Multicenter study of oxygen-insensitive handheld glucose point-of-care testing in critical care/hospital/ambulatory patients in the United States and Canada

Gerald J. Kost, Huynh Troung Vu, Judith H. Lee, Peggy Bourgeois, Frederick L. Kiechle, Carol Martin, Sam S. Miller, Anthony Okorodudu, John J. Podczasy, Robert Webster, Karen J. Whitlow

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objectives: Existing handheld glucose meters are glucose oxidase (GO)- based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b) determine the oxygen-sensitivity of GO- and GD- based electrochemical biosensor test strips; and c) evaluate the clinical performance of the new GD-based glucose meter system in critical care/hospital/ambulatory patients. Design: Multicenter study sites compared glucose levels determined with GD-based biosensors to glucose levels determined in whole blood with a perchloric acid deproteinization hexokinase reference method. One site also studied GO-based biosensors and venous plasma glucose measured with a chemistry analyzer. Biosensor test strips were used with a handheld glucose monitoring system. Bench and clinical oxygen sensitivity, hematocrit effect, and precision were evaluated. Setting: The study was performed at eight U.S. medical centers and one Canadian medical center. Patients: There were 1,248 patients. Results: The GO-based biosensor was oxygen-sensitive. The new GD-based biosensor was oxygen-insensitive. GD- based biosensor performance was acceptable: 2,104 (96.1%) of 2,189 glucose meter measurements were within ±15 mg/dL (±0.83 mmol/L) for glucose levels of ≤100mg/dL (≤5.55 mmol/L) or within ±15% for glucose levels of >100 mg/dL, compared with the whole-blood reference method results. With the GD- based biosensor, the percentage of glucose measurements that were not within the error tolerance were comparable for different specimen types and clinical groups. Bracket predictive values were acceptable for glucose levels used in therapeutic management. Conclusions: The performance of GD-based, oxygen- insensitive, handheld glucose testing was technically suitable for arterial specimens in critical care patients, cord blood and heelstick specimens in neonates, and capillary and venous specimens in other patients. Multicenter findings benchmark the performance of bedside glucose testing devices. With the new ±15 mg/dL → 100 mg/dL → ±15% accuracy criterion, point-of-care systems for handheld glucose testing should score 95% (or better), as compared with the recommended reference method. Physiologic changes, preanalytical factors, confounding variables, and treatment goals must be taken into consideration when interpreting glucose results, especially in critically ill patients, for whom arterial blood glucose measurements will reflect systemic glucose levels.

Original languageEnglish (US)
Pages (from-to)581-590
Number of pages10
JournalCritical Care Medicine
Volume26
Issue number3
DOIs
StatePublished - 1998

Fingerprint

Critical Care
Multicenter Studies
Canada
Glucose 1-Dehydrogenase
Oxygen
Glucose
Biosensing Techniques
Glucose Oxidase
Point-of-Care Testing
Point-of-Care Systems
Benchmarking
Hexokinase
Confounding Factors (Epidemiology)
Fetal Blood
Hematocrit
Critical Illness
Blood Glucose

Keywords

  • Bracket predictive value
  • Diabetes mellitus
  • Electrochemical biosensor
  • Glucose dehydrogenase
  • Glucose oxidase
  • Neonate
  • Performance criteria
  • Point-of-care testing
  • Substrate-specific electrode
  • Whole-blood analysis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Multicenter study of oxygen-insensitive handheld glucose point-of-care testing in critical care/hospital/ambulatory patients in the United States and Canada. / Kost, Gerald J.; Vu, Huynh Troung; Lee, Judith H.; Bourgeois, Peggy; Kiechle, Frederick L.; Martin, Carol; Miller, Sam S.; Okorodudu, Anthony; Podczasy, John J.; Webster, Robert; Whitlow, Karen J.

In: Critical Care Medicine, Vol. 26, No. 3, 1998, p. 581-590.

