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A glucose meter (or glucometer) is a medical device for determining the approximate amount of glucose in a drop of blood obtained by pricking the skin with a lancet. Glucose meters are portable and designed for use by laypersons, including those with diabetes.
The glucose meter is a key element of home blood glucose monitoring (HBGM, also called "home blood glucose monitoring") by people with diabetes mellitus or with proneness to hypoglycemia. Since approximately 1980, a primary goal of the management of type 1 diabetes has been the achievement of closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. This has greatly increased the trouble and time spent in the daily care of this disease but has also reduced rates of long-term complications and improved the management of short-term, potentially life-threatening complications such as hypoglycemia.
There are now dozens of models of glucose meters. Typical features common to most:
- The average size is now approximately the size of the palm of the hand, though some are smaller or a bit larger. They are battery-powered.
- A consumable element containing chemicals which react with glucose in the drop of blood is used for each measurement. For most models this element is a plastic test strip with a small spot impregnated with glucose oxidase and other components. Each strip can only be used once and is then discarded.
- The glucose value in mg/dl or mmol/l displayed in a small window. The preferred measurement unit varies by country. Mg/dl are preferred in the US, mmol/l in Canada and Europe. To convert mmol/l of glucose to mg/dl, multiply by 18. To convert mg/dl of glucose to mmol/l, divide by 18 or multiply by 0.055. Many machines can toggle between both types of measurements and there have been a couple of published instances in which someone with diabetes has been misled into the wrong actions by assuming that a reading in mmol/l was really a very low reading in mg/dl, or the converse. Other machines are pre-set at the factory and cannot be changed.
- Current "count times" range from 5 to 60 seconds for different models.
- The size of the drop of blood needed by different models currently varies from 0.3 to 10 μl. Older models required larger blood samples, usually defined as a "hanging drop" from the fingertip. Smaller volume requirements reduce the frequency of unproductive pricks.
- Smaller drop volumes have enabled "alternate site testing"-- pricking the forearm or other less sensitive areas instead of the fingertips. Although less uncomfortable, readings obtained from forearm blood lag behind fingertip blood in reflecting rapidly changing glucose levels in the rest of the body.
- All meters now include a clock which must be set for date and time, and a memory for past test results. The memory is an important aspect of diabetes care, as it enables the person with diabetes to keep a record of management and look for trends and patterns in blood glucose levels over days. Most memory chips can display an average of recent glucose readings.
- Many meters have now have more sophisticated data handing capabilities. Many can be downloaded by a cable or infrared to a computer which has software to display the test results in a variety of formats. Some meters allow entry of additional data throughout the day, such as insulin dose, amounts of carbohydrates eaten, or exercise.
- A number of meters have been combined with other devices, such as insulin injection devices, PDAs. A radio link to an insulin pump allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose. One model also measures beta-hydroxybutyrate in the blood to detect ketoacidosis (ketosis).
- Special glucose meters for multi-patient hospital use are now used. These provide more elaborate quality control records, and the data handling capabilities are designed to transfer glucoses into electronic medical records and the laboratory computer systems for billing purposes.
The cost of daily testing is one of the most expensive aspects of diabetes care. In 2006, the consumer cost of each glucose strip ranges from about States dollar|$" target="_blank" >*0.35 to 1.00 , so that testing 4 times a day costs about States dollar|$" target="_blank" >*3-4 a day for people with diabetes. Manufacturers often provide meters at no cost to induce use of the profitable test strips. Type 1 diabetics test as often as ten to twelve times a day due to the dynamics of insulin adjustment, whereas type 2 test less frequently, especially when insulin is not part of treatment.
Accuracy of glucose meters is a common topic of clinical concern. Nearly all of the meters have similar accuracy (±10-15%) when used optimally. However, a variety of factors can affect the accuracy of a test. Factors affecting accuracy of various meters have included calibration of meter, ambient temperature, pressure use to wipe off strip, size of blood sample, high levels of certain drugs in blood, hematocrit, dirt on meter, humidity, and aging of test strips. Models vary in their susceptibility to these factors, and in their ability to prevent or warn of inaccurate results with error messages. The Clarke error grid is a common way of analyzing and displaying accuracy of readings related to management consequences.
History
The earliest widely-used meter was the Ames Reflectance Meter, which was used in American hospitals in the 1970s. It was about 10 inches long and required connection to an electrical outlet for power. A moving needle indicated the blood glucose reading after 60 seconds.
Home glucose monitoring was demonstrated to improve glycemic control of type 1 diabetes in the late 1970s, and the first meters were marketed for home use around 1980. The 2 models initially dominant in North America in the 1980s were the Glucometer and the Accuchek meter, and to many nurses and other medical professionals these brand names became synonymous with the generic product (the Kleenex/Xerox phenomenon) and are still current in hospitals.
Test strips that changed color and could be read "visually", without a meter, were also widely used in the 1980s. They had the added advantage that they could be cut with scissors longitudinally to save money. As meter accuracy and insurance coverage improved, they lost popularity and are no longer marketed.
At least in North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of laboratories argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. Patients with diabetes and their endocrinologists eventually persuaded acceptance.
Home glucose testing was adopted for type 2 diabetes more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing.
Future
Noninvasive devices enabling continuous monitoring. Research is done using electric current, ultrasound and other methods for metering.
Since 2001 a first device (no full replacement for existing methods) is available.
It is speculated that within the next decade, meters may be replaced with continuous glucose sensors for many people with diabetes. This will likely decrease complications found in people with diabetes by limiting both high glucose levels, hypoglycemic events, and glycemic excursions.
Technology
So far all glucose meters have in some way employed the oxidation of glucose to gluconolactone catalyzed by glucose oxidase.
The first-generation devices relied on the same colorimetric reaction that is still used nowadays in glucose test sticks for urine. Besides glucose oxidase, the test kit containes a benzidine derivative, which is oxidized to a blue polymer by the hydrogen peroxide formed in the oxidation reaction. The disadvantage of this method was that the test stick had to be developed after a precise interval (the blood had to be washed away), and the meter needed to be calibrated frequently.
Today's glucometers use a coulometric method. Test strips contain a capillary that sucks up a reproducible amount of blood and an enzyme electrode containing glucose oxidase. The enzyme is reoxidized with an excess of ferrocyanide ion. The total charge passing through the electrode is measured and is proportional to the concentration of glucose in the blood.
Meter use for hypoglycemia
Although the apparent value of immediate measurement of blood glucose might seem to be higher for hypoglycemia than hyperglycemia, meters have been less useful. The primary problems are precision and ratio of false positive and negative results. An imprecision of ±15% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg/dl compared with 260 (i.e., a "true" glucose of 230±15%), but the difference between 70 mg/dl and 55 (i.e., 67±15%) represents a more unsatisfactory uncertainty. The imprecision is compounded by the relative likelihoods of false positives and negatives in populations of people with diabetes and those without diabetes. People with type 1 diabetes usually have glucose levels above normal, often ranging from 40 to 500 mg/dl (2.2 to 28 mmol/l), and when a meter reading of 50 or 70 (2.8 to 3.9 mmol/l) is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a "true positive" and little harm done if it is a "false positive." In contrast, people who do not have diabetes but periodically have hypoglycemic symptoms will have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e.g., congenital hyperinsulinism), to ensure that the average glucoses when fasting remain above 70 mg/dl (3.9 mmol/l).
"Glucose meter"