Self-Measurement of Blood Glucose Concentration: Clinical Significance of Patient-Generated Measurements

Pohl, Stephen L.; Gönder-Frederick, Linda; Cox, Daniel J.; Evans, William S.

doi:10.2337/diacare.8.6.617

Cited by 32 publications

(20 citation statements)

References 3 publications

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“…Only 45% of the patients' measurements were within 10% of the hexokinase value, and only 63% were within 15%; these figures fall far short of the ADA benchmarks. In addition, these results are in accord with numerous studies that report the failure of patients to achieve the ADA goal for SMBG accuracy (14)(15)(16)(17) The new EG was created to reflect the opinion of a large number of clinical diabetes experts. The consensus EG lacks the discontinuities of Clarke et al' s EG but, otherwise, it gives similar results.…”

Section: Figure 1-egs For Type 1 Diabetes (A) and Type 2 Diabetes (B)supporting

confidence: 67%

A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose.

et al. 2000

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OBJECTIVE -The objectives of this study were 1) to construct new error grids (EGs) for blood glucose (BG) self-monitoring by using the expertise of a large panel of clinicians and 2) to use the new EGs to evaluate the accuracy of BG measurements made by patients. RESEARCH DESIGN AND METHODS -To construct newEGs for type 1 and type 2 diabetic patients, a total of 100 experts of diabetes were asked to assign any error in BG measurement to 1 of 5 risk categories. We used these EGs to evaluate the accuracy of self-monitoring of blood glucose (SMBG) levels in 152 diabetic patients. The SMBG data were used to compare the new type 1 diabetes EG with a traditional EG.RESULTS -Both the type 1 and type 2 diabetes EGs divide the risk plane into 8 concentric zones with no discontinuities. The new EGs are similar to each other, but they differ from the traditional EG in several significant ways. When used to evaluate a data set of measurements made by a sample of patients experienced in SMBG, the new type 1 diabetes EG rated 98.6% of their measurements as clinically acceptable, compared with 95% for the traditional EG. CONCLUSIONS -The consensus EGs furnish a new tool for evaluating errors in the mea E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s 1144DIABETES CARE, VOLUME 23, NUMBER 8, AUGUST 2000 New error grid for blood glucose 152 patients who routinely monitor their own BG. The study was performed in a diabetes clinic with patients using their own meters. The distribution of errors in our sample is considered in light of both EGs and the latest recommendations of the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS Consensus EGWe surveyed 100 physicians at the 1994 ADA Annual Meeting to construct an unbiased tool to analyze the clinical significance of SMBG measurement errors. All of the respondents were clinicians who treated diabetic patients. Pursuant to constructing an EG in the fashion of Clarke et al. (6), each doctor was asked to assign any plausible error in BG measurement to 1 of 5 risk categories. The risk categories, in order of increasing severity, were defined as follows: A: no effect on clinical action; B: altered clinical action or little or no effect on clinical outcome; C: altered clinical action-likely to effect clinical outcome; D: altered clinical action-could have significant medical risk; and E: altered clinical action-could have dangerous consequences.The above definitions were intended to correspond to the definitions of the risk zones in the Clarke EG while allowing the respondents maximal freedom to set their own boundaries. For example, zone A of the Clarke EG is defined as Ͻ20% deviation or having both reference and measured BGs Ͻ70 mg/dl. In addition, the UVA authors (6) stated that "values falling within this range are clinically accurate in that they would lead to clinically correct treatment decisions." Our definition of zone A asks each respondent to define his or her own range of "clinically accurate measurements," which is clarified as having "no effe...

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Section: Figure 1-egs For Type 1 Diabetes (A) and Type 2 Diabetes (B)supporting

confidence: 67%

A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose.

et al. 2000

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show abstract

“…However, this list (5,7-11) is incomplete, with there being many additional studies incorporating EGA (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). What is important to point out is that in all of these published studies the authors reported both EGA results and standard statistical results.…”

mentioning

confidence: 99%

“…The actual clinical relevance is therefore limited." In fact, EGA was initially employed in a clinical setting, evaluating the accuracy of patient BG measurements, relative to reference laboratory readings (12), and the accuracy of patient BG estimates relative to their meter readings (14,16,35). EGA was specifically developed to identify the types and frequency of clinically significant errors (i.e., does meter/patient overestimate hypoglycemia [upper zones D and E], underestimate hyperglycemia [lower zones D and E], or misinterpret euglycemia for hyper-or hypoglycemia [C zones]).…”

mentioning

confidence: 99%

Understanding Error Grid Analysis

et al. 1997

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“…Correlation coefficients describe the linear relationship between 2 sets of data, as in this study. However, the correlation coefficients that evaluate the entire range of blood glucose values may misinterpret the true relationship between subsets of data, as explained in the report by Pohl et al [36]. Error grid analysis is an efficient method that describes the accuracy over the entire range of blood glucose values and evaluates the clinical significance of the accuracy of a particular system.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Blood Glucose Measurements Using Samples Obtained from the Forearm, Finger Skin Puncture, and Venous Serum

Park

Joo

et al. 2010

Ann Lab Med

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Self-Measurement of Blood Glucose Concentration: Clinical Significance of Patient-Generated Measurements

Cited by 32 publications

References 3 publications

A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose.

A new consensus error grid to evaluate the clinical significance of inaccuracies in the measurement of blood glucose.

Understanding Error Grid Analysis

Comparison of Blood Glucose Measurements Using Samples Obtained from the Forearm, Finger Skin Puncture, and Venous Serum

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