Research output: Contribution to journalArticle

Kost, Gerald J. ; Vu, Huynh Troung ; Lee, Judith H. ; Bourgeois, Peggy ; Kiechle, Frederick L. ; Martin, Carol ; Miller, Sam S. ; Okorodudu, Anthony ; Podczasy, John J. ; Webster, Robert ; Whitlow, Karen J. / Multicenter study of oxygen-insensitive handheld glucose point-of-care testing in critical care/hospital/ambulatory patients in the United States and Canada. In: Critical Care Medicine. 1998 ; Vol. 26, No. 3. pp. 581-590.
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abstract = "Objectives: Existing handheld glucose meters are glucose oxidase (GO)- based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b) determine the oxygen-sensitivity of GO- and GD- based electrochemical biosensor test strips; and c) evaluate the clinical performance of the new GD-based glucose meter system in critical care/hospital/ambulatory patients. Design: Multicenter study sites compared glucose levels determined with GD-based biosensors to glucose levels determined in whole blood with a perchloric acid deproteinization hexokinase reference method. One site also studied GO-based biosensors and venous plasma glucose measured with a chemistry analyzer. Biosensor test strips were used with a handheld glucose monitoring system. Bench and clinical oxygen sensitivity, hematocrit effect, and precision were evaluated. Setting: The study was performed at eight U.S. medical centers and one Canadian medical center. Patients: There were 1,248 patients. Results: The GO-based biosensor was oxygen-sensitive. The new GD-based biosensor was oxygen-insensitive. GD- based biosensor performance was acceptable: 2,104 (96.1{\%}) of 2,189 glucose meter measurements were within ±15 mg/dL (±0.83 mmol/L) for glucose levels of ≤100mg/dL (≤5.55 mmol/L) or within ±15{\%} for glucose levels of >100 mg/dL, compared with the whole-blood reference method results. With the GD- based biosensor, the percentage of glucose measurements that were not within the error tolerance were comparable for different specimen types and clinical groups. Bracket predictive values were acceptable for glucose levels used in therapeutic management. Conclusions: The performance of GD-based, oxygen- insensitive, handheld glucose testing was technically suitable for arterial specimens in critical care patients, cord blood and heelstick specimens in neonates, and capillary and venous specimens in other patients. Multicenter findings benchmark the performance of bedside glucose testing devices. With the new ±15 mg/dL → 100 mg/dL → ±15{\%} accuracy criterion, point-of-care systems for handheld glucose testing should score 95{\%} (or better), as compared with the recommended reference method. Physiologic changes, preanalytical factors, confounding variables, and treatment goals must be taken into consideration when interpreting glucose results, especially in critically ill patients, for whom arterial blood glucose measurements will reflect systemic glucose levels.",
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T1 - Multicenter study of oxygen-insensitive handheld glucose point-of-care testing in critical care/hospital/ambulatory patients in the United States and Canada

AU - Kost, Gerald J.

AU - Vu, Huynh Troung

AU - Lee, Judith H.

AU - Bourgeois, Peggy

AU - Kiechle, Frederick L.

AU - Martin, Carol

AU - Miller, Sam S.

AU - Okorodudu, Anthony

AU - Podczasy, John J.

AU - Webster, Robert

AU - Whitlow, Karen J.

