As a result of the study, guidelines were subsequently developed to evaluate meter accuracy in an outpatient setting. Further effort is needed to establish standards for evaluating SMBG.

OBJECTIVE -To determine whether clinically significant differences exist in fasting blood glucose (BG) at the forearm, palm, and thigh relative to the fingertip; to assess the impact of prandial status by comparing BG between alternative sites and the fingertip at several time intervals after carbohydrate intake; to assess the effects of moderate brief exercise on site-to-site differences in BG; to evaluate the impact of site preparation by local rubbing on alternative-site testing (AST) equivalence; and to determine levels of perceived pain and satisfaction associated with AST.RESEARCH DESIGN AND METHODS -Fasting BG was measured using the One Touch Ultra (LifeScan, Milpitas, CA) at the fingertip, palm, thigh, and each forearm (with local rubbing) in 86 patients with type 2 diabetes. A 40-g carbohydrate meal was consumed and BG was again measured from each site at 60, 90, and 120 min postmeal, with an additional forearm test at 90 min without local rubbing. Patients then exercised for 15 min with repeat BG at each site. Differences in BG between sites were assessed using repeated-measures ANOVA and regression analyses.RESULTS -Significant differences in BG at alternative sites were found 60 min postmeal (P ϭ 0.0003) and postexercise (P ϭ 0.037). Specifically, clinically significant differences (expressed as percent difference from the fingertip) at 60 min include Ϫ8.8 Ϯ 10.8% at the forearm and Ϫ13.7 Ϯ 10.7% at the thigh, and postexercise ϩ19.1 Ϯ 19.1% at the forearm and ϩ15.6 Ϯ 22.6% at the thigh. However, no significant differences were observed between sites in either the fasting state or at 90 and 120 min postmeal. The dynamic results suggest a time lag in equilibration of forearm and thigh BG during periods of rapid glucose change. Palm and fingertip BG test results were similar at all time points.CONCLUSIONS -AST results are consistent with fingertip BG results in both the fasting state and 2 h postmeal; no benefit from site preparation by local rubbing was noted. However, testing at sites other than the hand cannot be recommended 1 h postmeal or immediately after exercise. AST is equivalent and appropriate for use at testing times commonly used in clinical practice. With technological advances available in some SMBG devices, the requirement of smaller blood samples, and the capillary action of the strip itself, alternative-site testing (AST) can now be performed at sites such as the forearm or thigh. As a result of these advances, increasing numbers of patients are considering testing at alternative sites to increase the frequency of testing while limiting the potential pain associated with fingertip testing. However, the validity and similarity of AST relative to fingertip blood glucose (BG) testing have been broadly debated. In particular, the reliability and reproducibility of postprandial BG results have been reported to demonstrate significant differences between samples obtained at the forearm and fingertip, even when the samples are collected simultaneously (2-7). Limited data have been reported re...

Modem transfer of BG data can provide an accurate and clinically useful option for communication between patients and their HCP and has comparable effects on A1C.

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