A replay

I recently published a Letter to the Editor to Clinical Chemistry, which critiques a simulation of glucose error on insulin dosing. The authors’ reply to my Letter leaves something to be desired. Since a subscription is required to view these, here is the gist of my Letter and the authors’ reply.

The authors modeled glucose error as two times the CV plus bias to simulate 95% of the error. I argued that one needs to also

1)      model random patient interferences

2)      model user error

3)      to model 95% of the error results isn’t good enough – they need to model 100% of the errors.

They answered #1 only saying I was correct but they don’t know how to model random patient interferences. I don’t think it’s that hard. Putting  – “hematocrit interference” glucose –  in Google yielded 435 results including a paper by one of the authors! (Evaluation of the impact of hematocrit and other interference on the accuracy of hospital-based glucose meters). Another title in this list is: A mathematical model to assess the influence of hematocrit on point of care glucose meter performance. Of course, there are other interfering substances and general methods to assess them.

But more importantly, the authors did not answer points 2 and 3 in their reply.

In 2001, I critiqued a similar paper (one of the current authors c0-wrote the earlier article) and their reply was similar. In my earlier critique, I only mentioned point 1 above.

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