Significant Insulin Dose Errors May Occur if Blood Glucose Results are Obtained from Miscoded Meters

Raine, Charles H.; Schrock, Linda E.; Edelman, Steven V.; Mudaliar, Sunder; Zhong, Weiping; Proud, Lois J.; Parkes, Joan Lee

doi:10.1177/193229680700100211

Cited by 47 publications

(49 citation statements)

References 12 publications

(11 reference statements)

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“…Our previous study demonstrated that miscoded meters have the potential of producing such values. 8 This paper examines potential glycemic outcomes from insulin doses administered on the basis of improperly coded meters. Insulin dose recommendations based on commonly used correction formulas may result in serious adverse clinical outcomes if glucose data are wrong.…”

Section: Resultsmentioning

confidence: 99%

“…10 We have shown that with deliberately miscoded meters, there was a potential for insulin errors of as much as +5 units when a correction scheme is used to determine an insulin dose, given that a glucose meter is miscoded. 8 In deliberately miscoded meters, errors as great as -36.23% [standard deviation (SD) 6.34] or +26.53% (SD 12.45) relative to the reference YSI glucose were observed.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,7 In our published study, blood glucose (BG) data obtained from deliberately miscoded glucose meters were used to demonstrate potential errors in insulin dose based on erroneous blood glucose results caused by miscoding. 8 In the current paper we relate these calculated potential insulin dose errors to possible adverse blood glucose outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Predicted Blood Glucose from Insulin Administration Based on Values from Miscoded Glucose Meters

Raine¹,

Pardo

Parkes

2008

J Diabetes Sci Technol

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Objectives: The proper use of many types of self-monitored blood glucose (SMBG) meters requires calibration to match strip code. Studies have demonstrated the occurrence and impact on insulin dose of coding errors with SMBG meters. This paper reflects additional analyses performed with data from Raine et al. (JDST, 2:205–210, 2007). It attempts to relate potential insulin dose errors to possible adverse blood glucose outcomes when glucose meters are miscoded. Methods: Five sets of glucose meters were used. Two sets of meters were autocoded and therefore could not be miscoded, and three sets required manual coding. Two of each set of manually coded meters were deliberately miscoded, and one from each set was properly coded. Subjects ( n = 116) had finger stick blood glucose obtained at fasting, as well as at 1 and 2 hours after a fixed meal (Boost®; Novartis Medical Nutrition U.S., Basel, Switzerland). Deviations of meter blood glucose results from the reference method (YSI) were used to predict insulin dose errors and resultant blood glucose outcomes based on these deviations. Results: Using insulin sensitivity data, it was determined that, given an actual blood glucose of 150–400 mg/dl, an error greater than +40 mg/dl would be required to calculate an insulin dose sufficient to produce a blood glucose of less than 70 mg/dl. Conversely, an error less than or equal to −70 mg/dl would be required to derive an insulin dose insufficient to correct an elevated blood glucose to less than 180 mg/dl. For miscoded meters, the estimated probability to produce a blood glucose reduction to less than or equal to 70 mg/dl was 10.40%. The corresponding probabilities for autocoded and correctly coded manual meters were 2.52% ( p < 0.0001) and 1.46% ( p < 0.0001), respectively. Furthermore, the errors from miscoded meters were large enough to produce a calculated blood glucose outcome less than or equal to 50 mg/dl in 42 of 833 instances. Autocoded meters produced zero (0) outcomes less than or equal to 50 mg/dl out of 279 instances, and correctly coded manual meters produced 1 of 416. Conclusions: Improperly coded blood glucose meters present the potential for insulin dose errors and resultant clinically significant hypoglycemia or hyperglycemia. Patients should be instructed and periodically reinstructed in the proper use of blood glucose meters, particularly for meters that require coding.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicted Blood Glucose from Insulin Administration Based on Values from Miscoded Glucose Meters

Raine¹,

Pardo

Parkes

2008

J Diabetes Sci Technol

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“…A correction dose of insulin based on inaccurately high readings could have the potential for severe hypoglycemia as shown in research. 1 Failure to take a correction dose for an inaccurately low reading could allow hyperglycemia to continue. 1 Based on the Raines study, 1 miscoding does contribute to errors in blood glucose results.…”

Section: Resultsmentioning

confidence: 99%

Miscoding and other User Errors: Importance of Ongoing Education for Proper Blood Glucose Monitoring Procedures

Schrock

2008

J Diabetes Sci Technol

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“…The training status of all glucometer operators included healthcare providers and family members, but details remained unknown. Raine et al concluded that up to 16% of patients do not use glucometers properly and this leads to ±33% errors [7].…”

Section: Discussionmentioning

confidence: 99%

Correlation between capillary and venous blood glucose levels in diabetic patients

et al. 2015

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Background: Rapid blood glucose estimation is required to prescribe treatments and to make dose adjustments in diabetic patients. However, measuring plasma glucose levels is time consuming. Therefore, the use of glucometers has greatly increased. Objectives: To measure the correlation between capillary and venous blood glucose levels. Methods: Seventy patients with type 2 diabetes mellitus (T2DM) were enrolled in the present study and informed written consent was obtained from all participants. Demographic characteristics and clinical information was noted. Capillary and venous glucose levels were determined. Statistical Package for Social Sciences version 21 was used for data analysis. Results: Mean age of patients was 52 ± 12 years. It included 29% men; 71% women; 9% smokers; and 90% poor. Mean venous glucose was 11.73 ± 4.64 mmol/L and mean capillary glucose 12.57 ± 5.21 mmol/L. These findings demonstrated a significant intermethod mean difference of 0.84 mmol/L (P < 0.001). Inter-glucose difference was not significant at glucose levels near normal. However, it increased gradually with rise in glucose measurements and was significant at elevated glucose levels. Both concordance correlation coefficient and intraclass correlation coefficient demonstrated positive correlation and more consistency between glucose estimations. A Bland and Altman plot presented excellent agreement between glucometrically and photometrically determined glucose levels. Conclusion: A positive correlation coefficient showed strong association between capillary and venous glucose measurements.

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Significant Insulin Dose Errors May Occur if Blood Glucose Results are Obtained from Miscoded Meters

Cited by 47 publications

References 12 publications

Predicted Blood Glucose from Insulin Administration Based on Values from Miscoded Glucose Meters

Predicted Blood Glucose from Insulin Administration Based on Values from Miscoded Glucose Meters

Miscoding and other User Errors: Importance of Ongoing Education for Proper Blood Glucose Monitoring Procedures

Correlation between capillary and venous blood glucose levels in diabetic patients

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