There was an era when a physician named Thomas Willis in 1675 ascribed urine of diabetic patients as sweet\u2014\u201cas if imbued with a honey or sugar\u201d. Apparently, back then, by tasting urine, one of the distinctive features of diabetes was substantiated. Later, Mathew Dobson (1735-1784) identified that the sweet substance passed in the urine and present in the blood of diabetic subjects was actually sugar.1<\/p>\n
In this day and age, after centuries apart, we are fortunate to have escaped such predicament. Realistically, with the advent of newer technologies, it is now possible to measure glucose at the point of care, i.e. at the physician\u2019s office, in a hospital setting, at home, or at the accident site. Such easy-to-use testing of a biochemical parameter, carried out near the patients without going through sample processing and analysis in advanced clinical laboratories, to obtain results that prompt therapeutic decision is known as point-of-care testing (POCT).2 The glucometer is one of such POCT devices in most common use today.<\/p>\n
Self-monitoring of blood glucose (SMBG) is recommended in patients with type 1 or type 2 diabetes under intensive insulin regimen (i.e., receiving insulin injection several times a day). Typically, patients are encouraged to measure their glucose level before and after having meals and snacks, at bedtime, during suspicion of hypoglycemic episodes, and after the treatment of hypoglycemia. This means that a patient with diabetes under insulin therapy is required to undertake glucose testing approximately 6-10 times a day. In addition, glucose monitoring before intense exercise and prior to driving is also advised.3<\/p>\n
Undoubtedly, POCT for glucose assists diabetic patients under insulin therapy to be cognizant of glycemic status and achieve long term glycemic control, consequently reducing microvascular and macrovascular complications and improving health outcomes. However, real challenges faced by users remain in choosing glucometers that are highly accurate amongst the numerous POCT devices for glucose that are available in the market and to understand the function, and execute the testing process without committing an error. Today, innovation in technology has led to marked improvement in the devices, assuring both accuracy and convenience.<\/p>\n
So, what are the factors to look into when choosing a glucose meter?<\/strong><\/p>\n The American Diabetes Association Standard of Care 2020 recommends that glucometers in use for SMBG should meet accuracy standards as specified by either US Food and Drug Administration ( FDA) or ISO 15197:2013. Also, if SMBG is prescribed, it is the physician’s responsibility to ascertain that the patient has received adequate instruction on its operability and adjustment to therapy.3<\/p>\n <\/p>\n An evaluation of underlying analytical principle during the selection of a laboratory testing device is considered virtually indispensable. The most commonly employed analytical technique in the currently available quantitative POCT devices for glucose are photometry (reflectance\/spectrophotometry) and electrochemistry.<\/p>\n The POCT device for glucose measurement system consists of single use test strips containing various layers, or membranes. When the blood specimen obtained from the finger-stick is spotted to the strip, it then flows through the layers of the test strip. These layers serve to spread specimen, filter larger particles such as RBC, and support the analysis process. The analytical layer is impregnated with enzymes that recognize the molecule of interest (glucose). The commonly used enzymes are glucose oxidase (GOX) and glucose dehydrogenase (GDH). The reaction between the enzyme and substrate glucose is converted into a signal by a transducer, and the signal is then processed into a readable result. Electrochemical sensors are the most commonly used transducers.4<\/p>\n Now, why is it important for us to understand the analytical method and process? It is because there are various physiological and external factors that interfere with the process and generate erroneous results. The common clinically relevant interferences are oxygen, hematocrit, drugs (acetaminophen, dopamine, mannitol, icodextrin), uric acid, bilirubin, triglyceride, maltose, and galactose. For instance, the GOX method is influenced by O2 saturation. If there is high O2 saturation, then it underestimates blood glucose, while if the O2 saturation decreases, then it overestimates the blood glucose.5 On the contrary, GDH method is not affected by O2 saturation; however, it is susceptible to interference by other carbohydrates, such as maltose, galactose, and xylose.6<\/p>\n ADA recommends that clinicians have to be familiar with the interfering factors that are sensitive to glucometer reading, leading to blood glucose results that disagree with the clinical signs and symptoms.3 The list of interfering factors may be available in the guidebook of the respective glucometer. Interestingly, some glucometers even correct for these interfering factors, which can be inquired during the selection process.