title: Importance of blood glucose meter and carbohydrate estimation accuracy.
abstract: BACKGROUND
  The clinical significance of blood glucose meter (BGM) error in the presence of increasing carbohydrate errors in diabetes patients who use both the BGM result and the carbohydrate estimation to dose insulin is unknown.
  
  
  METHODS
  This Monte Carlo simulation modeled diabetes patients who calculate insulin dosages based on BGM results and carbohydrate estimations. It evaluated the likelihood of on-target insulin dosing and clinically significant insulin dose errors based on data from five BGMs with different levels of performance (expressed as bias and imprecision [coefficient of variation (%CV)]) and increasing levels of carbohydrate estimation errors. The study was performed across three separate preprandial glucose (PPG) ranges (90-150, 150-270, and 270-450 mg/dl).
  
  
  RESULTS
  When carbohydrate estimation is accurate (%CV = 0%), the likelihood for on-target insulin doses ranged 50.1-98.5%. The likelihood depended on BGM performance and PPG range. In the presence of carbohydrate estimation errors (%CV = 5-20%), the likelihood of on-target insulin dosages markedly decreased (range, 27.2-80.1%) for all BGMs, the likelihood of insulin underdosing (range, 0-12.8%) and overdosing (range, 0-32.3%) increased, and the influence of BGM error on insulin dosing accuracy was blunted. Even in the presence of carbohydrate error, the BGM with the best performance (bias 1.35% and %CV = 4.84) had the highest probability for on-target insulin dosages.
  
  
  CONCLUSIONS
  Both BGM and carbohydrate estimation error contribute to insulin dosing inaccuracies. The BGM with the best performance was associated with the most on-target insulin dosages.
authors.affiliation: Medical Affairs, LifeScan Inc., Milpitas, California 95035, USA. nvirdi@its.jnj.com
authors.forename: Naunihal S
authors.initials: NS
authors.lastname: Virdi
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahoney
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods / Q000592:standards; D002241:Carbohydrates / Q000032:analysis* / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D016013:Likelihood Functions; D008508:Medication Errors / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012107:Research Design; D013223:Statistics as Topic / Q000379:methods / Q000592:standards*
chemical_list: D001786:Blood Glucose; D002241:Carbohydrates; D007004:Hypoglycemic Agents; D007328:Insulin