Clinical Impact of Prandial State, Exercise, and Site Preparation on the Equivalence of Alternative-Site Blood Glucose Testing

• Published in: Diabetes care Vol. 26; no. 4; pp. 981 - 985
• Main Authors: BINA, Dawn M, ANDERSON, Robyn L, JOHNSON, Mary L, BERGENSTAL, Richard M, KENDALL, David M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-04-2003
• Subjects: Adult; Biological and medical sciences; Blood Glucose Self-Monitoring - methods; Blood sugar; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diagnostic tests; Eating - physiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Evaluation; Exercise; Exercise - physiology; Fingers; Forearm; Glucose; Glucose monitors; Hand; Humans; Injections; Management. Various non-drug treatments. Langerhans islet grafts; Measurement; Medical sciences; Methods; Postprandial Period - physiology; Reproducibility of Results; Time Factors; United States; Endocrinopathy; Human; Physical exercise; Site; Postprandial; Samplings; Non insulin dependent diabetes; Biological monitoring; Preparation; Adult; Fast; Comparative study; Glycemia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.26.4.981

Clinical Impact of Prandial State, Exercise, and Site Preparation on the Equivalence of Alternative-Site Blood Glucose Testing
Dawn M. Bina , CMT ,
Robyn L. Anderson , MPH ,
Mary L. Johnson , RN, CDE ,
Richard M. Bergenstal , MD and
David M. Kendall , MD
International Diabetes Center, Minneapolis, Minnesota
Abstract
OBJECTIVE —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.
RESEARCH DESIGN AND METHODS —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.
RESULTS —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.
CONCLUSIONS —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.
AST, alternative-site testing
BG, blood glucose
SMBG, self-monitoring of blood glucose
Footnotes
Address correspondence and reprint requests to Robyn L. Anderson, MPH, International Diabetes Center, 3800 Park Nicollet Blvd.,
Minneapolis, MN 55416. E-mail: anderro{at}parknicollet.com .
Received for publication 17 October 2002 and accepted in revised form 23 December 2002.
D.M.B. and R.M.B. have received grant/research support from LifeScan, Inc., a manufacturer of pharmaceuticals related to the
treatment of diabetes.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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