Reply to: “Considerations about the use of glucometers for testing glucose tolerance”
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Estéfani Martínez-Chávez
,
Blanca Fabre-Estremera
To the Editor,
We thank Lavin-Gomez B.A. and Guerra Ruíz A.R. [1] for their valuable comments to our paper titled “Use of point-of-care glucometers during an oral glucose tolerance test in children for prediabetes and diabetes diagnosis: A comparison study” [2]. We are extremely grateful for your interest in our study and for your suggestions, which substantially contribute to the debate on this issue. Please, find below our response to your considerations.
Pre-analytical sample handling: Thank you for your observation. We would like to clarify that serum tubes with gel are used in our center during the oral glucose tolerance test. A centrifuge is available in the Unit of Diabetes to minimize the effects of in vitro glycolysis. In our paper, we acknowledge the potential influence of in vitro glycolysis on fasting samples as a limitation. Thanks to the study, our sample handling protocol was optimized to ensure that fasting samples are centrifuged within 20 min of collection.
Correlation between glucose measurements: Comparative analysis of the methods revealed that the differences observed in glucose results obtained with the POCTACI (Accu-Chek® Inform-II, Roche Diagnostics, Basel, Switzerland) and the central laboratory (Atellica®Solution-CH; Siemens Healthineers, Erlangen, Germany) were not statistically significant. These differences complied with our quality specifications for glucose concentrations of 100, 125, 140 and 200 mg/dL. However, in the light of the clinical impact of diagnostic discrepancies, we decided to examine the diagnostic concordance between the two methods.
The results revealed that differences in glucose concentrations between POCTACI and the central laboratory tended to increase as glucose concentrations rose. Thus, the POCT glucometer yielded lower results than the central laboratory at higher glucose concentrations. Due to the study design, the reason for lower glucometer results at 30, 60 and 120 min, as compared to laboratory results, could not be determined. Future research that controls for additional variables may help explain these observed differences.
Interference of hematocrit in glucose measurement: The POCTACI and POCTACP glucometers (Accu-Chek® Performa, Roche Diagnostics, Basel, Switzerland) used in our laboratory do not measure hematocrit. Given the interest in this variable, we examined hematocrit results in our study population. Of the 98 patients included, a hemogram was included in the laboratory test request of 50 patients. POCTACI and laboratory-based diagnoses were consistent in 68 % (34) of cases (see Figure 1).
Separate analysis of diagnostic discrepancies revealed that in 3 of the 4 patients with hematocrit results >43 % (range 44–49 %), diagnostic discrepancies could have had a clinical impact. In all cases, the results obtained with the glucometer were lower than those of the central laboratory. Additionally, in 2 of the 5 cases with hematocrit results <43 % (range 36–42 %), diagnostic discrepancies could have had clinical implications. In the both cases, lower results were obtained with the glucometer, as compared to the laboratory (see Table 1). Therefore, in our study, when hematocrit was <43 %, the inverse relationship between hematocrit and glucose described in the literature [3] was not observed.
In our study population, we found that glucometer tended to underdiagnose prediabetes and diabetes, except in cases of impaired fasting glycemia. Thus, diagnostic discrepancies in the latter were probably due to in vitro glycolysis in fasting samples. In our study, a clear influence of hematocrit was not observed on glucose results.
Next-generation glucometers with capacity to measure hematocrit could yield more precise readings and reduce variations. This would pave the way for the potential use of POCT glucometers for diagnostic purposes in the near future. We once again thank Lavin-Gomez BA and Guerra Ruíz AR for their valuable comments, which contributed to the debate about the use of glucometers in the clinic.
Diagnostic concordance between POCTACI and the central laboratory as a function of hematocrit values. Distribution of the 50 patients with hematocrit values available. Analysis of diagnostic concordance between POCTACI and the central laboratory. Hematocrit values were categorized into three groups: hematocrit<43 % (mean 41 %, SD: 1.8, diagnostic concordance 73 %); hematocrit=43 % (diagnostic concordance 60 %) and hematocrit>43 % (mean 46 %, SD: 1.5, with a diagnostic concordance of 63 %).
