| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Articles |
1
Department of Pathology, University of Virginia Medical School, Charlottesville, VA 22908.
a Address correspondence to this author at: Department of Pathology, Box 800214, University of Virginia Medical School, Charlottesville, VA 22908.
Background: Proposed quality specifications for glucose meters allow results to be in error by 5–10% or more of the "true" concentration. Because meters are used as aids in the adjustment of insulin doses, we aimed to characterize the quantitative effect of meter error on the ability to identify the insulin dose appropriate for the true glucose concentration.
Methods: Using Monte Carlo simulation, we generated random "true" glucose values within defined intervals. These values were converted to "measured" glucose values using mathematical models of glucose meters having defined imprecision (CV) and bias. For each combination of bias and imprecision, 10 000–20 000 true and measured glucose concentrations were matched with the corresponding insulin doses specified by selected insulin-dosing regimens. Discrepancies in prescribed doses were counted and their frequencies plotted in relation to bias and imprecision.
Results: For meters with a total analytical error of 5%, dosage
errors occurred in 
8–23% of insulin doses. At 10% total error,
16–45% of doses were in error. Large errors of insulin dose (two-step
or greater) occurred >5% of the time when the CV and/or bias exceeded
10–15%. Total dosage error rates were affected only slightly
by choices of sliding scale among insulin dosage rules or by the range
of blood glucose. To provide the intended insulin dosage 95% of the
time required that both the bias and the CV of the glucose meter be
<1% or <2%, depending on mean glucose concentrations and the rules
for insulin dosing.
Conclusions: Glucose meters that meet current quality specifications allow a large fraction of administered insulin doses to differ from the intended doses. The effects of such dosage errors on blood glucose and on patient outcomes require study.
The following articles in journals at HighWire Press have cited this article:
|
|
 |
|
  D. Bhansali, H. S. Chima, A. R. Peretti, and V. Ramarajan Comparative Testing for Better Glycemic Control Lab Med, August 1, 2009; 40(8): 478 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J O'Kane and J. Pickup Self-monitoring of blood glucose in diabetes: is it worth it? Ann Clin Biochem, July 1, 2009; 46(4): 273 - 282. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Moghissi, M. T. Korytkowski, M. DiNardo, D. Einhorn, R. Hellman, I. B. Hirsch, S. E. Inzucchi, F. Ismail-Beigi, M. S. Kirkman, and G. E. Umpierrez American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control Diabetes Care, June 1, 2009; 32(6): 1119 - 1131. [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Scott, D. E. Bruns, J. C. Boyd, and D. B. Sacks Tight Glucose Control in the Intensive Care Unit: Are Glucose Meters up to the Task? Clin. Chem., January 1, 2009; 55(1): 18 - 20. [Full Text] [PDF]
|
|
|
|
|
|
K. Dungan, J. Chapman, S. S. Braithwaite, and J. Buse Glucose Measurement: Confounding Issues in Setting Targets for Inpatient Management Diabetes Care, February 1, 2007; 30(2): 403 - 409. [Full Text] [PDF]
|
|
|
|
|
|
G. B.B. Kristensen, K. Nerhus, G. Thue, and S. Sandberg Standardized Evaluation of Instruments for Self-Monitoring of Blood Glucose by Patients and a Technologist Clin. Chem., June 1, 2004; 50(6): 1068 - 1071. [Full Text] [PDF]
|
|
|
|
|
|
S. Skeie, G. Thue, K. Nerhus, and S. Sandberg Instruments for Self-Monitoring of Blood Glucose: Comparisons of Testing Quality Achieved by Patients and a Technician Clin. Chem., July 1, 2002; 48(7): 994 - 1003. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Sacks, D. E. Bruns, D. E. Goldstein, N. K. Maclaren, J. M. McDonald, and M. Parrott Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus Clin. Chem., March 1, 2002; 48(3): 436 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Bruns Laboratory-related Outcomes in Healthcare Clin. Chem., August 1, 2001; 47(8): 1547 - 1552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Krouwer How to Improve Total Error Modeling by Accounting for Error Sources Beyond Imprecision and Bias Clin. Chem., July 1, 2001; 47(7): 1329 - 1330. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
