Evaluation of the Impact of Hematocrit and Other Interference on the Accuracy of Hospital-Based Glucose Meters

Abstract

Background: Most glucose meter comparisons to date have focused on performance specifications likely to impact subcutaneous dosing of insulin. We evaluated four hospital-based glucose meter technologies for accuracy, precision, and analytical interferences likely to be encountered in critically ill patients, with the goal of identifying and discriminating glucose meter performance specifications likely to impact intensive intravenous insulin dosing. Methods: Precision, both within-run and day-to-day, was evaluated on all four glucose meters. Accuracy (bias) of the meters and analytical interference were evaluated by comparing results obtained on whole blood specimens to plasma samples obtained from these whole blood specimens run on a hexokinase reference method. Results: Precision was acceptable and differed little between meters. There were significant differences in the degree to which the meters correlated with the reference hexokinase method. Ascorbic acid showed significant interference with three of the four meters. Hematocrit also affected the correlation between whole blood and plasma hexokinase glucose on three of the four glucose meters tested, with the magnitude of this interference also varying by glucose meter technology. Conclusions: Correlation to plasma hexokinase values and hematocrit interference are the main variables that differentiate glucose meters. Meters that correlate with plasma glucose measured by a reference method over a wide range of glucose concentrations and minimize the effects of hematocrit will allow better glycemic control for critically ill patients.