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Hughes K, Moore C, Woods S, Wilkes E. Precision and accuracy of a point of care glucometer for detection of hypoglycaemia in horses. Vet J 2024; 305:106109. [PMID: 38599544 DOI: 10.1016/j.tvjl.2024.106109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024]
Abstract
Point-of-care (POC) glucometry is commonly used in horses; however, measurement error with this method when analysing hypoglycaemic samples (<4 mmol/L) is unknown. The objective of this study was to determine the precision and accuracy of glucometry in hypoglycaemic horses in comparison to a laboratory method of glucose measurement (LAB). Repeatability coefficients were 0.47 mmol/L for POC and 0.09 mmol/L for LAB, and coefficients of variation were 10 % and 2.11 %, for the POC and LAB methods, respectively. Systemic bias with the POC method was present, with a mean bias of -0.26 mmol/L (95 % limits of agreement: -0.88 - 0.37) in comparison to LAB, and <70% of measurements were within 20 % of paired LAB results. Prior to use of glucometers, assessment of the diagnostic performance of the equipment is necessary, including determination of acceptable criteria and reference ranges for hypoglycaemic samples.
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Affiliation(s)
- Kristopher Hughes
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Locked Bag 588, Boorooma Street, Wagga Wagga, NSW 2678, Australia.
| | - Claire Moore
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Locked Bag 588, Boorooma Street, Wagga Wagga, NSW 2678, Australia
| | - Sophie Woods
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Locked Bag 588, Boorooma Street, Wagga Wagga, NSW 2678, Australia
| | - Edwina Wilkes
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Locked Bag 588, Boorooma Street, Wagga Wagga, NSW 2678, Australia
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Wong D, Malik C, Dembek K, Estell K, Marchitello M, Wilson K. Evaluation of a continuous glucose monitoring system in neonatal foals. J Vet Intern Med 2021; 35:1995-2001. [PMID: 34096103 PMCID: PMC8295665 DOI: 10.1111/jvim.16186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Monitoring blood glucose concentrations is common in critically ill neonatal foals, especially septic foals and those receiving naso‐esophageal feedings or IV parenteral nutrition. Glucose typically is measured using a point‐of‐care (POC) glucometer but requires repeated restraint and blood collections, which may cause irritation at venipuncture sites and increased demands on nursing staff. Continuous glucose monitoring systems (CGMS) may provide an accurate alternative for monitoring blood glucose concentration. Objectives To determine the correlation and accuracy of a CGMS to monitor neonatal foals' blood glucose concentrations as compared to a POC glucometer and laboratory chemistry analysis (CHEM). Animals Samples from 4 healthy and 4 ill neonatal foals. Methods A CGMS was placed on each foal, and glucose measurements acquired from this device were compared to simultaneous measurements of blood glucose concentration using a POC glucometer and CHEM. Results Two‐hundred matched glucose measurements were collected from 8 neonatal foals. The mean bias (95% limits of agreement) between CGMS and CHEM, CGMS and POC glucometer, and POC glucometer and CHEM was 3.97 mg/dL (−32.5 to 40.4), 18.2 mg/dL (−28.8 to 65.2), and 22.18 mg/dL (−9.3 to 53.67), respectively. The Pearson's correlation coefficient (r) was significantly correlated among all devices: GCMS and CHEM (r = 0.81), CGMS and POC glucometer (r = 0.77) and POC glucometer‐CHEM (r = 0.92). Conclusions and Clinical Importance Within the blood glucose concentration ranges in this study (78‐212 mg/dL), CGMS measurements were significantly correlated with CHEM, suggesting that it is an acceptable method to provide meaningful, immediate, and continuous glucose concentration measurements in neonatal foals while eliminating the need for repeated restraint and blood collection.
