Glucose Measurement: Confounding Issues in Setting Targets for Inpatient Management

American Association Of Clinical Endocrinologists And American College Of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement

“…Any factor that interferes or impacts these enzymes or the BGM itself can degrade overall accuracy. Variation can be due to issues such as competing blood substrates (e.g., maltose, vitamin C) (161,162), environmental issues (e.g., cold temperature, high altitude with reduced oxygen pressure), and factors related to individual patients. Reduced accuracy and precision have been observed in tests performed by patients and other lay users compared with highly trained, experienced health professionals (163).…”

Dexametasona para profilaxis de náuseas y vómitos postoperatorios: efecto sobre la glicemia en pacientes con diabetes mellitus tipo 2 y en no diabéticos sometidos a cirugía laparoscópica

“…El uso de sangre capilar en aparatos portátiles, como el utilizado en este estudio, pueden presentar diferencias signifi cativas en los resultados de la medición cuando se comparan con las obtenidas en el laboratorio de referencia 15 .…”

“…Diversas características de los pacientes, como la presencia de hipotensión, anemia, mala perfusión periférica, hipotermia y uso de drogas vasoactivas, entre otros, aumentan la posibilidad de lecturas erróneas con los aparatos portátiles 15,16 .…”

A dead heat: target normal glucose levels in the intensive care unit—but with caution

“…Miles and colleagues suggest that the benefits observed in Leuven could be an artefact of the process of care and may not translate faithfully to other settings; admittedly, his assertions are hypotheses and unproven [2]. To add to this, the clinical trial data supporting the glucose target of ≤6.1 mmol/l are based on arterial blood measurements, and differences in the technical details of glucose measurement in the intensive care unit (ICU) can substantially affect results [7]. In many ways, none of our individual opinions in this regard is paramount, since the management of hyperglycaemia in the setting of critical illness requires a common vision and a continuous process of care involving multiple individuals from a dozen or so disciplines.…”