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VOLUME 20 , ISSUE 11 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Validity of bedside blood glucose measurement in critically ill patients with intensive insulin therapy

Ata Mahmoodpoor, Hadi Hamishehkar, Kamran Shadvar, Afshin Iranpour, Vahid Fattahi

Keywords : Glucometer, Intensive Care Unit, insulin therapy, laboratory, validity

Citation Information : Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Fattahi V. Validity of bedside blood glucose measurement in critically ill patients with intensive insulin therapy. Indian J Crit Care Med 2016; 20 (11):653-657.

DOI: 10.4103/0972-5229.194009

License: CC BY-ND 3.0

Published Online: 00-11-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aims: There have been variable results on the practice of tight glycemic control, and studies have demonstrated that point-of-care (POC) glucometers have variable accuracy. Glucometers must be accurate, and many variables can affect blood glucose levels. The purpose of this study was to determine the difference between blood glucose concentrations obtained from POC glucometers and laboratory results in critically ill patients with intensive insulin therapy. Materials and Methods: This was a descriptive study which enrolled 300 critically ill patients. Four samples of arterial blood were collected and analyzed at the bedside with the POC glucometer and also in the central laboratory to obtain the blood glucose level. To define the effect of various factors on this relation, we noted the levels of hemoglobin (Hb), PaO2, body temperature, bilirubin, history of drug usage, and sepsis. Results: There were not any significant differences between blood sugar levels using laboratory and glucometer methods of measurements. There was a good and significant correlation between glucose levels between two methods (r = 0.81, P< 0.001). Among evaluated factors (body temperature, bilirubin level, blood pressure, Hb level, PaO2, sepsis, and drugs) which added one by one in model, just drugs decreased the correlation more than others (r = 0.78). Conclusions: The results of POC glucometer differ from laboratory glucose concentrations, especially in critically ill patients with unstable hemodynamic status while receiving several drugs. This may raise the concern about using POC devices for tight glycemic control in critically ill patients. These results should be interpreted with caution because of the large variation of accuracy among different glucometer devices.


