Diabetes Care, Vol 17, Issue 10 1110-1123, Copyright © 1994 by American Diabetes Association
The effect of recurrent practice at home on the acceptability of capillary blood glucose readings. Accuracy of self blood glucose testing
UM Kabadi, KM O'Connell, J Johnson and M Kabadi
Medical Service, Carl T. Hayden VA Medical Center, Phoenix, Arizona 85012.
OBJECTIVE--To judge how reliably patients perform capillary blood glucose
testing over time with recurrent practice at home and to assess if a clinic
glucose meter is an acceptable alternative to the clinical laboratory for
monitoring patient performance. RESEARCH DESIGN AND METHODS--We compared
capillary blood glucose readings obtained by patients with their own
equipment and the venous blood glucose determinations by the clinical
laboratory at three biweekly visits during the initial phase in 40 subjects
attending the diabetes clinic at the Veterans' Affairs Medical Center in
Phoenix, Arizona. We also compared patient-generated readings using their
own equipment and the readings obtained by the clinic glucose meter and
strips at five weekly visits during the second phase in 11 subjects who
continued further participation. Error grid analysis was used for both
comparisons. Capillary blood glucose readings obtained with clinic glucose
meter and strips on one hand were correlated with venous blood glucose
levels determined by the clinical laboratory. RESULTS--During the initial
phase, 30 subjects consistently obtained clinically acceptable comparisons
(zone A on the error grid, i.e., within 20% of the laboratory value) or
improved over time, 9 subjects showed deterioration, and 1 subject failed
to obtain zone A results on any of the visits. Three subjects who had
consistently obtained zone A results during the initial phase maintained
their performance, whereas eight subjects who had failed to achieve zone A
values by the end of the initial phase gradually improved and ultimately
achieved zone A values by the end of the study. A highly significant
correlation was noted between clinic meter readings and laboratory values
(r = 0.93, P < 0.00001). CONCLUSIONS--Clinically acceptable user
proficiency in capillary blood glucose testing can be maintained in most
subjects, with recurrent intensive education during follow-up clinic
visits. Therefore, we recommend that these comparisons be performed and
patient's technique be observed at each visit to monitor their performance.
The clinic glucose meter is a suitable alternative to a clinical laboratory
for user proficiency checks.