title: False elevation of blood glucose levels measured by GDH-PQQ-based glucometers occurs during all daily dwells in peritoneal dialysis patients using icodextrin.
abstract: OBJECTIVE
  False elevation of blood glucose levels measured by glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ)-based glucose self-monitoring systems; glucometer) in peritoneal dialysis (PD) patients using icodextrin solution has been well documented. However, adverse hypoglycemic events caused by misreadings for blood glucose are still being reported. We aimed to study blood glucose levels measured simultaneously using different methods in PD patients with switching of icodextrin, and throughout daily exchanges either using icodextrin or not.
  
  
  METHODS
  We recruited 100 PD patients, including 40 using icodextrin; 128 hemodialysis patients served as a reference. Fasting serum glucose was measured using our laboratory reference method (LAB) and 2 glucose self-monitoring systems based on glucose dehydrogenase nicotinamide adenine dinucleotide (GDH-NAD) and GDH-PQQ respectively. 80 PD patients had a second follow-up study. A time course study was performed in 16 PD patients through measuring fingertip glucose using the 2 glucose self-monitoring systems during daily exchanges.
  
  
  RESULTS
  The differences in measured serum glucose levels in (PQQ minus LAB) versus (NAD minus LAB) were markedly increased in PD patients using icodextrin compared to other patient groups, and was further confirmed by the follow-up study in patients that switched to icodextrin. The high serum glucose levels measured by the GDH-PQQ-based glucose self-monitoring system were present throughout all exchanges during the day in patients using icodextrin solution.
  
  
  CONCLUSIONS
  False elevation of blood glucose measured by GDH-PQQ-based glucose self-monitoring systems exists in patients using icodextrin. To avoid misinterpretation of hyperglycemia and subsequent over-injection of insulin, GDH-PQQ-based glucose self-monitoring systems should not be used in PD patients.
authors.affiliation: Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chiu-Yeh
authors.initials: CY
authors.lastname: Tsai
authors.forename: Su-Chu
authors.initials: SC
authors.lastname: Lee
authors.forename: Chi-Chih
authors.initials: CC
authors.lastname: Hung
authors.forename: Jia-Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Kuo
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods; D015314:Dialysis Solutions / Q000009:adverse effects*; D005189:False Positive Reactions; D005260:Female; D005936:Glucans / Q000009:adverse effects*; D005947:Glucose / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D013624:Taiwan
chemical_list: D001786:Blood Glucose; D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D005947:Glucose