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Affiliation(s)
- David Wong
- Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Caitlin Malik
- Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Katarzyna Dembek
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Krista Estell
- Marion duPont Scott Equine Medical Center, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Megan Marchitello
- Marion duPont Scott Equine Medical Center, Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
| | - Katie Wilson
- Virginia Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Karapinar T, Tumer KC, Buczinski S. Evaluation of the Freestyle Optium Neo H point-of-care device for measuring blood glucose concentrations in sick calves. J Vet Intern Med 2020; 34:1650-1656. [PMID: 32420677 PMCID: PMC7379022 DOI: 10.1111/jvim.15794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022] Open
Abstract
Background Data on the performance of a glucometer in calves with different diseases are currently lacking. Objective The primary objective of this study was to evaluate the reliability of a point of care glucometer in calves affected by different diseases relative to a traditional bench‐top autoanalyzer. Animals One hundred ninety‐six calves with different disorders in a referral hospital. Methods Prospective study. Venous blood samples were used for the determination of glucose concentrations in blood and plasma using the Freestyle Optium Neo H and autoanalyzer, respectively. Data were subjected to Passing‐Bablok regression and Bland‐Altman plots. The Freestyle Optium Neo H was the test method and the autoanalyzer was the reference method. The diagnostic performance of the glucometer relative to the autoanalyzer was assessed using 3 different plasma glucose concentrations. Results The Passing‐Bablok regression for the glucometer against the reference method revealed the presence of both proportional bias (1.12; 95% confidence interval [CI], 1.07‐1.18) and constant bias (−11.25; 95% CI, −16.0 to −7.70). The glucometer yielded 92.2%‐100% sensitivity and 86.4%‐96% specificity for the assessing glucose concentration based on different concentration thresholds. Conclusions and Clinical Importance The Freestyle Optium Neo H showed proportional and constant biases relative to the reference method. The glucometer showed poor performance according to criteria recommended by the International Standards Organization and the American Society for Veterinary Clinical Pathology. However, the glucometer determined hypoglycemia with high sensitivity and specificity therefore it might be used to diagnose hypoglycemia in calves with different diseases until calf‐specific POC glucometers are developed.
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Affiliation(s)
- Tolga Karapinar
- Department of Internal Medicine, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Kenan Cagri Tumer
- Department of Internal Medicine, Faculty of Veterinary Medicine, Firat University, Elazig, Turkey
| | - Sébastien Buczinski
- Département des sciences cliniques, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
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Precision and accuracy of a point-of-care glucometer in horses and the effects of sample type. Vet J 2019; 252:105359. [PMID: 31554585 DOI: 10.1016/j.tvjl.2019.105359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
Point-of-care glucometry is used commonly in clinical and research settings; however, accuracy and precision of this method are concerns. The objectives of this study were to determine the accuracy of glucometry in adult horses and the precision of duplicate measurements. Blood samples were collected from 62 horses into one plain syringe, one EDTA tube and three fluoride oxalate (FO) tubes. Immediately after collection, glucose concentrations in whole blood were determined, in duplicate, by glucometry from the syringe (plain whole blood [WB] group), EDTA tube (EDTA group) and one FO tube (FO group). One FO sample was used to measure plasma glucose concentration by a laboratory chemistry analyser (LAB group) ≤1 h after collection. The third FO tube was used to measure plasma glucose concentration by glucometry after 3 h storage (FO3hr group). Adequate precision was present for all groups (coefficient of variation: 0.7-3.5%) except WB (5.5-9.4%). Between groups, correlations were significant (P < 0.05; except for WB-EDTA), varied with group comparison, and tended to be lowest for comparisons involving WB. Mean bias was lowest for WB-LAB and greatest for FO-LAB and FO3hr-LAB; however, the limits of agreement were ≥4.65 mmol/L for WB-LAB and ≤2.75 mmol/L for most other comparisons. For the glucometer used, performance was influenced by sample type: WB was unsuitable, while FO or EDTA samples resulted in adequate precision and accuracy, provided under-estimation of glucose concentrations is accounted for by using method-specific reference ranges. Glucometer performance and optimal sample type(s) should be determined prior to use in horses.
