Home glucose monitoring systems fall short in hospital settings
Using FDA-approved home glucose monitoring systems in the surgical setting can lead to harmful treatment errors, particularly resulting in hypoglycemia, according to researchers at the University of Florida College of Medicine.
Anesthesiologist Mark J. Rice, MD, is leading an effort to inform physicians about the shortcomings of the home glucose meters in hospital settings, and to call the FDA’s attention to the need for better regulation surrounding clinical use of the meters.
“They’re faster and cheaper, but they’re not always accurate,” Rice said. “They were regulated and approved for home use, then in stealth fashion they ended up in the hospitals.”
Rice has presented his findings on the technology, accuracy and regulation of glucose measurement devices to fellow physicians at the University Hospital Zurich Institute for Anesthesiology in Switzerland. He will also speak with physicians at Austria’s University Hospital Innsbruck. Previously, Rice and colleagues published their findings in the journal Anesthesia & Analgesia.
Errors and other weaknesses
According to Rice, while useful in home settings, the meters can cause errors due to the presence of other chemicals or medications in the blood and health conditions such as anemia. Inaccurate readings could cause detrimental effects on the central nervous system or impair wound healing and alter consciousness.
One CDC study found that on average, readings from some over-the-counter devices differed by as much as 32% from values obtained in a central laboratory.
“Dr. Rice outlined very clearly the strengths and weaknesses of the current technology used to measure glucose, so that we who use the devices are aware of the inaccuracies and pitfalls in measurement,” Robert Peterfreund, MD, PhD, of the Massachusetts General Hospital department of anesthesia, critical care and pain medicine, said in a press release. Peterfreund authored an editorial to accompany Rice’s paper in Anesthesia & Analgesia.
Rice recommends that physicians confirm abnormal blood glucose meter readings using central laboratory measurements, and refrain from using the devices in clinical trials that call for accurate glucose measurements.
In-hospital glucose control
The issue of keeping tight control of blood glucose levels before, during and after surgery has been controversial. A decade ago, a report in The New England Journal of Medicine indicated that tightly controlling blood glucose in the ICU might reduce death rates. In response, the American Diabetes Association urged reining in blood glucose levels in critically ill patients.
More recently, however, studies suggest that tight control of blood glucose is associated with increased hypoglycemia and death among adults in ICUs and that the general population of critically ill adults might not benefit.
Surgical patients might experience fluctuations in blood glucose levels for various reasons; some might have pre-existing or undiagnosed diabetes. In addition, factors such as fasting before surgery, disruption of medication regimens, taking certain medicines and stress can affect blood glucose levels.
“The problem is, how do you measure that?” Rice said.
Physicians can send patient samples to a central laboratory for testing then wait for the results. Or, they can use meters at bedside and get results within seconds.
“Turnaround time has got to be short in order to have optimal clinical benefit,” Peterfreund said. “With point-of-care devices, the turnaround time is very rapid. Of course, if it’s not accurate it doesn’t help you at all.”
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