Avril
We have setup three plasma "glucose" tests with different reference
ranges in our Telepath2000 system plus a range of standard comments
added depending on the clinical question asked. The data entry clerks
seenm to be good at identifying fasted from non fasted but we do get a
few errors. Fasting/randomIt is a tick box on the request and the
phlebotomist records time of last meal and/or carbohydrate containing
drink whenever there is a test likely to be affected.
Fasting glucose 3.6 - 6.0 mmol/L
Random glucose 3.0 - 7.8 mmol/L
Glu2 - 2 hrs post 75g glucose GTT - 3.6 - 7.8
The fasting glucose range was increased form 5.4 to 6.0 after the WHO
etc Guidelines were published. We have evidence that 6.0 is too high -
plenty of type 2 diabetics with fasting glucose in the range 5.5 - 6.0 -
and hence add a cautionary comment. A comment is also added to random
glucose results above 7.7 but below 11.1 advising them to repeat in
fasted state.
Suprisingly in this day of NSF for diabetes and local guidelines we
have some GPs who have difficulties.
Paul Eldridge
Biochemist
Lewisham Hospital
>>> Avril Owen <[log in to unmask]> 03/01 3:54 pm >>>
Dear colleagues
Following an overwhelming demand by our requesters (both primary care
and
acute services) we have recently made a decision to highlight abnormal
results on our paper reports. As a consequence of this, we have had to
provide a reference range for our blood glucose results, otherwise
grossly
abnormal values would not be highlighted. After consultation with
colleagues
and our diabetologist, we decided on an arbitrary range of 2.2-11.1
mmol/L
(2.2 being the threshold for hypoglycaemia, and 11.1 being the
diagnostic
level for diabetes in a 2h glucose following glucose load).
As a result we have had a phone call from a GP who seriously dislikes
this
range, and who claims that this might result in early diabetics being
labelled 'normal'. This is the only complaint so far. To be honest, we
would
prefer not to quote a reference range for glucose at all, but seeing as
we
have to, does anyone have any suggestions or comments that would help
us?
Best regards
Avril Owen
Principal Biochemist
Department of Clinical Chemistry
Ysbyty Gwynedd
Bangor
Wales
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