Diagnostic discordance between POCTACI and the central laboratory.
| POCTACI | Central laboratory | Clinical impact | Hematocrit, % |
|---|---|---|---|
| IFG | Normal | None | 36 |
| IFG | Normal | 40 | |
| IFG | Normal | 42 | |
| IFG | Normal | 43 | |
| IFG | Normal | ? | |
| IFG | Normal | ? | |
| IFG | Normal | ? | |
| Normal | IGT | 47 | |
| IFG | IFG+IGT | ? | |
| IGT | Diabetes | ? | |
| Normal | IGT | Mild | 41 |
| IGT | Diabetes | 44 | |
| IGT | Diabetes | ? | |
| Normal | IGT | Severe | 48 |
| Normal | IGT | ? | |
| IFG+IGT | Diabetes | 47 | |
| IGT | Diabetes | 41 |
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IFG, impaired fasting glucose; IGT, impaired glucose tolerance; POCTACI, connected glucometer.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: Martínez Chávez E: writing – original draft, writing – review and editing, visualization. Fabre-Estremera B, Manzano Ocaña M, Fernández-Calle P, Buño Soto A and Oliver P: writing – review and editing. All authors have accepted responsibility for the entire content of this manuscript and have approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
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Article Note: The original article can be found here: https://doi.org/10.1515/almed-2024-0148.
References
1. Lavin-Gomez, BA, Guerra Ruíz, AR. Consideraciones acerca del uso de glucómetros durante la prueba de tolerancia oral a la glucosa [Manuscrito no publicado]. Servicio de Análisis Clínicos, Hospital Universitario Marqués de Valdecilla.Suche in Google Scholar
2. Fabre-Estremera, B, Martínez-Chávez, E, Manzano Ocaña, M, Carcavilla Urquí, A, Morales Sánchez, MÁ, Pinilla Tejado, I, et al.. Use of point-of-care glucometers during an oral glucose tolerance test in children for prediabetes and diabetes diagnosis: a comparison study. Estudio comparativo. Adv Lab Med 2024;5:197–204. https://doi.org/10.1515/almed-2024-0017.Suche in Google Scholar PubMed PubMed Central
3. Solnica, B, Skupien, J, Kusnierz-Cabala, B, Slowinska-Solnica, K, Witek, P, Cempa, A, et al.. The effect of hematocrit on the results of measurements using glucose meters based on different techniques. Clin Chem Lab Med 2011;50:361–5. https://doi.org/10.1515/cclm.2011.770.Suche in Google Scholar
© 2024 the author(s), published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
Artikel in diesem Heft
- Frontmatter
- Editorial
- Lights and shadows of artificial intelligence in laboratory medicine
- Luces y sombras de la inteligencia artificial en la medicina de laboratorio
- Review / Artículo de Revisión
- Fundamentals of lipoprotein(a) request and quantification in the clinical laboratory
- Aspectos fundamentales en la solicitud y determinación de la lipoproteína(a) en el laboratorio clínico
- Original Article / Artículo Original
- Evaluating seven bioinformatics platforms for tertiary analysis of genomic data from whole exome sequencing in a pilot group of patients
- Evaluación de siete programas bioinformáticos para el análisis terciario de datos genómicos generados a partir de la secuenciación del exoma completo en un grupo piloto de pacientes
- Parameters of glycemic variability in continuous glucose monitoring as predictors of diabetes: a prospective evaluation in a non-diabetic general population
- Parámetros de variabilidad glucémica de la monitorización continua de glucosa como predictores de diabetes: evaluación prospectiva en una población general sin diabetes
- Reference intervals of hematological parameters in the Chilean adult population and the Mapuche ethnic group
- Intervalos de referencia de parámetros hematológicos en población chilena adulta y en la etnia mapuche
- Lipid metabolism in overweight/obese children vs. normal weight children in a north-eastern region of Spain
- Estudio del metabolismo lipídico en niños aragoneses con sobrepeso/obesidad vs. niños normopeso
