Interferences and Limitations in Blood Glucose Self-Testing


Posted Jul 26 , 2019 01:35 AM

Interferences and Limitations in Blood Glucose Self-Testing: An Overview of the Current Knowledge.
Erbach M, et al. Journal of Diabetes Science and Technology 2016;10:1161-1168

Institute Summary (excerpted from the article):

In general, patients with diabetes performing self-monitoring of blood glucose (SMBG) can strongly rely on the accuracy of measurement results. However, various factors such as application errors, extreme environmental conditions, extreme hematocrit values, or medication interferences may potentially falsify blood glucose readings. Incorrect blood glucose readings may lead to treatment errors, for example, incorrect insulin dosing. Therefore, the diabetes team as well as the patients should be well informed about limitations in blood glucose testing. The aim of this article is to review the current knowledge on limitations and interferences in blood glucose testing with the perspective of their clinical relevance. Due to the rapid technological progress, it should be kept in mind that performance of most more recent BG meters may not always be reflected by the reviewed literature, since it reports on data generated with older BG generations. Moreover, it is important to note that some studies on limitations of BG meters were performed under extreme conditions which do not comply with the approved conditions of usage. Manufacturing of test strips is a complex process involving various factors, so it is unreasonable to assume that all test strips—even within a certain brand—will produce (almost) identical measurement results. Requirements for BG systems—including accuracy—are described in detail in the internationally accepted standard ISO 15197 according to the currently applicable version ISO 15197:2013. Despite passing the requirements of this standard, BG measurement may be compromised by usage of deteriorated test strips, which may result from inappropriate storage, mechanical stress, or usage after the expiry date. This is one of many reasons to purchase test strips from reputable sources where storage according to the package insert can be guaranteed. Error sources which can directly be influenced by the userare, for example, utilization of expired test strips, contamination of the test finger with glucose containing fluids, inappropriate hand washing, insufficient blood sample or, in general, failure to comply with operating instructions.

Why is this important?

Self-monitoring of blood glucose (SMBG) both in insulin treated and non-insulin-treated people with diabetes is supported by recently published trials, reviews, meta-analyses, and guidelines, and is recommended to be performed in a structured approach. Patients with appropriate training and a good technique for performance of BG testing can typically rely on the precision of BG measurement results. The risk of misinterpretation of BG readings can be minimized by detailed information on the factors potentially affecting BG measurement which are thoroughly reviewed in this article. process are mandatory prerequisites for reliable SMBG results. Adequate handling and storage of BG systems inclusive of test strips, as well as proper performance of the quantifying process are mandatory prerequisites for reliable SMBG results. Appropriate patient education and diabetes management team training are mandatory. Do you check your patients’ SMBG technique? Do you ask how they store their test strips? Do you ask if they are aware that higher temperatures can affect the accuracy of the glucose measurement?

Concluding Thought: Know your technology!

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