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Gerber KL, Freeman KP. ASVCP guidelines: quality assurance for portable blood glucose meter (glucometer) use in veterinary medicine. Vet Clin Pathol 2016; 45:10-27. [DOI: 10.1111/vcp.12310] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karen L. Gerber
- College of Public Health, Medical and Veterinary Sciences; James Cook University; Townsville Qld Australia
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Radcliffe RM, Buchanan BR, Cook VL, Divers TJ. The clinical value of whole blood point-of-care biomarkers in large animal emergency and critical care medicine. J Vet Emerg Crit Care (San Antonio) 2015; 25:138-51. [PMID: 25590562 DOI: 10.1111/vec.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/15/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To summarize the current medical literature and provide a clinical perspective of whole blood point-of-care (POC) biomarkers in large animal emergency and critical care practice. DATA SOURCES Original studies, reviews, and textbook chapters in the human and veterinary medical fields. SUMMARY POC biomarkers are tests used to monitor normal or disease processes at or near the patient. In both human and veterinary medicine these tools are playing an increasingly important role in the management of critical diseases. The most important whole blood POC biomarkers available for veterinary practitioners include l-lactate, cardiac troponin I, serum amyloid A, triglyceride, creatinine, and glucose, although many other tests are available or on the horizon. CONCLUSION Whole blood POC biomarkers enable clinicians to provide improved management of critical diseases in large animals. These tools are especially useful for establishing a diagnosis, guiding therapy, and estimating disease risk and prognosis.
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Affiliation(s)
- Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Tennent-Brown BS, Koenig A, Williamson LH, Boston RC. Comparison of three point-of-care blood glucose meters for use in adult and juvenile alpacas. J Am Vet Med Assoc 2011; 239:380-6. [DOI: 10.2460/javma.239.3.380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Rapid evaluation and intervention is a requirement and a characteristic of patient management in neonatal intensive care units, and this applies for equine neonates also. Appropriate interventions are based on solid knowledge of age, maturity, and species-specific differences in reference ranges. Point-of-care (POC) testing devices speedup decision making regarding treatments and interventions. However, there are potential limitations of these devices when applied to age groups and species beyond those they were specifically developed for. This article discusses the age-specific differences in the reference ranges and the potential limitations of POC devices currently used, which may affect delivery of care.
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Berkeley EV, Linklater WL, Dierenfeld ES. Dietary impact on circulating glucose profiles in the white rhinoceros. J Anim Physiol Anim Nutr (Berl) 2010; 95:245-51. [DOI: 10.1111/j.1439-0396.2010.01047.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Glucose assessment and regulation are important factors in the treatment of hospitalized horses and foals. HYPOTHESIS/OBJECTIVES The purpose of this study was to compare glucose measurement by a veterinary glucometer, adjusted by code for use in horses and foals, to a reference chemistry analyzer. It was hypothesized that the veterinary glucometer and reference analyzer would yield similar results and that interpretation of glucose values obtained from a veterinary glucometer would result in clinically appropriate decisions. ANIMALS Fifty blood samples from adult horses and 50 blood samples from neonatal foals admitted to the Colorado State University Veterinary Hospital or Equine Reproduction Laboratory for evaluation. METHODS Glucose concentrations from fresh whole blood samples were evaluated in duplicate with a veterinary glucometer and these values were compared with those obtained with a reference plasma chemistry analyzer. The accuracy of glucometer measurement was evaluated with a Clarke error grid. RESULTS The veterinary glucometer accurately measured whole blood glucose concentrations in both horses and foals when compared with a reference plasma chemistry analyzer. Nearly 97% of the glucometer values obtained in this study would have resulted in appropriate clinical decisions based on the Clarke error grid analysis. CONCLUSIONS AND CLINICAL IMPORTANCE The veterinary glucometer evaluated has potential utility for point-of-care whole blood glucose evaluation in both horses and foals.
