Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review

IntroductionGlucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit. Arterial blood gas analyzers and glucose meters are commonly used to measure blood-glucose concentration in an intensive care unit; however, their accuracies are still unclear.MethodsWe performed a systematic literature search (January 1, 2001, to August 31, 2012) to find clinical studies comparing blood-glucose values measured with glucose meters and/or arterial blood gas analyzers with those simultaneously measured with a central laboratory machine in critically ill adult patients.ResultsWe reviewed 879 articles and found 21 studies in which the accuracy of blood-glucose monitoring by arterial blood gas analyzers and/or glucometers by using central laboratory methods as references was assessed in critically ill adult patients. Of those 21 studies, 11 studies in which International Organization for Standardization criteria, error-grid method, or percentage of values within 20% of the error of a reference were used were selected for evaluation. The accuracy of blood-glucose measurements by arterial blood gas analyzers and glucose meters by using arterial blood was significantly higher than that of measurements with glucose meters by using capillary blood (odds ratios for error: 0.04, P < 0.001; and 0.36, P < 0.001). The accuracy of blood-glucose measurements with arterial blood gas analyzers tended to be higher than that of measurements with glucose meters by using arterial blood (P = 0.20). In the hypoglycemic range (defined as < 81 mg/dl), the incidence of errors using these devices was higher than that in the nonhypoglycemic range (odds ratios for error: arterial blood gas analyzers, 1.86, P = 0.15; glucose meters with capillary blood, 1.84, P = 0.03; glucose meters with arterial blood, 2.33, P = 0.02). Unstable hemodynamics (edema and use of a vasopressor) and use of insulin were associated with increased error of blood glucose monitoring with glucose meters.ConclusionsOur literature review showed that the accuracy of blood-glucose measurements with arterial blood gas analyzers was significantly higher than that of measurements with glucose meters by using capillary blood and tended to be higher than that of measurements with glucose meters by using arterial blood. These results should be interpreted with caution because of the large variation of accuracy among devices. Because blood-glucose monitoring was less accurate within or near the hypoglycemic range, especially in patients with unstable hemodynamics or receiving insulin infusion, we should be aware that current blood glucose-monitoring technology has not reached a high enough degree of accuracy and reliability to lead to appropriate glucose control in critically ill patients.

[1]  Katsuhiko Kuwa,et al.  Approved IFCC recommendation on reporting results for blood glucose (abbreviated). , 2005, Clinical chemistry.

[2]  Jean-Charles Preiser,et al.  Microvascular blood flow is altered in patients with sepsis. , 2002, American journal of respiratory and critical care medicine.

[3]  Deborah J. Cook,et al.  Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data , 2009, Canadian Medical Association Journal.

[4]  P. Tangkau,et al.  Accuracy of AccuChek glucose measurement in intensive care patients * , 2009, Critical care medicine.

[5]  Y. Jang,et al.  Standards of Medical Care in Diabetes-2010 by the American Diabetes Association: Prevention and Management of Cardiovascular Disease , 2010 .

[6]  V. Basevi.  Standards of Medical Care in Diabetes—2010 , 2010, Diabetes Care.

[7]  F. Machado,et al.  Accuracy of different methods for blood glucose measurement in critically ill patients. , 2009, Sao Paulo medical journal = Revista paulista de medicina.

[8]  M. S. Kirkman,et al.  Comment on: American Diabetes Association. Standards of Medical Care in Diabetes—2011. Diabetes Care 2011;34(Suppl. 1):S11–S61 , 2011 .

[9]  T. Stojaković,et al.  Comparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit. , 2011, Journal of critical care.

[10]  J. G. van der Hoeven,et al.  Accuracy of bedside glucose measurement from three glucometers in critically ill patients* , 2008, Critical care medicine.

[11]  A. D. Jeffrey,et al.  Evaluation of the Impact of Hematocrit and Other Interference on the Accuracy of Hospital-Based Glucose Meters , 2008 .

[12]  Stephane Heritier,et al.  Intensive versus conventional glucose control in critically ill patients. , 2009, The New England journal of medicine.

[13]  Hartzell V Schaff,et al.  Accuracy of roche accu-chek inform whole blood capillary, arterial, and venous glucose values in patients receiving intensive intravenous insulin therapy after cardiac surgery. , 2007, American journal of clinical pathology.

[14]  M. Cameli,et al.  Prediction of stroke volume by global left ventricular longitudinal strain in patients undergoing assessment for cardiac transplantation. , 2011, Journal of critical care.

[15]  Amy Callahan,et al.  Accuracy of bedside capillary blood glucose measurements in critically ill patients , 2006, Intensive Care Medicine.

