Impact of Glucose Measurement Processing Delays on Clinical Accuracy and Relevance

Jangam, Sujit; Hayter, Gary; Dunn, Timothy

doi:10.1177/193229681300700311

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Recent literature has suggested that blood glucose measurements can be affected by the duration of time from when a blood sample is drawn from the patients to the time it is analyzed, with delays of 15 minutes or more possibly affecting outcomes. 14,38 In an effort to assess the potential impact of this effect, a secondary subgroup analysis was performed of paired values in our data set that were drawn within 15 minutes of each other. Thirty-one of the 46 paired glucose values (67.4%) were drawn within 15 minutes of each another, with the mean time between paired values in this subgroup of 5.4 minutes (SD = 4.8).…”

Section: Discussionmentioning

confidence: 99%

Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings

Howell

Parrett

Malcom

2019

J Diabetes Sci Technol

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Background: Intravenous vitamin C therapy has been associated with reduced mortality in patients with sepsis. Of potential concern with this therapy are falsely elevated point-of-care (POC) blood glucose values vs laboratory analyzed (LA) readings. The purpose of this study was to compare POC and LA blood glucose measurements in patients receiving intravenous vitamin C therapy. Methods: All adults (≥18 years old) admitted from January 2017 to December 2018 who received at least two doses of intravenous vitamin C and had at least one paired blood glucose collection were eligible for inclusion. The primary endpoint was the accuracy in paired blood glucose values determined using the International Organization for Standardization (ISO) 15197:2013 criteria. Paired values were assessed for clinical impact using the Parkes consensus error grid analysis. A subgroup analysis was conducted to determine the impact of impaired renal function on outcomes. Results: Fourteen patients were included for analysis with 46 paired blood glucose levels. Compliance with ISO15197:2013 criteria was met in 34 (73.9%) paired values, which did not meet the minimum criteria for accuracy. Subgroup analysis showed that the paired values from patients with impaired renal function did not meet the minimum requirements for compliance, while those from patients without impaired renal function did. The Parkes error grid showed that the variation in POC measurements likely had minimal clinical impact. Conclusions: Our study suggests that most patients receiving vitamin C for sepsis may still be monitored at POC with the glucose meter used in our study with minimal clinical impact.

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Section: Discussionmentioning

confidence: 99%

Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings

Howell

Parrett

Malcom

2019

J Diabetes Sci Technol

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“…Again [21] in their study reported a result inconsistent with this present study, that the decline in serum glucose concentration for all samples stored at 25°C was found to be statistically significant with the Mean glucose value of 1 hour statistically different from baseline value and that at 25°C, serum glucose concentration was found to be decreasing with mean of 10.8% per hour. One of the studies, [22] Jangam et al observed that delays of 15 min or more in analysis reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95% and that in their study the accuracy was less than 65% for delays of 60 min. The relative stability of the glucose in these samples up to 24 hours as is reported in this study is not similar with the results of the study of the other authors [19][20][21][22] as stated above but seems to be in line with findings of Mingoas et al [23].…”

Section: Discussionmentioning

confidence: 91%

“…One of the studies, [22] Jangam et al observed that delays of 15 min or more in analysis reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95% and that in their study the accuracy was less than 65% for delays of 60 min. The relative stability of the glucose in these samples up to 24 hours as is reported in this study is not similar with the results of the study of the other authors [19][20][21][22] as stated above but seems to be in line with findings of Mingoas et al [23]. The relative low atmospheric (room) temperature in the study location which sometimes are as low as the 17 o C among other things may be responsible for the stability of the glucose in the sample up to 24hours.…”

Section: Discussionmentioning

confidence: 91%

The Impact of Delayed Separation of Plasma and Serum Sample on Glucose Parameter of Apparently Healthy Students of Federal School of Medical Laboratory Technology (Science), Jos, Nigeria

