Cordero SO, Morales CI, Sánchez VLD, Noriega PA

Language: Spanish
References: 14
Page: 9-18
PDF size: 407.03 Kb.

ABSTRACT

Introduction: To maintain strict glucose control the clinic must have equipment that determines trustworthy test results. Objective: To compare the result of glucose from capillary and venous samples obtained at the patient’s bedside by means of three different electronic systems, with results of the venous sample reported by the Clinical Laboratory, and to evaluate which of the three systems achieved best correlation and agreement. Material and methods: We evaluated three systems: Ascensia Elite�; Precision Q×I×D®, and SureStep™ Plus. The Clinical Laboratory System was Vitros 250 Johnson-Johnson®. We obtained capillary and venous blood samples from 25 patients every 6 h from the first blood drawing sample. Venous samples were processed in the Laboratory within 30 min of blood drawing. Statistical analysis consisted of descriptive statistics, inferential analysis comprised determination of r and r², and significance level was set at ‹ 0.05. Agreement analysis was carried out with the Bland and Altman test. Results: We obtained 500 samples from 25 patients; 489 samples participated in the statistical analysis. Values of r and r² of capillary sample of SureStep™ Plus, Ascensia Elite™, and Precision Q×I×D® systems were 0.943, 0.910, 0.902 respectively. For venous samples, values were 0.940, 0.909, 0.913 respectively, all with a value of p ‹ 0.001. Conclusions: We recommend using patient bedside glucose measurement systems and adjusting intensive treatment with insulin, carrying out a clinical laboratory-processed glucose determination at least every 8 h. The system with best performance was presented by the SureStep™ Plus system.

REFERENCES

1. Wolfe RR, Allsop JR, Burke JE. Glucose metabolism in man: responses to intravenous glucose infusion. Metabolism 1979; 28: 210-220.

2. Wolf RR, Herndon DN, Jahoor F, Miyoshi H, Wolfe M. Effect of severe burn injury on substrate cycling by glucose and fatty acids. N Engl J Med 1987; 317: 403-408.

3. Shangraw RE, Jahoor F, Miyoshi H et al. Differentiation between septic and postburn insulin resistance. Metabolism 1989; 38: 983-989.

4. Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med 1995; 98: 75-84.

5. McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin 2001; 17: 107-124.

6. Fietsam R Jr, Bassett J, Glover JL. Complications of coronary artery surgery in diabetic patients. Am Surg 1991; 57:551-557.

7. O´Neill PA, Davies I, Fullerton KJ, Bennett D. Stress hormone and blood glucose response following acute stroke in the elderly. Stroke 1991; 22: 842-847.

8. Scott JF, Robinson GM, French JM, O´Connell JE, Alberti KG, Gray CS. Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST). Stroke 1999; 30: 793-799.

9. Van Den Berghe G, Wouters P, Weekers F et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359-1367.

10. SureStepTMPro, Technical Bulletin, Number 054-867A, 1997.

11. Altman DG, Bland JM. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 33: 307-310.

12. Sacks DB. Carbohydrates. In: Burtis CA, and Ashwood ER editors. Tietz Textbook of Clinical Chemistry. Philadelphia: W.B. Saunders Company 1994: 959.

13. Clement S, Braithwaite SS, Magee MM, Ahmann A, Smith EP, Schafer RG. Management of Diabetes and Hyperglycemia in Hospitals. Diabetes Care 2004; 27: 553-583.

14. Ray JG, Hamielec C, Mastracci T. Pilot study of the accuracy of bedside glucometry in the intensive care unit. Crit Care Med 2001; 29: 737-748.