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Affiliation(s)
- E S Hackett
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
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Hollis AR, Furr MO, Magdesian KG, Axon JE, Ludlow V, Boston RC, Corley KTT. Blood glucose concentrations in critically ill neonatal foals. J Vet Intern Med 2008; 22:1223-7. [PMID: 18691362 DOI: 10.1111/j.1939-1676.2008.0174.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
REASONS FOR PERFORMING STUDY Critical illness is associated with hyperglycemia in humans, and a greater degree and duration of hyperglycemia is associated with nonsurvival. Hypoglycemia is also seen in critically ill humans, and is associated with nonsurvival. This might also be true in the critically ill foal. OBJECTIVES To investigate the association of blood glucose concentrations with survival, sepsis, and the systemic inflammatory response syndrome (SIRS). METHODS Blood glucose concentrations at admission (515 foals) and 24 hours (159 foals), 36 hours (95), 48 hours (82), and 60 hours (45) after admission were analyzed. Logistic regression analyses were performed to investigate the association of glucose concentrations with survival, sepsis, a positive blood culture, or SIRS. RESULTS 29.1% of foals had blood glucose concentrations within the reference range (76-131 mg/dL) at admission, 36.5% were hyperglycemic, and 34.4% were hypoglycaemic. Foals that did not survive to hospital discharge had lower mean blood glucose concentrations at admission, as well as higher maximum and lower minimum blood glucose concentrations in the 1st 24 hours of hospitalization, and higher blood glucose at 24 and 36 hours. Foals with blood glucose concentrations <2.8 mmol/L (50 mg/dL) or >10 mmol/L (180 mg/dL) at admission were less likely to survive. Hypoglycemia at admission was associated with sepsis, a positive blood culture, and SIRS. CONCLUSIONS AND POTENTIAL RELEVANCE Derangements of blood glucose concentration are common in critically ill foals. Controlling blood glucose concentrations may therefore be beneficial in the critically ill neonatal foal, and this warrants further investigation.
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Affiliation(s)
- A R Hollis
- New Bolton Center, Kennett Square, PA, USA
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Hollis AR, Dallap Schaer BL, Boston RC, Wilkins PA. Comparison of the Accu-Chek Aviva point-of-care glucometer with blood gas and laboratory methods of analysis of glucose measurement in equine emergency patients. J Vet Intern Med 2008; 22:1189-95. [PMID: 18638018 DOI: 10.1111/j.1939-1676.2008.0148.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND More information is needed regarding accuracy of commonly used methods of glucose measurement in the critically ill horse. HYPOTHESIS Glucometry will have good agreement with a laboratory standard. Glucometry with plasma will have better agreement than when performed with whole blood. ANIMALS Fifty sequentially admitted equine emergency patients, aged >1year. METHODS Venous blood was collected at admission and immediately analyzed by point-of-care glucometry on both whole blood (POC/WB) and plasma (POC/PL), a multielectrode blood gas analyzer with whole blood (BLG), and a standard laboratory method with plasma (CHEM). Paired data were compared using Lin's concordance correlation, Pearson's correlation, and robust regression. Bias and limits of agreement were tested by the Bland-Altman technique. Bivariate regression analysis was used to explore confounding factors. RESULTS Concordance was significant for all comparisons, and was strongest for CHEM-POC/PL (0.977) and weakest for POC/WB-POC/PL (0.668). Pearson's correlation was excellent for all comparisons except those with POC/WB. All comparisons had excellent robust regression coefficients except those with POC/WB. CONCLUSIONS AND CLINICAL IMPORTANCE POC glucometry with plasma had excellent agreement with a laboratory standard, as did blood gas analysis. POC glucometry with whole blood correlated poorly with a laboratory standard. These differences may be clinically important, and could affect decisions based on glucose concentrations.
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Affiliation(s)
- A R Hollis
- School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, PA 19348, USA
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