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.
Source: Diabetes In Control Dot Com: Diabetes Care
April 2003.
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