J Korean Soc Endocrinol.  2006 Aug;21(4):281-289. 10.3803/jkes.2006.21.4.281.

Clinical Usefulness of Glucose Testing from the Forearm in Diabetic Patients

• Lee SW
• Chon S
• Oh S
• Woo JT
• Kim SW
• Kim JW
• Kim YS
• Paeng JR
• Koh G
• Nam HH

• KMID: 2200843
• DOI: http://doi.org/10.3803/jkes.2006.21.4.281

Abstract

BACKGROUND: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens(R) (i-Sens, Inc. Korea) device for diabetic patients.
METHODS
We measured the glucose level at the forearm by use of CareLance(R) (vaccum assisted lancing device) and also at the finger tip simultaneously by use of the CareSens(R) device at fasting and postprandial 2 hours, respectively. At the same time, the glucose levels of venous samples were checked by the laboratory method (BIOSEN 5030, EKF, Germany) and compared with those glucose level measured by the CareSens(R) device. We also checked the ease of use of the CareLance(R) and the associated pain of the patients by means of a visual analogue scale (VAS) at the time of blood sampling.
RESULTS
The glucose level obtained from the forearm and finger tip correlated well with that from the laboratory method, respectively. Error grid analysis showed that 100% of the measurements were clinically acceptable; forearm blood glucose testing by use of CareLance(R) was less painful and it was as easy to use as the finger prick (P < 0.05 and P = 0.04, respectively).
CONCLUSION
Forearm testing is an acceptable alternative to finger prick testing for measuring blood glucose in diabetic patients.

MeSH Terms

Blood Glucose
Blood Glucose Self-Monitoring
Compliance
Diabetes Mellitus
Fasting
Fingers
Forearm*
Glucose*
Humans
Blood Glucose
Glucose

Figure

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  Fig. 1 Blood glucose testing at finger tip and forearm by CareSens®. The finger tip was pricked by lancing device (A) and blood glucose level was measured through test strip (B). The forearm was lanced with CareLance® (vaccum assisted lancing device) (C) and blood glucose level was measured through test strip (D).

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  Fig. 2 Comparison of fasting glucose measurements at the forearm by CareSens® with the reference method (venous sampling) using the Clarke error grid analysis (n = 30); 100% of measurements were within zones A and B (93% within A).

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  Fig. 3 Bland-Altman analysis of fasting glucose measurements at the forearm by CareSens® with reference method (n = 30). The mean difference (solid line) and limits of agreement (mean ± 2SD, dotted line) are shown (7.98 ± 28.02%).

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  Fig. 4 Comparison of fasting glucose measurements at the finger tip by CareSens® with the reference method (venous sampling) using the Clarke error grid analysis (n = 30); 100% of measurements were within zones A and B (100% within A).

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  Fig. 5 Bland-Altman analysis of fasting glucose measurements at the finger tip by CareSens® with reference method (n = 30). The mean difference (solid line) and limits of agreement (mean ± 2SD, dotted line) are shown (1.87 ± 26.08%).

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  Fig. 6 Comparison of postprandial 2 hour glucose measurements at the forearm by CareSens® with the reference method (venous sampling) using the Clarke error grid analysis (n = 30); 100% of measurements were within zones A and B (90% within A).

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  Fig. 7 Bland-Altman analysis of postprandial 2 hour glucose measurements at the forearm by CareSens® with reference method (n = 30). The mean difference (solid line) and limits of agreement (mean ± 2SD, dotted line) are shown (10.18 ± 21.18%).

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  Fig. 8 Comparison of postprandial 2 hour glucose measurements at the finger tip by CareSens® with the reference method (venous sampling) using the Clarke error grid analysis (n = 30); 100% of measurements were within zones A and B (100% within A).

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  Fig. 9 Bland-Altman analysis of postprandial 2 hour glucose measurements at the finger tip by CareSens® with reference method (n = 30). The mean difference (solid line) and limits of agreement (mean ± 2SD, dotted line) are shown (4.51 ± 17.74%).

• 

  Fig. 10 Distribution of pain levels according to VAS at the forearm and finger tip.

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