Estimated Risk for Insulin Dose Error Among Hospital Patients Due to Glucose Meter Hematocrit Bias in 2020

Abstract

Context.— Glycemic control requires accurate blood glucose testing. The extent of hematocrit interference is difficult to assess to assure quality patient care. Objective.— To predict the effect of patient hematocrit on the performance of a glucose meter and its corresponding impact on insulin-dosing error. Design.— Multilevel mixed regression was conducted to assess the extent that patient hematocrit influences Roche Accu-Chek Inform II glucose meters, using the Radiometer ABL 837 as a reference method collected during validation of 35 new meters. Regression coefficients of fixed effects for reference glucose, hematocrit, an interaction term, and random error were applied to 4 months of patient reference method results extracted from the laboratory information system. A hospital inpatient insulin dose algorithm was used to determine the frequency of insulin dose error between reference glucose and meter glucose results. Results.— Fixed effects regression for method and hematocrit predicted biases to glucose meter results that met the “95% within ±12%” for the US Food and Drug Administration goal, but combinations of fixed and random effects exceeded that target in emergency and hospital inpatient units. Insulin dose errors were predicted from the meter results. Twenty-eight percent of intensive care unit, 20.8% of hospital inpatient, and 17.7% of emergency department results were predicted to trigger a ±1 insulin dose error by fixed and random effects. Conclusions.— The current extent of hematocrit interference on glucose meter performance is anticipated to cause insulin error by 1-dose category, which is likely associated with low patient risk.

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“…But, many diabetic patients who rely on these meters do not realize that the results obtained by glucose meters may be incorrect and misleading and in some cases can lead to catastrophic errors in care, even deaths . Accuracy of household blood glucose meters is limited by many factors such as capillary blood glucose differences, tissue fluid interference, and current meter status, requiring regular calibration − by biochemical analyzers. The biochemical analyzer quantifies venous serum glucose based on photoelectric colorimetry − and the result, with more accuracy, is generally used as a standard clinically.…”