title: Accuracy and precision of glucose monitoring are relevant to treatment decision-making and clinical outcome in hospitalized patients with diabetes.
abstract: METHODS
  The accuracy and precision of three blood glucose meters (BGMs) were evaluated in 600 hospitalized patients with type 1 (n = 200) or type 2 (n = 400) diabetes. Capillary blood glucose values were analyzed with Accu-Chek(®) Aviva [Roche (Hellas) S.A., Maroussi, Greece], Precision-Xceed(®) [Abbott Laboratories (Hellas) S.A., Alimos, Greece], and Glucocard X-Sensor(®) (Menarini Diagnostics S.A., Argyroupolis, Greece). At the same time plasma glucose was analyzed using the World Health Organization's glucose oxidase method.
  
  
  RESULTS
  Median plasma glucose values (141.2 [range, 13-553] mg/dL) were significantly different from that produced by the BGMs (P < 0.001). The Accu-Chek Aviva underestimated hypoglycemia (plasma glucose ≤55 mg/dL) by a mean difference of 4.1 mg/dL (95% confidence interval [CI] 0-28 mg/dL), and the Precision-Xceed did so by a mean difference of 6.2 mg/dL (95% CI 0-29 mg/dL); the same was true for the Glucocard X-Sensor by a mean difference of 9.1 mg/dL (CI 0-57 mg/dL) (P < 0.001 for all BGMs). Hyperglycemia (plasma glucose ≥250 mg/dL) was overestimated with the Accu-Chek Aviva and the Precision-Xceed by a mean difference of 4.8 mg/dL (95% CI 0-41 mg/dL) and 10.4 mg/dL (CI 0-92 mg/dL), respectively; the same was true for the Glucocard X-Sensor by a mean difference of 20.3 mg/dL (95% CI 0-100 mg/dL) (P < 0.001 for all BGMs). Asymptomatic hypoglycemia was detected in 28% of type 1 and in 18% of type 2 diabetes patients. In all cases, the BGMs were unreliable in sensing hypoglycemia. Multivariate linear regression analysis demonstrated that low blood pressure and hematocrit significantly affected glucose measurements obtained with all three BGMs (P < 0.05).
  
  
  CONCLUSIONS
  In hospitalized diabetes patients, all three frequently used BGMs undersensed hypoglycemia and oversensed hyperglycemia to some extent. Patients and caregivers should be aware of these restrictions of the BGMs.
authors.affiliation: First Department of Propaedeutic Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece. c_v_24@yahoo.gr
authors.forename: Christina
authors.initials: C
authors.lastname: Voulgari
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tentolouris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D007003:Hypoglycemia / Q000175:diagnosis*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000150:complications; D008297:Male; D008422:Materials Testing; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents