Issues and implications in the selection of blood glucose monitoring technologies

Over the last 2 decades assay technology originating in the laboratory has been adapted for the special situation of in vitro blood glucose monitoring in the home, at work or play, or at the bedside. The availability of blood glucose monitoring devices has had a significant impact on the treatment of diabetes, especially with respect to involving the patients in their treatment. The unique requirements of this type of testing have led to novel developments in sample acquisition techniques, analyte detection, measurement techniques, and error detection. The performance of these in vitro devices in terms of accuracy and imprecision is largely dependent on factors that contribute to variation in response that are related to testing with blood samples outside of the laboratory. These factors include, for example, variations in environmental conditions, the variability of hematocrit and oxygen concentrations of the blood, and the fact that the blood is used undiluted. Therefore, the technologies used have been selected, developed, optimized, and calibrated to minimize the impact of these factors. The technologies also must be capable of providing accurate, reproducible results over the large range of clinical interest from the hypoglycemic range to glucose concentrations 10 to 15 to 20 times greater. However, when selecting a technology there are invariably some trade-offs to consider. Thus, the products must be optimized to balance performance, reliability, and cost. Examples are discussed.