POC Glucose Test Of The Palm Capillary Blood

BackgroundDiabetes mellitus (DM) is one of the most common chronic diseases in our country today and the prevalence has been increasing rapidly in the past 20-30 years. An epidemiology study published in 2010 showed that the age-standardized prevalence rates of DM and pre-DM among the adults above and equal to 20 years old in the country were 9.7% and 15.5% respectively. The chronic complications of DM involve multiple organs resulting in high morbidity and disability rate, so DM has become a serious public health concern. Self-monitoring of blood glucose is an important supportive tool in the comprehensive management model for DM. Pain and repeated invasion in the currently widely adopted point of care (POC) blood glucose test on finger contribute to the poor compliance of the patients with SMBG. Alternative site testing (AST) is needed to replace the finger testing partly. Palm is one of the AST sites which people could try. However, the clinical accuracy and feasibility of the palm AST still need further evaluation.ObjectiveThis study is to research the application of SMBG in the DM management and the evaluation method for POC blood glucose testing by portable meters, and to explore the possible issues in palm testing by the meters, and to assess the clinical accuracy and feasibility of palm capillary blood glucose testing by the diabetes patients, and to evaluate the complementary substitution of the traditional SMBG approach, finger capillary glucose testing, by the palm testing, and to promote the effective utility of SMBG in order to help the diabetes patients achieve the treatment goals.MethodsThis study reviewed the related background knowledge in the literature and conducted a system review of the studies on POC glucose testing of palm capillary blood in the publications. A field study to compare the palm testing with other testing methods in fasting patients was implemented. Based on the results of the system review and the field study some strategies and suggestions were proposed to promulgate the palm AST and improve SMBG execution.ResultsSystemic review:Totally there are 6 English publications and 1 Chinese publication enrolled into the systemic review.The study finds that the below factors don't affect the results of blood glucose AST:√DM type (type 1 or type 2)√Treatment drug/approach (nutrition and exercise treatment, oral drugs, insulin and combination treatment)Also the systemic review identifies that:1 Among the various AST sites the palm generates the POC glucose testing data closest to those by the finger POC testing and venous blood glucose testing.2 The physiologic conditions in which the blood glucose level varies fast significantly affect the AST results. Compared with the status of fasting and two hours after food in-take, conditions within a short period prior to insulin injection or oral drug administration, exercise and food in-take have rapid change in blood glucose concentrations. In later cases the difference between the results of blood glucose tests on various sites is increased.Field study:Field study was conducted on 174 type 1 or type 2 diabetes patients.1 It is found by comparing the POC glucose test on palm capillary whole blood with the YSI2300 biochemical glucose test on finger capillary blood plasma:the difference between the palm testing result and the finger testing result of 98% of the tested patients meets the criteria set by ISO; the results of Parkes error grid analysis:96.6% in Zone A and 3.4% in Zone B. it is showed that palm testing achieves the required clinical accuracy.2 It is found by comparing the POC glucose test on palm capillary whole blood with the biochemical glucose assay on venous blood plasma:the difference between the palm testing result and the venous blood glucose testing result of 99% of the tested patients meets the criteria set by ISO; the results of Parkes error grid analysis:96.6% in Zone A and 3.4% in Zone B. it is showed that palm testing achieves the required clinical accuracy.The questionnaire survey finds:91.0% of the surveyed patients agreed that it was easy to hold the meter when performing the finger test;78.5% of the surveyed patients agreed that it was easy to hold the meter when performing the palm test;98.3% of the surveyed patients agreed that it was easy to read the number on the screen;99.4% of the surveyed patients agreed that it was easy to learn the palm test operation;98.9% of the surveyed patients agreed that it was easy to perform the palm test;90.4% of the surveyed patients agreed that the blood sample quantity of palm test was enough;63.8% of the surveyed patients agreed that the palm test was less painful than the finger test.71.8% of the surveyed patients agreed that they would try more palm test in daily SMBG.ConclusionThe palm AST is accurate and feasible. It meets the requirements for the patients to conduct SMBG. Hence it could contribute to improve the SMBG and the comprehensive management of DM to promote the palm AST. It is suggested to promulgate the palm AST in several target populations such as people testing blood glucose frequently, people sensitive to pain in finger testing, and people whose finger function could be impaired by finger testing. Palm testing is only recommended in fasting or preprandial conditions. For SMBG after food, exercise and drug the finger testing is still at the first priority.