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Item
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Alternative-Site
Testing (AST) Is Consistent With Fingertip BG Results
AST
results are consistent with fingertip BG results in
both the fasting state and 2 h postmeal; no benefit from
site preparation by local rubbing
The
objective of the study was to determine whether clinically
significant differences exist in fasting blood glucose
(BG) at the forearm, palm, and thigh relative to the
fingertip; to assess the impact of prandial status by
comparing BG between alternative sites and the
fingertip at several time intervals after carbohydrate intake;
to assess the effects of moderate brief exercise on site-to-site
differences in BG; to evaluate the impact of site preparation
by local rubbing on alternative-site testing (AST) equivalence;
and to determine levels of perceived pain and satisfaction associated
with AST.
Fasting
BG was measured using the One Touch Ultra (LifeScan,
Milpitas, CA) at the fingertip, palm, thigh, and each
forearm (with local rubbing) in 86 patients with type 2
diabetes. A 40-g carbohydrate meal was consumed and BG
was again measured from each site at 60, 90, and 120 min
postmeal, with an additional forearm test at 90 min without local
rubbing. Patients then exercised for 15 min with repeat BG
at each site. Differences in BG between sites were assessed using
repeated-measures ANOVA and regression analyses.
Significant
differences in BG at alternative sites were found 60
min postmeal (P = 0.0003) and postexercise (P =
0.037). Specifically, clinically significant differences
(expressed as percent difference from the fingertip) at
60 min include -8.8 ± 10.8% at the forearm and -13.7
± 10.7% at the thigh, and postexercise +19.1 ± 19.1%
at the forearm and +15.6 ± 22.6% at the thigh.
However, no significant differences were observed
between sites in either the fasting state or at 90 and
120 min postmeal. The dynamic results suggest a time
lag in equilibration of forearm and thigh BG during periods of
rapid glucose change. Palm and fingertip BG test results were
similar at all time points.
From
the results it was concluded that AST results are consistent with
fingertip BG results in both the fasting state and 2 h
postmeal; no benefit from site preparation by local
rubbing was noted. However, testing at sites other than
the hand cannot be recommended 1 h postmeal or
immediately after exercise. AST is equivalent and appropriate
for use at testing times commonly used in clinical practice.
Diabetes
Care April 2003
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