- Short Communication / Comunicación Breve
- Evaluating the research parameters available on the Sysmex® XN-series hematology analyzers as markers of dysplasia in peripheral blood
- Valoración de los parámetros de investigación de los analizadores hematológicos de la serie XN (Sysmex®) como marcadores de displasia en sangre perifèrica
- Evaluation of an alternative centrifugation protocol for reducing total turnaround time
- Evaluación de un protocolo de centrifugación alternativo que permita reducir el tiempo de respuesta total
- Case Report / Caso Clínico
- Jordans’ anomaly in Chanarin-Dorfman syndrome
- Anomalía de Jordans en síndrome de Chanarin-Dorfman
- Letter to the Editor / Carta al Editor
- Considerations about the use of glucometers in glucose tolerance tests
- Consideraciones acerca del uso de glucómetros durante la prueba de tolerancia oral a la glucosa
- Reply to: “Considerations about the use of glucometers for testing glucose tolerance”
- Respuesta a la carta al editor: “Consideraciones acerca del uso de glucómetros durante la prueba de tolerancia oral a la glucosa” (https://doi.org/10.1515/almed-2024-0108)
Artikel in diesem Heft
- Frontmatter
- Editorial
- Lights and shadows of artificial intelligence in laboratory medicine
- Luces y sombras de la inteligencia artificial en la medicina de laboratorio
- Review / Artículo de Revisión
- Fundamentals of lipoprotein(a) request and quantification in the clinical laboratory
- Aspectos fundamentales en la solicitud y determinación de la lipoproteína(a) en el laboratorio clínico
- Original Article / Artículo Original
- Evaluating seven bioinformatics platforms for tertiary analysis of genomic data from whole exome sequencing in a pilot group of patients
- Evaluación de siete programas bioinformáticos para el análisis terciario de datos genómicos generados a partir de la secuenciación del exoma completo en un grupo piloto de pacientes
- Parameters of glycemic variability in continuous glucose monitoring as predictors of diabetes: a prospective evaluation in a non-diabetic general population
- Parámetros de variabilidad glucémica de la monitorización continua de glucosa como predictores de diabetes: evaluación prospectiva en una población general sin diabetes
- Reference intervals of hematological parameters in the Chilean adult population and the Mapuche ethnic group
- Intervalos de referencia de parámetros hematológicos en población chilena adulta y en la etnia mapuche
- Lipid metabolism in overweight/obese children vs. normal weight children in a north-eastern region of Spain
- Estudio del metabolismo lipídico en niños aragoneses con sobrepeso/obesidad vs. niños normopeso
- Short Communication / Comunicación Breve
- Evaluating the research parameters available on the Sysmex® XN-series hematology analyzers as markers of dysplasia in peripheral blood
- Valoración de los parámetros de investigación de los analizadores hematológicos de la serie XN (Sysmex®) como marcadores de displasia en sangre perifèrica
- Evaluation of an alternative centrifugation protocol for reducing total turnaround time
- Evaluación de un protocolo de centrifugación alternativo que permita reducir el tiempo de respuesta total
- Case Report / Caso Clínico
- Jordans’ anomaly in Chanarin-Dorfman syndrome
- Anomalía de Jordans en síndrome de Chanarin-Dorfman
- Letter to the Editor / Carta al Editor
- Considerations about the use of glucometers in glucose tolerance tests
- Consideraciones acerca del uso de glucómetros durante la prueba de tolerancia oral a la glucosa
- Reply to: “Considerations about the use of glucometers for testing glucose tolerance”
- Respuesta a la carta al editor: “Consideraciones acerca del uso de glucómetros durante la prueba de tolerancia oral a la glucosa” (https://doi.org/10.1515/almed-2024-0108)