Abara

Ibanga

Nwapi

et al. 2023

JAMPS

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Background: Estimation of glucose is very important in clinical diagnosis of diabetes mellitus, hyperglycemia and hypoglycemia. The core aim of clinical laboratory service is to produce accurate, precise and reliable test results. The ability of laboratories to do this lies in the availability of well trained personnel, equipment, electricity etc. There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even further and the need for proper diagnosis cannot be overemphasized. Aim: In this study we have tried to evaluate the impact of delayed separation of plasma and serum from cells and clot on glucose level. Method: A total of fifty (50) randomly selected apparently healthy students of Federal School of Medical Laboratory Technology (Science), Jos were recruited as subject into this study. Blood samples were collected from each of the subjects into plain and anticoagulant bottles for serum and plasma respectively. An aliquot was analyzed within 10 minutes to obtain a baseline value where other values after timely delays were compared. The samples were spun but not separated from the cells/clot all through the period of the analysis. Blood glucose was determined by glucose Oxidase Colourimetric assay kit obtained from Randox Laboratories Limited United Kingdom. Data were analyzed using student’s t-test and performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: Result obtained shows the mean and standard deviation of all timing for plasma and serum. In plasma it shows that the means±SD of 2, 4 and 24hours (5.2±0.7, 5.1±0.4 and 5.3±0.5 respectively) were not significantly varied when compared to the baseline (0 hour) value (5.3±0.5). That of baseline and 24 hours (5.3±0.5 and5.3±0.5 respectively) were significantly higher (P<0.001) than that of 48 and 74 hours (1.0±0.20 and 7±0.2 respectively). In serum, similar results were obtained. Conclusion: In conclusion, where possible, it is advised that the established best practices in processing and analysis of samples be adhered to. However, the results of this work shows reasonably stable results for blood glucose determination could be obtained within 24 hours. Therefore, instead of discarding the sample, it might seem more appropriate that the sample be analyzed and the result reported indicating the number of hours delayed within 24hours.

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“…During an acute admission, patients often receive rapid intravenous infusions of therapies that may alter concentrations of blood constituents. This is particularly relevant to glucose where delays of 15 min or more have been shown to reduce clinical accuracy to below the ISO standards [29]. The effect of the timing of the samples, however, is unlikely to be as significant for sodium or potassium as they do not have the same degree of post-prandial peaks and troughs as glucose and have a more stable diurnal variation [30].…”

Section: Discussionmentioning

confidence: 99%

The Benefits and Limitations of Point of Care Testing for Patients with Diabetes Who are Acutely Unwell

Lightbody¹,

Reddy‐Kolanu²,

Sapey³

2017

J Diabetes Metab

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Diabetic emergencies are associated with derangements in glucose and electrolytes with guidelines supporting treatment and serial monitoring. In clinical practice this is often achieved using a venous blood sample assessed using a blood gas analyzer (BGA), however their accuracy in measuring glucose, potassium and sodium in acutely unwell adults is unknown. Capillary blood tests can measure these parameters using a BGA and may be more acceptable to patients. We compared capillary and venous BGA results to gold standard venous laboratory sodium, potassium and glucose in acutely unwell diabetic patients and healthy controls to determine their accuracy and acceptability.Methods: 48 acutely unwell diabetic patients and 23 healthy adults had consecutive bloods taken from arterialized ear lobe (EP) and finger prick (FP) (capillary bloods) and a standard venous sample. Venous samples were sent to an accredited NHS hospital biochemistry laboratory (VL) for reporting as well as being analyzed in a BGA (VBG). Results were compared to internationally agreed acceptability criteria using Bland-Altman limits of agreements. Patient preferences were recorded.Results: VBG glucose met acceptability criteria (results within 20% of VL result) as did FP glucose when glucose values were ≥ 11.2 mmol/l but not when results were within the normoglycaemic range. Venous and capillary BGA potassium did not meet acceptability criteria (within 0.5 mmol/l of VL result) although capillary samples were more accurate than the VBG results (p<0.001). FP, EP and VBG sodium all met acceptability criteria (>95% within 4 mmol/l of VL result). Participants found capillary tests less painful (p<0.001) and preferred FP testing method to serial venous blood tests (p=0.002). Conclusion:Capillary and VBG samples can be used to guide acutely unwell diabetic patient treatment (with capillary testing preferred by patients) but caution is required as there is deviation from laboratory results, for potassium particularly.Ethical approval was provided by NRES West Midlands (14/WM/1057).

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Impact of Glucose Measurement Processing Delays on Clinical Accuracy and Relevance

Cited by 10 publications

References 17 publications

Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings

Impact of High-Dose Intravenous Vitamin C for Treatment of Sepsis on Point-of-Care Blood Glucose Readings

The Impact of Delayed Separation of Plasma and Serum Sample on Glucose Parameter of Apparently Healthy Students of Federal School of Medical Laboratory Technology (Science), Jos, Nigeria

The Benefits and Limitations of Point of Care Testing for Patients with Diabetes Who are Acutely Unwell

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