Diabetes Centre, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Diabet Med. 2011 Oct;28(10):1272-6. doi: 10.1111/j.1464-5491.2011.03362.x.
Icodextrin is a glucose polymer used to maintain an osmotic gradient in peritoneal dialysis. Metabolites of icodextrin are known to cause overestimation of blood glucose in glucose meters using glucose dehydrogenase/pyrroloquinolinequinone systems. The aim of this study is to determine the extent of icodextrin interference in glucose meters using the newer glucose dehydrogenase/NAD or glucose oxidase systems. This has not been established previously.
Fasting blood samples (n = 4) were spiked with either one icodextrin metabolite (maltose, maltotriose or maltotetraose) or a combination, at various blood concentrations expected during dialysis. Samples were tested in triplicate on: five glucose-meters, a Radiometer® (glucose oxidase/hydrogen peroxide) and laboratory (hexokinase) analysers. Each meter was also tested on blood from six patients undergoing dialysis. Accuracy was evaluated as % Bias = [(meter glucose - laboratory glucose)/laboratory glucose] × 100.
A single icodextrin metabolite affected glucose measurements and, in combination, the interferences were additive in the two Accu-Chek® and Optium® Xceed meters by > 10%. Amongst these meters, the Optium Xceed 5-s machine was less affected. Meters using glucose oxidase were least affected by interference. A similar trend in interference was observed in vivo.
While meters using glucose dehydrogenase/NAD are less affected by icodextrin metabolites, interference can still be demonstrated. The degree of interference can vary in different glucose meters using this enzyme/cofactor system, as seen in the Optium Xceed machines. Icodextrin is an important source of interference that sometimes even experienced professionals are unaware of and which leads to clinically significant errors in insulin dose adjustment. Awareness of this interference and selection of the most appropriate glucose meters are crucial to minimize this hazard.
艾考糊精是一种葡萄糖聚合物，用于维持腹膜透析中的渗透梯度。艾考糊精的代谢物已知会导致使用葡萄糖脱氢酶/吡咯喹啉醌系统的血糖仪对血糖值产生过高估计。本研究旨在确定使用更新的葡萄糖脱氢酶/NAD 或葡萄糖氧化酶系统的血糖仪中艾考糊精的干扰程度。这在以前尚未确定。
空腹血样（n=4）分别加入一种艾考糊精代谢物（麦芽糖、麦芽三糖或麦芽四糖）或组合，在透析过程中预期的各种血液浓度下进行添加。将样品在五台血糖仪、一台 Radiometer®（葡萄糖氧化酶/过氧化氢）和实验室（己糖激酶）分析仪上进行三次重复测试。每台血糖仪还在六名接受透析的患者的血液上进行了测试。准确性评估为%偏差=[（血糖仪血糖-实验室血糖）/实验室血糖]×100。
单个艾考糊精代谢物会影响血糖测量值，而在组合中，在 Accu-Chek®和 Optium® Xceed 两台血糖仪中，干扰作用相加超过 10%。在这些血糖仪中，Optium Xceed 5-s 机器受影响较小。使用葡萄糖氧化酶的血糖仪受干扰影响最小。在体内也观察到了类似的干扰趋势。
虽然使用葡萄糖脱氢酶/NAD 的血糖仪受艾考糊精代谢物的影响较小，但仍能证明存在干扰。在使用这种酶/辅酶系统的不同血糖仪中，干扰的程度可能会有所不同，正如 Optium Xceed 机器所看到的那样。艾考糊精是一个重要的干扰源，有时甚至是经验丰富的专业人员也没有意识到，这会导致胰岛素剂量调整的临床显著错误。了解这种干扰并选择最合适的血糖仪对于最大限度地减少这种危险至关重要。