PY - 1998

Y1 - 1998

N2 - Objectives: Existing handheld glucose meters are glucose oxidase (GO)- based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b) determine the oxygen-sensitivity of GO- and GD- based electrochemical biosensor test strips; and c) evaluate the clinical performance of the new GD-based glucose meter system in critical care/hospital/ambulatory patients. Design: Multicenter study sites compared glucose levels determined with GD-based biosensors to glucose levels determined in whole blood with a perchloric acid deproteinization hexokinase reference method. One site also studied GO-based biosensors and venous plasma glucose measured with a chemistry analyzer. Biosensor test strips were used with a handheld glucose monitoring system. Bench and clinical oxygen sensitivity, hematocrit effect, and precision were evaluated. Setting: The study was performed at eight U.S. medical centers and one Canadian medical center. Patients: There were 1,248 patients. Results: The GO-based biosensor was oxygen-sensitive. The new GD-based biosensor was oxygen-insensitive. GD- based biosensor performance was acceptable: 2,104 (96.1%) of 2,189 glucose meter measurements were within ±15 mg/dL (±0.83 mmol/L) for glucose levels of ≤100mg/dL (≤5.55 mmol/L) or within ±15% for glucose levels of >100 mg/dL, compared with the whole-blood reference method results. With the GD- based biosensor, the percentage of glucose measurements that were not within the error tolerance were comparable for different specimen types and clinical groups. Bracket predictive values were acceptable for glucose levels used in therapeutic management. Conclusions: The performance of GD-based, oxygen- insensitive, handheld glucose testing was technically suitable for arterial specimens in critical care patients, cord blood and heelstick specimens in neonates, and capillary and venous specimens in other patients. Multicenter findings benchmark the performance of bedside glucose testing devices. With the new ±15 mg/dL → 100 mg/dL → ±15% accuracy criterion, point-of-care systems for handheld glucose testing should score 95% (or better), as compared with the recommended reference method. Physiologic changes, preanalytical factors, confounding variables, and treatment goals must be taken into consideration when interpreting glucose results, especially in critically ill patients, for whom arterial blood glucose measurements will reflect systemic glucose levels.

AB - Objectives: Existing handheld glucose meters are glucose oxidase (GO)- based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b) determine the oxygen-sensitivity of GO- and GD- based electrochemical biosensor test strips; and c) evaluate the clinical performance of the new GD-based glucose meter system in critical care/hospital/ambulatory patients. Design: Multicenter study sites compared glucose levels determined with GD-based biosensors to glucose levels determined in whole blood with a perchloric acid deproteinization hexokinase reference method. One site also studied GO-based biosensors and venous plasma glucose measured with a chemistry analyzer. Biosensor test strips were used with a handheld glucose monitoring system. Bench and clinical oxygen sensitivity, hematocrit effect, and precision were evaluated. Setting: The study was performed at eight U.S. medical centers and one Canadian medical center. Patients: There were 1,248 patients. Results: The GO-based biosensor was oxygen-sensitive. The new GD-based biosensor was oxygen-insensitive. GD- based biosensor performance was acceptable: 2,104 (96.1%) of 2,189 glucose meter measurements were within ±15 mg/dL (±0.83 mmol/L) for glucose levels of ≤100mg/dL (≤5.55 mmol/L) or within ±15% for glucose levels of >100 mg/dL, compared with the whole-blood reference method results. With the GD- based biosensor, the percentage of glucose measurements that were not within the error tolerance were comparable for different specimen types and clinical groups. Bracket predictive values were acceptable for glucose levels used in therapeutic management. Conclusions: The performance of GD-based, oxygen- insensitive, handheld glucose testing was technically suitable for arterial specimens in critical care patients, cord blood and heelstick specimens in neonates, and capillary and venous specimens in other patients. Multicenter findings benchmark the performance of bedside glucose testing devices. With the new ±15 mg/dL → 100 mg/dL → ±15% accuracy criterion, point-of-care systems for handheld glucose testing should score 95% (or better), as compared with the recommended reference method. Physiologic changes, preanalytical factors, confounding variables, and treatment goals must be taken into consideration when interpreting glucose results, especially in critically ill patients, for whom arterial blood glucose measurements will reflect systemic glucose levels.

KW - Bracket predictive value

KW - Diabetes mellitus

KW - Electrochemical biosensor

KW - Glucose dehydrogenase

KW - Glucose oxidase

KW - Neonate

KW - Performance criteria

KW - Point-of-care testing

KW - Substrate-specific electrode

KW - Whole-blood analysis

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