Assessment of the performance of blood glucose monitoring systems for monitoring dysglycaemia in neonatal patients

• Published in: BMJ paediatrics open 2018-10, Vol.2 (1), p.e000339-e000339
• Main Authors: Ba, Yin, Xu, Jin, Yuan, Lin, Zhu, Haiyan, Yang, Yipei, Lam, Mei Mei, Zhang, Shulian, Xiao, Mili, Xu, Jiayin, Zhang, Rong, Chen, Chao
• Format: Article
• Language: English
• Subjects: Accuracy; Bias; blood glucose monitoring; Clinical outcomes; Data analysis; dysglycaemia; Endocrinology; Glucose monitoring; Hyperglycemia; Hypoglycemia; Intensive care; ISO standards; isotope dilution Liquid Chromatography Mass Spectrometry; Laboratories; Lactose; Mass spectrometry; Monitoring systems; neonates; Newborn babies; Patients; Pediatrics; Risk assessment; Scientific imaging; Software
• ISSN: 2399-9772; 2399-9772
• DOI: 10.1136/bmjpo-2018-000339

ObjectiveTo validate a three-step protocol that assesses the clinical risk associated with using blood glucose monitoring systems (BGMS) in neonates for the management of dysglycaemia.MethodThe three-step validation approach included confirmation of the accuracy of the reference method using National Institute of Standards and Technology (NIST) glucose standards, assessment of analytical risk performed on whole blood collected from paediatric patients routinely tested for glucose and a clinical risk assessment performed using heel stick capillary samples collected from 147 new-born babies and neonates admitted to intensive care. BGMS glucose measurements were compared with the NIST aligned laboratory reference method.ResultsThe accuracy of the laboratory reference method was confirmed with the NIST standards. Specificity studies demonstrated that the accuracy of one of the BGMS was affected, particularly, in the hypoglycaemic range, by known interference factors including haematocrit, ascorbic acid, lactose, galactose, N-acetylcysteine and glutathione. The accuracy of the other BGMS was unaffected. The clinical performance of this BGMS in neonates met the system accuracy criteria of Clinical and Laboratory Standards Institute (CLSI) POCT 12-A3 standard for evaluating hospital BGMS with 95.1% of glucose measurements within±0.67 mmol/L for samples ≤5.55 mmol/L and 95.6% within±12.5% for samples>5.55 mmol/L.ConclusionsThis three-step validation protocol provides a challenging approach for determining the accuracy and reliability of BGMS for managing dysglycaemia in neonates. StatStrip BGMS achieved analytical and clinical performance criteria confirming its suitability for use in neonates. We advocate that this validation approach should be considered for performance evaluations of both BGMS and continuous glucose monitoring systems going forward.