AACC 2014 and glucose meters

July 31, 2014

glucose

There was a symposium about glucose meters with three outstanding talks. BTW, one nice feature of this year’s AACC meeting was that one could easily download each speaker’s presentation. The first talk by Dr. David Sacks reviewed the current glucose meter error grids:

the 2013 version of ISO 15197 for SMBG meters
the 2013 version of POCT12-A3 for hospital meters
the 2014 draft FDA guidance for SMBG meters
the 2014 draft FDA guidance for hospital meters

Dr. Sacks never mentioned that the 2014 draft FDA guidance for hospital meters says: don’t use the ISO standard – it does not adequately protect patients. Now, the FDA probably meant don’t use POCT12-A3, since that standard is for hospital meters, but the point is FDA is not happy with either the ISO or CLSI glucose meter standard, which is why they wrote their own.

After the talks, there was a question and answer session whereby Mitch Scott, the chair of the symposium, asked Dr. Sacks why the POCT12-A3 standard allows 2% of results to be unspecified (meters can have any values relative to reference). This is somewhat of a strange question since Dr. Scott was a member of the POCT12-A3 committee and previously answered this question himself in a public meeting – as the 2% was a compromise. Dr. Sacks’s answer was different. He said you can’t prove that 100% of the results are within limits, which is of course true but this is not a reason for setting such a goal. I made this point in a brief comment. I have also published the absurdity that goes with Dr. Sacks’s reasoning in that no one would specify a goal for 98% “right” site surgery (95% in the article since it dealt with an earlier standard) – see: Wrong thinking about glucose standards. Krouwer JS Clin Chem 2010;56:874-875. And since there are about 8 billion glucose meter results in the US each year, allowing 2% to be anywhere means that 160 million glucose results could potentially harm patients. Another way to say that 2% of a huge number is still a very big number.

 

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Published: Acute Versus Chronic Injury in Error Grids

July 19, 2014

article

This is a Letter to the editor (1) based on a new revision to the glucose meter error grid (2). The gist of the Letter is as follows. The glucose meter error grid procedure involved surveying clinicians as to what glucose levels would prompt them to treat patients. But this deals with symptoms or acute injury. If a glucose meter met these limits, one might think all is well. But diabetes also involves complications from continued elevated glucose. The Letter proposed a different error grid is required for chronic injury.

References

  1. Krouwer JS and Cembrowski GS Acute Versus Chronic Injury in Error Grids J Diabetes Sci Technol. http://dst.sagepub.com/content/early/2014/07/16/1932296814543662 Note: subscription may be required.
  2. Klonoff DC, Lias C, Vigersky R, et al The surveillance error grid. J Diabetes Sci Technol. 2014;8:658-672.