title: Influence of repetitive finger puncturing on skin perfusion and capillary blood analysis in patients with diabetes mellitus.
abstract: BACKGROUND
  Frequent puncturing of fingers to check blood glucose in patients with type 1 diabetes might alter skin perfusion and, hence, influence the representativeness of the blood sample. We investigated the influence of repetitive puncturing on skin microcirculatory perfusion using laser Doppler fluxmetry and on the preanalytical phase of capillary blood analysis for small molecules (glucose) and large particles (cholesterol).
  
  
  METHODS
  In 49 patients with long-standing (mean, 21 years) type 1 diabetes, with a mean puncture frequency of three times daily for a mean duration of 13 years, laser Doppler skin perfusion was measured in a finger at a frequently punctured site and compared with a similar site of another finger of the same hand, which was never punctured. In the supine position with the hand level with the heart, resting flux (RF), peak flux (PF), and the microcirculatory reserve capacity (MRC; PF - RF) were assessed. Subsequently, blood samples for capillary whole blood glucose and cholesterol analyses were taken from the same sites.
  
  
  RESULTS
  No significant differences were found between the puncture and control sites in mean RF (2.3 vs 2.0 V; P = 0.14, paired-samples t-test), PF (3.3 vs 3.1 V; P = 0.24), MRC (1.0 vs 1.0 V; P = 0.65), glucose (10.2 vs 10.2 mmol/L; P = 0.69), or cholesterol (5.1 vs 5.2 mmol/L; P = 0.26). Power calculation for a RF of 2.0 V and the SD and n of this study indicate a power (beta) of 80% to detect a 25% change in RF at P <0.05.
  
  
  CONCLUSIONS
  Repetitive finger puncturing in diabetics appears not to injure local skin microcirculatory perfusion nor to influence results of capillary blood analysis for glucose and cholesterol.
authors.affiliation: Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: de Graaff
authors.forename: G J
authors.initials: GJ
authors.lastname: Hemmes
authors.forename: T
authors.initials: T
authors.lastname: Bruin
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: R P
authors.initials: RP
authors.lastname: Michels
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: G T
authors.initials: GT
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001800:Blood Specimen Collection; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood* / Q000503:physiopathology; D005260:Female; D005385:Fingers; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D011677:Punctures; D012867:Skin / Q000098:blood supply*
chemical_list: D001786:Blood Glucose; D002784:Cholesterol