COMPARISION BETWEEN BED SIDE TESTING OF BLOOD GLUCOSE BY GLUCOMETER Vs CENTRALIZED TESTING IN A TERTIARY CARE HOSPITAL

Authors

  • Ayaz Baig
  • Imran Siddiqui
  • Abdul Jabbar
  • Syed Iqbal Azam
  • Salman Sabir
  • Shahryar Alam
  • Farooq Ghani

Abstract

Background: To determine the accuracy, turnaround time and cost effectiveness of bedsidemonitoring of blood glucose levels by non–laboratory health care workers and centralized testingof blood glucose by automated analyzer in a tertiary care hospital. Methods: The study wasconducted in Section of Chemical Pathology, Department of Pathology and Microbiology andSection of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi,from April 2005 to March 2006.One hundred and ten patients were included in the study. Theblood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, usingBiosensor Technology. At the same time venous blood was obtained to analyze glucose in clinicallaboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. Results: Weobserved good correlation between bed side glucometer and laboratory automated analyzer forglucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference wasobserved for glucose values less than 3.3 mmol/L (p=0.002) and glucose values more than 16.67mmol/l (p= 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lowerthan centralized lab based testing. Conclusion: Bedside glucometer testing, though less expensivedoes not have good accuracy in acutely ill patient with either very high or very low blood glucoselevels.Key words: Bed side testing; Glucometer; Centralized glucose testing

References

Jacobs E, Vadasdi E, Sarkozi L, Colman N. Analytical

evaluation of i-STAT Portable Clinical Analyzer and use by

nonlaboratory health-care professionals.Clin Chem

;39(6):1069-74.

Friedman BA, Mitchell W. Integrating information from

decentralized laboratory testing sites. The creation of a valueadded network. Am J Clin Pathol 1993; 99:637-42.

Ellis Jacob. Point of care (near-patient) testing. Kaplan LA,

Pesce AJ, Kazmierezak SC.Clinical Chemistry 3rded: New

York: Mosby; 1996.p.313-22.

Nanji AA, Poon R, Hinberg I. Near-patient testing. Quality of

laboratory test results obtained by non-technical personnel in

a decentralized setting. Am J Clin Pathol 1998; 89(6):797-

Winkelman JW, Wybenga DR, Tanasijevic MJ. The fiscal

consequences of central vs distributed testing of glucose. Clin

Chem 1994; 40(8):1628-30.

Dillion AE, Menard MK, Rust P, Newman RB, VanDorsten

JP. Glucometer analysis of one-hour glucose challenge

samples. Am J Obstet Gynecol 1997; 177(5):1120-23.

Nosanchuk JS, Keefner R. Cost analysis of point-of-care

laboratory testing in a community hospital. Am J Clin Pathol

; 103(2):240-43.

Hamid MH, Chishti AL, Maqbool S. Clinical utility and

accuracy of a blood glucose meter for detection of neonatal

hypoglycemia.J Coll Physicians Surg Pak 2004; 14(4):225-28

Greendyke RM. Cost analysis. Bedside glucose testing. Am J

Clin Pathol1992; 97(1):106-7.

Trajanoski Z, Brunner GA, Gfrerer RJ, Wach P, Pieber TR.

Accuracy of home blood glucose meters during

hypoglycemia. Diabetes Care 1996; 19(12):1412-15.

Tang Z, Du X, Louie RF, Kost GJ. Effects of drugs on

glucose measurements with handheld glucose meters and

portable glucose analyzer. Am J Clin Pathol 2000; 113(1):75-

Sacks DB, Bruns DE, Goldstein DE, Maclaren NK,

McDonald JM, Parrott M. Guidelines and recommendations

for laboratory analysis in the diagnosis and management of

diabetes mellitus. Clin Chem 2002; 48(3):436-72.

Atkin SH, Dasmahapatra A, Jaker MA, Chorost MI, Reddy

S. Fingerstick glucose determination in shock. Ann Intern

Med 1991; 114(12):1020-24.

Nosanchuk JS, Salvatore JD. Improved pneumatic tube

system shortens stat turnaround time. Lab Med 1977; 8:21-

Nosanchuk JS, Stull R, Keefner R. The effect of substitution

of plasma for serum on chemistry turnaround time. Lab Med

; 22: 465-69.

Saxena S, Wong ET. Does the emergency department need a

dedicated stat laboratory? Continuous quality improvement

as a management tool for the clinical laboratory. Am J Clin

Pathol 1993; 100(6):606-10.

Zaloga GP, Hill TR, Strickland RA, Kennedy D, Visser M,

Ford K et al. Bed side blood gas and electrolyte monitoring

in critically ill patients. Crit Care Med 1989; 17(9): 920-25.

Most read articles by the same author(s)