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  1. Murphy CV, Coffey R, Cook CH, Gerlach AT, Miller SF. Early glycemic control in critically ill patients with burn injury. J Burn Care Res 2011;32:583-90.
  2. Prisco L, Iscra F, Ganau M, Berlot G. Early predictive factors on mortality in head injured patients: A retrospective analysis of 112 traumatic brain injured patients. J Neurosurg Sci 2012;56:131-6.
  3. Chi A, Lissauer ME, Kirchoffner J, Scalea TM, Johnson SB. Effect of glycemic state on hospital mortality in critically ill surgical patients. Am Surg 2011;77:1483-9.
  4. Parish M, Mahmoodpoor A, Sanaie S. Validity of fasting blood sugar on the day of surgery compared with the preinduction blood glucose level in type II diabetic patients. Pak J Med Sci 2007;23:202-5.
  5. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009;360:1283-97.
  6. Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: A meta-analysis including NICE-SUGAR study data. CMAJ 2009;180:821-7.
  7. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The surviving sepsis campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010;38:367-74.
  8. Mahmoodpoor A, Hamishehkar H, Shadvar K, Beigmohammadi M, Iranpour A, Sanaie S. Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients. Indian J Crit Care Med 2016;20:67-71.
  9. Mahmoodpoor A, Hamishehkar H, Beigmohammadi M, Sanaie S, Shadvar K, Soleimanpour H, et al. Predisposing factors for hypoglycemia and its relation with mortality in critically ill patients undergoing insulin therapy in an Intensive Care Unit. Anesth Pain Med 2016;6:e33849.
  10. Le HT, Harris NS, Estilong AJ, Olson A, Rice MJ. Blood glucose measurement in the Intensive Care Unit: What is the best method? J Diabetes Sci Technol 2013;7:489-99.
  11. Kanji S, Buffie J, Hutton B, Bunting PS, Singh A, McDonald K, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med 2005;33:2778-85.
  12. Finkielman JD, Oyen LJ, Afessa B. Agreement between bedside blood and plasma glucose measurement in the ICU setting. Chest 2005;127:1749-51.
  13. Mahmoodpoor A, Ali-Asgharzadeh A, Parish M, Amir-Aslanzadeh Z, Abedini N. A comparative study of efficacy of intensive insulin therapy versus conventional method on mortality and morbidity of critically ill patients. Pak J Med Sci 2011;27:496-9.
  14. Kulkarni A, Saxena M, Price G, O'Leary MJ, Jacques T, Myburgh JA. Analysis of blood glucose measurements using capillary and arterial blood samples in intensive care patients. Intensive Care Med 2005;31:142-5.
  15. Holzinger U, Warszawska J, Kitzberger R, Herkner H, Metnitz PG, Madl C. Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring. Intensive Care Med 2009;35:1383-9.
  16. Nya-Ngatchou JJ, Corl D, Onstad S, Yin T, Tylee T, Suhr L, et al. Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients. Diabetes Metab Res Rev 2015;31:147-54.
  17. Pointer JE. Glucose analysis: Indications for ordering and alternatives to the laboratory. Ann Emerg Med 1986;15:372-6.
  18. Sherwood MJ, Warchal ME, Chen ST. A new reagent strip (Visidex) for determination of glucose in whole blood. Clin Chem 1983;29:438-46.
  19. Critchell CD, Savarese V, Callahan A, Aboud C, Jabbour S, Marik P. Accuracy of bedside capillary blood glucose measurements in critically ill patients. Intensive Care Med 2007;33:2079-84.
  20. Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, et al. Position statement executive summary: Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011;34:1419-23.
  21. Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL. Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 1987;10:622-8.
  22. ISO.In vitro Diagnostic Test Systems – Requirements for Blood-glucose Monitoring Systems for Self-testing in Managing Diabetes Mellitus. ISO 15197. 1st ed. Geneva: ISO; 2003.
  23. Kotwal N, Pandit A. Variability of capillary blood glucose monitoring measured on home glucose monitoring devices. Indian J Endocrinol Metab 2012;16 Suppl 2:S248-51.
  24. Denfeld QE, Goodell TT, Stafford KN, Kazmierczak S. Precision and accuracy: Comparison of point-of-care and laboratory glucose concentrations in cardiothoracic surgery patients. J Cardiovasc Nurs 2011;26:512-8.
  25. Tang Z, Du X, Louie RF, Kost GJ. Effects of drugs on glucose measurements with handheld glucose meters and a portable glucose analyzer. Am J Clin Pathol 2000;113:75-86.
  26. Kitsommart R, Ngerncham S, Wongsiridej P, Kolatat T, Jirapaet KS, Paes B. Accuracy of the StatStrip versus SureStep Flexx glucose meter in neonates at risk of hypoglycemia. Eur J Pediatr 2013;172:1181-6.
  27. Inoue S, Egi M, Kotani J, Morita K. Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: Systematic review. Crit Care 2013;17:R48.
  28. Mahmoodpoor A, Sanaie S, Golzari SE. Slow deadoptation of a strategy: Was tight glycemic control truly impractical? Adv Biosci Clin Med 2015;3:1-2.
  29. Meynaar IA, van Spreuwel M, Tangkau PL, Dawson L, Sleeswijk Visser S, Rijks L, et al. Accuracy of AccuChek glucose measurement in intensive care patients. Crit Care Med 2009;37:2691-6.
  30. Lonjaret L, Claverie V, Berard E, Riu-Poulenc B, Geeraerts T, Genestal M, et al. Relative accuracy of arterial and capillary glucose meter measurements in critically ill patients. Diabetes Metab 2012;38:230-5.
  31. Juneja D, Pandey R, Singh O. Comparison between arterial and capillary blood glucose monitoring in patients with shock. Eur J Intern Med 2011;22:241-4.
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