Implementing tight glycaemic control: performance of bedside glucometers

Introduction

Implementing tight glycaemic control (TGC) in the ICU requires accurate blood glucose (BG) monitoring. We evaluated the performance of two bedside glucometers (GM) in ICU patients.

Methods

Four hundred and fifty-two arterial blood samples were prospectively analysed in 37 adult ICU patients subjected to TGC. Arterial BG was simultaneously determined using a reference test (ABL^®) and two GM (Accu-Chek^® and HemoCue^®). Data were analysed using linear regression and the Bland–Altman (BA) method.

Results

Correlation between the reference method and both GM in the overall BG range was reasonable, but not perfect (r² ≥ 0.93). This was further underlined by BA analysis (Figures 1 and 2), showing a bias to overestimate BG with GM. In the TGC range (80–110 mg/dl) correlation was low for both GM (r² ≤ 0.66). This was confirmed by BA analysis, demonstrating broad limits of agreement: +14.2 and -26.6 mg/dl for Accu-Chek^® and +5.5 and -31.1 mg/dl for HemoCue^®.

Figure 1

(abstract P141)

Figure 2

(abstract P141)

Conclusion

The accuracy of the tested GM in our ICU patients was insufficient for safe clinical practice. Therefore, to avoid potentially harmful hypoglycaemia, caution is warranted when TGC is implemented exclusively based on BG results obtained by GM.