 7.2%). With a zone of indifference set for \u00b15%, the difference between analyzers was -0.67% (CI: -1.79% to 0.45%), demonstrating non-inferiority between methods. Utilization of a 4-channel glucometer demonstrated clinically indistinguishable results compared with mathematical correction for hematocrit.<\/p>\n

Recommendations<\/h3>\n

Current single-channel glucometers do not accurately reflect serum glucose values in anemic patients. Either a 4-channel glucometer (Nova, Biomedical) or a mathematical correction factor for a single channel device should be used when hematocrit is <34%.<\/p>\n

Recognition<\/h3>\n