[16]  J. Hamilton,et al.  Comparison of glucose point-of-care values with laboratory values in critically ill patients. , 2009, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[17]  E. Moghissi.  Reexamining the evidence for inpatient glucose control: new recommendations for glycemic targets. , 2010, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[18]  V. Cardenas,et al.  Comparison of POCT and central laboratory blood glucose results using arterial, capillary, and venous samples from MICU patients on a tight glycemic protocol. , 2008, Clinica chimica acta; international journal of clinical chemistry.

[19]  Maryclare Prasnikar,et al.  Comparison of point-of-care and laboratory glucose analysis in critically ill patients. , 2007, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[20]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[21]  P. Marik,et al.  Original ResearchCritical Care MedicineToward Understanding Tight Glycemic Control in the ICU: A Systematic Review and Metaanalysis , 2010 .

[22]  J. Vincent,et al.  Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock* , 2004, Critical care medicine.

[23]  O. Fourcade,et al.  Relative accuracy of arterial and capillary glucose meter measurements in critically ill patients. , 2012, Diabetes & metabolism.

[24]  S. Elatrous,et al.  Bedside capillary blood glucose measurements in critically ill patients: influence of catecholamine therapy. , 2010, Diabetes research and clinical practice.

[25]  Michael Bailey,et al.  Hypoglycemia and outcome in critically ill patients. , 2010, Mayo Clinic proceedings.

[26]  Lisa Halvorsen,et al.  Differences in glucose values obtained from point-of-care glucose meters and laboratory analysis in critically ill patients. , 2009, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[27]  B. Afessa,et al.  Agreement between bedside blood and plasma glucose measurement in the ICU setting. , 2005, Chest.

[28]  Annette Rebel,et al.  The Accuracy of Point-of-Care Glucose Measurements , 2012 .

[29]  Brian Hutton,et al.  Reliability of point-of-care testing for glucose measurement in critically ill adults* , 2005, Critical care medicine.

[30]  N. Clark,et al.  Standards of Medical Care in Diabetes: Response to Power , 2006 .

[31]  G. Cembrowski,et al.  Accuracy of glycemic measurements in the critically ill. , 2008, Diabetes technology & therapeutics.

[32]  John A Myburgh,et al.  Hypoglycemia and risk of death in critically ill patients. , 2012, The New England journal of medicine.

[33]  S. Kazmierczak,et al.  Precision and Accuracy: Comparison of Point-of-Care and Laboratory Glucose Concentrations in Cardiothoracic Surgery Patients , 2011, The Journal of cardiovascular nursing.

[34]  M. J. Rice,et al.  Challenges to Glycemic Measurement in the Perioperative and Critically Ill Patient: A Review , 2009, Journal of diabetes science and technology.

[35]  Julian P T Higgins,et al.  Recent developments in meta‐analysis , 2008, Statistics in medicine.

[36]  N. Adhikari,et al.  Does intensive insulin therapy really reduce mortality in critically ill surgical patients? A reanalysis of meta-analytic data , 2010, Critical care.

[37]  B. Karon,et al.  Evaluation of the Impact of Hematocrit and Other Interference on the Accuracy of Hospital-Based Glucose Meters , 2008 .

[38]  J. Petersen,et al.  Accuracy and precision of point-of-care testing for glucose and prothrombin time at the critical care units. , 2001, Clinica chimica acta; international journal of clinical chemistry.

[39]  John C. Sieverdes,et al.  Examples of mHealth technology for supporting guidelines for care and self-management of diabetes Guidelines for care American Diabetes Association standards of medical care in diabetes , 2010 .

[40]  Peter Beelen,et al.  Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion , 2002, Critical care medicine.

[41]  P. Marik,et al.  ACCURACY OF BEDSIDE CAPILLARY BLOOD GLUCOSE MEASUREMENTS IN CRITICALLY ILL PATIENTS.: 259 , 2006 .

[42]  C. Wade,et al.  Error rates resulting from anemia can be corrected in multiple commonly used point-of-care glucometers. , 2008, The Journal of trauma.

[43]  Brian P. Kavanagh,et al.  Glycemic Control in the ICU , 2010 .

[44]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[45]  David B Sacks,et al.  Tight glucose control in the intensive care unit: are glucose meters up to the task? , 2009, Clinical chemistry.

[46]  D. R. Hadden,et al.  Influence of Sample Type on the Interpretation of the Oral Glucose Tolerance Test for Gestational Diabetes Mellitus , 1991, Diabetic medicine : a journal of the British Diabetic Association.

[47]  A. Vuagnat,et al.  Accuracy of bedside glucometry in critically ill patients: influence of clinical characteristics and perfusion index. , 2008, Mayo Clinic proceedings.

[48]  Saxon Ridley.  Critical care. , 2003, Anaesthesia.

[49]  Jaap E Tulleken,et al.  Accuracy and feasibility of point-of-care and continuous blood glucose analysis in critically ill ICU patients , 2006, Critical care.

[50]  J G Ray,et al.  Pilot study of the accuracy of bedside glucometry in the intensive care unit , 2001, Critical care medicine.