-----Original Message-----
From: Arkir Zehra
Sent: 18 October 2005 11:00
To: 'Bruce Muller'
Subject: RE: Optium Medisense Glucose Meters
Dear Bruce
Lab glucose results were obtained almost at the same time as meter results
as we have a satellite lab in the Diabetic Clinic therefore there is no
question of delayed separation. Samples were collected, put on meter
straight away, spun in microcentrifuge for 2 min and analysed using the lab
instrument almost immediately. Time difference we are talking about between
meter values and lab values are minutes rather than hours.
Zehra
-----Original Message-----
From: Bruce Muller [mailto:[log in to unmask]]
Sent: 18 October 2005 10:28
To: [log in to unmask]; Arkir Zehra
Subject: Re: Optium Medisense Glucose Meters
Dear Zehra,
Are you seeing the well documented failure of fluoride to properly
preserve glucose? Variable decreases in glucose up to 1.0 mmol/L occur
during the first couple of hours in fluoride. The values then level
off. You can stop the process by centrifugation of course, the sooner
after phlebotomy, the better.
Perhaps Medisense is right and the lab wrong in your study?
For more information, see attached Focus poster.
Bruce Muller
>>> Zehra Arkir <[log in to unmask]> 17/10/2005 18:14:57 >>>
Dear ACB members
We have recently rolled out Optium Medisense glucose meters at Guy's
and St
Thomas' Hospitals and receiving increasing number of concerns from
nursing
staff regarding the following:
* GTT screening results where venous blood glucose
concentrations
are different to lab glucose
Background:
* Initial evaluation of meters showed good correlation with
lab
glucose (y = 1.0384x + 0.1389). This was done using capillary blood
but
there were some samples where venous blood was provided as part of GTT
which
were not known at the time
* Re-analysis of results from venous blood samples revealed an
equation y = 1.0724x + 0.893 showing positive bias against the lab
glucose
when venous blood is used but there were results with no difference
despite
use of venous blood.
Lab glucose
Optium
4.4
4.9
6.4
6.8
5.7
6
4.9
5
5
6.4
11.5
13.3
6.7
8.2
4.8
6.2
4
6.3
5.1
6.7
4.1
5.3
4.9
6.4
5.5
7.2
5.6
7.4
5.9
7.7
7.1
9.2
Optium meter is plasma-calibrated and although venous blood is
acceptable it
may give 'slightly higher' results as reported in Clinica Chimica Acta
(353-
2005, p127-131).
Second reported incidence:
* ITT where Optium meter failed to detect hypoglycaemia. This
was
done using venous blood
Time (min)
Lab glucose
Optium glucose
-30
5.4
6.4
0
5.2
5.5
15
3.7
5.1
30
3.5
4.2
45
3.2
4.4
60
3.3
3.6
75
1.5
3.4
90
2.8
3.5
Following the incidence in ITT, as a precaution we analysed both venous
and
capillary samples for the next ITT together with simultaneous lab
glucose in
our Diabetic Clinic Lab as well as using Roche Advantage (Accu check)
meter
(this was the meter used in the hospital prior to change over to Optium
and
nurses had no problems previously).
Time
Capillary Optium
Capillary Advantage
Venous Optium
Venous Advantage
Venous online lab glucose
-30
4.8
4.9
5.6
4.6
4.3
0
5.1
4.7
5.4
4.7
4.4
15
3.3
2.8
3.1
2.2
2.2
30
1.8
1.3
1.7
1.2
1.4
45
4.7
4.8
4.2
3.8
3.6
60
7
6.8
5.8
5.2
5.1
90
9.4
9.4
9.3
7.7
7.4
120
10.1
10.2
10.5
9
9
Questions
* Has Optium users experienced similar problems? If they did
what
precautions did they take?
o Obviously its not ideal to do capillary sampling several times
when
there is a venous access during the ITT
* There are significant differences in glucose concentrations
between venous and capillary blood but why is this only evident in
some
samples?
* Could that be explained by the fact that Optium is calibrated
may
be using capillary but not venous blood and the fiddle factor used is
not
always valid?
Many thanks in advance
Zehra Arkir
Principal Clinical Biochemist
Guy's & St Thomas' Hospital NHS Foundation Trust
Department of Chemical Pathology
5th Floor North Wing
St Thomas' Hospital
London
Tel: 02071881253
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