<\/p>\n Most of the glucometers available in the market still require finger-stick to obtain blood volume. Glucometers that require larger blood volume may inadvertently result in consumers milking or squeezing fingers to obtain desired volume, or attempt multiple finger-sticks, leading to great nuisance. Thankfully, newer glucometers require blood volume as low as 0.3 microliters to 1.0 microliters.<\/p>\n Another important factor to look into is the speed at which a glucometer processes the finger-stick blood specimen. Newer glucometers can generate result within 4-8 seconds after the specimen is spotted to the test strip.<\/p>\n Quality control is another very important aspect to consider during the purchase of glucose meter. Some glucometers pack may include quality control solution of known concentration of glucose (low, medium, high). The functionality of glucometer, as well as the test strip, can be frequently assessed using quality control materials. It is recommended to use the control solution from the same brand as the glucometer device. The QC check can be performed during the purchase of a glucometer after opening a fresh batch of test strip and whenever the blood glucose level seems unfitting.<\/p>\n Range of detection is also another important factor to consider when purchasing a glucometer. Glucometers should be able to detect critical low (40 mg\/dl) and critical high (400 mg\/dl) blood glucose levels. However, the latest glucose meter device has detection range as low as 0 mg\/dl, and as high as 1000 mg\/dl.<\/p>\n Glucometers have capacity to store the data with date and time stamp, i.e., when was the blood sugar measured and what was the value? This is important, as patient can keep track of their trend in glycemia and discuss with treating doctor during the next visit. Some glucometers have less storage capacity, whereas some can store up to 1000 test results. Not only the test result, glucometers have space for quality control results data, as well. Even better, some newer glucometers provide unlimited storage capacity. It is always wise to inquire about the storage capacity of a glucometer.<\/p>\n Some of the glucometers confer wireless connectivity, especially via Bluetooth, to external devices like smart phones. The data generated in the glucometer can be easily synced to mobile smartphones for clear display and sharing. In addition, glucometers offer mechanism to integrate the data to the hospital information system, consisting of laboratory information system and electronic medical record, through Wi-Fi. This allows better documentation and helps clinicians understand patient\u2019s glycemic status quickly.<\/p>\n There are myriads of glucometers available in the market, especially in online shops of Nepal, pharmacies, medical supplies store, or even some supermarkets. The cost of most of the glucometers available in Nepali market may range from less than Rs.1000 to Rs. 3500. The strips have to be purchased separately. The strips come in different packs, such as 25 per pack or 50 per pack, and again, the cost ranges from less than Rs, 1000 per pack up to Rs. 2000. Moreover, it is important to ensure the validity of the test strips, so that they are utilized within the expiry date.<\/p>\n Most of the glucometers are handheld and portable device that readily fit into the pocket, handbag or the glove compartment of the vehicle. Consumers can request information on the dimension as well as weight of the glucometer. A small and light-weight glucometer is more than a cherry on top.<\/p>\n Overall, purchasing glucometer for SMBG or hospital use is an important decision to make. On the occasion when a treating physician has to recommend glucometer to the patient for SMBG, it would be a wise step to investigate whether the glucometer meets the accuracy standard as proposed by ISO 15197: 2013 or US FDA. Ultimately, laboratory professionals and clinicians can sit together in reaching judgment for selection of a glucometer for the patient.<\/p>\n There was an era when a physician named Thomas Willis in 1675 ascribed urine of diabetic patients as sweet\u2014\u201cas if imbued with a honey or sugar\u201d. Apparently, back then, by tasting urine, one of the distinctive features of diabetes was substantiated. Later, Mathew Dobson (1735-1784) identified that the sweet substance passed in the urine and …<\/p>\n","protected":false},"author":46,"featured_media":1979,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[284,283,285,147],"class_list":["post-1978","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-diagnostics-and-imaging","tag-diabetes","tag-glucometer","tag-glucose","tag-technology"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/medicosnext.com\/wp-content\/uploads\/2021\/01\/Glucometer.bmp","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts\/1978","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/users\/46"}],"replies":[{"embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1978"}],"version-history":[{"count":0,"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/posts\/1978\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=\/wp\/v2\/media\/1979"}],"wp:attachment":[{"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1978"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1978"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicosnext.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1978"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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