Blood glucose monitoring, critically ill patients, first and second drops of blood
Citation Information :
Saini V, Das K, Saini S, Kaur S. Using the first drop of blood for monitoring blood glucose values in critically ill patients: An observational study. Indian J Crit Care Med 2016; 20 (11):658-661.
Context: Using the first drop or second drop of blood while measuring blood glucose (BG) values.
Objective: The study was planned to compare the BG values from the first and second drops of blood. Research Settings: The study was conducted at the Main Intensive Care Unit, PGIMER, Chandigarh, India.
Research Design: This study was a comparative study.
Materials and Methods: Ninety patients aged 2–93 years were enrolled in this study. BG values from the first and second drops of blood were taken and compared.
Statistical Analysis Used: Agreement between two drops was assessed using Bland–Altman analysis. A bias of <10 mg/dl was considered clinically acceptable. Linear regression of the mean difference (bias) with the BG readings was performed.
Results: One thousand four hundred and seven pairs of BG readings were taken from the enrolled patients. BG values had a bias of 3.9 ± 14.9 mg/dl. Nearly 96.7% of BG readings were within the limits of agreement. The absolute difference between first and second drops of blood was calculated; nearly 75.4% of the readings had fallen between 0 and 10 mg/dl, i.e. clinically acceptable range.
Conclusion: There is no compete concordance of values of blood glucose between the first and the second drops of blood; any of the drops can be used for measuring BG values as the difference is not statistically significant. However, if hands are visibly clean and to decrease the blood loss in the critically ill patients where the BG values are measured frequently, using the first drop of blood is advised.
Clain J, Ramar K, Surani SR. Glucose control in critical care. World J Diabetes 2015;6:1082-91.
The Johns Hopkins Medical Institution Point-of-Care Glucose Testing Using the Nova StatStrip Glucose Hospital Meter for Current Glucometer Operators. Available from: http://www.zotero://attachment/31/. [Last accessed on 2015 Mar 26].
Marx J, Hockberger R, Walls R, Adams J. Rosen's Emergency Medicine. St. Louis: Mosby; 2010. p. 3163.
Sarvghadi F, Yasari F. Causes and clinical presentation of hypoglycemia in patients with low blood glucose admitted to the emergency ward. Int J Endocrinol Metab 2007;4:119. Available from: http //www.endometabol.com/?page=article&article_id=1982. [Last accessed on 2015 Mar 29].
Alex A. Hyperglycemia (High Blood Glucose). American Diabetes Association. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html. [Last accessed on 2015 Mar 29].
Stress, Illness and High Blood Sugar – Mayo Clinic. Available from: http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/diabetes-blog/bgp-20056560. [Last accessed on 2015 Mar 29].
Tirimacco R, Tideman PA, Dunbar J, Simpson PA, Philpot B, Laatikainen T. Should Capillary Blood Glucose Measurements be Used in Population Surveys? Science Direct. Available from: http://www.sciencedirect.com/science/article/pii/S1877593409000599. [Last accessed on 2015 Mar 29].
10 Ways to Master Your Blood Glucose Meter: Diabetes Forecast ®. Available from: http://www.diabetesforecast.org/2012/apr/10-ways-to-master-your-blood-glucose-meter.html. [Last cited on 2015 Mar 27].
No Coding – What is No Coding and the Importance of Coding; 2016. Available from: http://www.diabetes.co.uk/diabetes_care/the-importance-of-coding.html. [Last cited on 2016 Oct 22].
1st ed. 2016. Available from: https://www.manualslib.com/manual/917266/Sd-Codefree.html. [Last cited on 2016 Oct 22].
Kahn CR, Weir GL, King GL, Jacohson AM, Moses AC, Smith RJ. Joslin's Diabetes Melitus. 14th ed. Boston: Lippincott Williams and Wilkins; 2005. p. 1149.
Li M, Wang X, Shan Z. Deciding between using the first or second drop of blood for the self monitoring of blood glucose. Prim Care Diabetes 2014;8:365-9.
Palese A, Fabbro E, Casetta A, Mansutti I. First or second drop of blood in capillary glucose monitoring: Findings from a quantitative study. J Emerg Nurs 2016;42:420-6.
Hortensius J, Slingerland RJ, Kleefstra N, Logtenberg SJ, Groenier KH, Houweling ST, et al. Self-monitoring of blood glucose: The use of the first or the second drop of blood. Diabetes Care 2011;34:556-60.