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Comparison of a human portable blood glucose meter, veterinary portable blood glucose meter, and automated chemistry analyzer for measurement of blood glucose concentrations in dogs

Beth M. Johnson DVM, DACVIM1, Michael M. Fry DVM, MS, DACVP2, Bente Flatland DVM, MS, DACVIM, DACVP3, and Claudia A. Kirk DVM, PhD, DACVIM, DACVN4
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  • 1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 2 Department of Pathobiology, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 3 Department of Pathobiology, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 4 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.

Abstract

Objective—To compare blood glucose concentrations measured with 2 portable blood glucose meters (PBGMs) validated for use in dogs (PBGM-D) and humans (PBGM-H) and an automated chemistry analyzer.

Design—Validation study.

Sample Population—92 samples of fresh whole blood and plasma from 83 dogs with various diseases.

Procedures—Each PBGM was used to measure whole blood glucose concentration, and the automated analyzer was used to measure plasma glucose concentration. Passing-Bablok linear regression and Bland-Altman plots were used to determine correlations and bias between the PBGMs and the automated analyzer. Calculated acceptability limits based on combined inherent instrument imprecision were used with Bland-Altman plots to determine agreement. Clinical relevance was assessed via error grid analysis.

Results—Although correlation between results of both PBGMs and the standard analyzer was > 0.90, disagreement was greater than could be explained by instrument imprecision alone. Mean difference between PBGM-H and chemistry-analyzer values was −15.8 mg/dL. Mean difference between PBGM-D and chemistry-analyzer values was 2.4 mg/dL. Linear regression analysis revealed proportional bias of PBGM-H (greater disagreement at higher glucose concentrations); no proportional bias was detected for PBGM-D. No constant bias was detected for either PBGM. Error grid analysis revealed all measurements from both PBGMs were within zones without an anticipated effect on clinical outcome.

Conclusions and Clinical Relevance—Neither PBGM had exact agreement with the automated analyzer; however, the disagreement detected did not have serious clinical consequences. Our findings stressed the importance of using the same device for monitoring trends in dogs and using instrument-specific reference ranges.

Abstract

Objective—To compare blood glucose concentrations measured with 2 portable blood glucose meters (PBGMs) validated for use in dogs (PBGM-D) and humans (PBGM-H) and an automated chemistry analyzer.

Design—Validation study.

Sample Population—92 samples of fresh whole blood and plasma from 83 dogs with various diseases.

Procedures—Each PBGM was used to measure whole blood glucose concentration, and the automated analyzer was used to measure plasma glucose concentration. Passing-Bablok linear regression and Bland-Altman plots were used to determine correlations and bias between the PBGMs and the automated analyzer. Calculated acceptability limits based on combined inherent instrument imprecision were used with Bland-Altman plots to determine agreement. Clinical relevance was assessed via error grid analysis.

Results—Although correlation between results of both PBGMs and the standard analyzer was > 0.90, disagreement was greater than could be explained by instrument imprecision alone. Mean difference between PBGM-H and chemistry-analyzer values was −15.8 mg/dL. Mean difference between PBGM-D and chemistry-analyzer values was 2.4 mg/dL. Linear regression analysis revealed proportional bias of PBGM-H (greater disagreement at higher glucose concentrations); no proportional bias was detected for PBGM-D. No constant bias was detected for either PBGM. Error grid analysis revealed all measurements from both PBGMs were within zones without an anticipated effect on clinical outcome.

Conclusions and Clinical Relevance—Neither PBGM had exact agreement with the automated analyzer; however, the disagreement detected did not have serious clinical consequences. Our findings stressed the importance of using the same device for monitoring trends in dogs and using instrument-specific reference ranges.

Contributor Notes

Supported by Dr. Karen Tobias and the Angel Fund.

The authors thank Charles Lewis, Martha Daughtridge, and Shanna Hillsman for data collection.

Address correspondence to Dr. Johnson (bethjohnson@utk.edu).