The accuracy of home glucose meters for the glucose range anticipated in pregnancy

Home glucose meters are used almost universally for the management of pregnant women with diabetes. However, the degree of accuracy of meters in general and particularly for the lower glucose range, is questionable. Six of the most commonly used meters in Australia were evaluated for analytical accuracy for glucose levels < 8.0 mmol/L--a level below which many important clinical management decisions are made. Two meters, Elite and Precision QID, cannot be recommended. The other 4 meters, Glucometer 3, Reflolux S, Alpha and Advantage produced results with a higher degree of analytical accuracy. Of the meters tested, the Accutrend Alpha had the highest proportion of results within 5% and 10% of a laboratory reference method, the lowest bias with the Altman Bland method of comparison, and is recommended for use in pregnancy. No meter approached the analytical accuracy goal recommended by the American Diabetes Association. Manufacturers should be encouraged to develop or adapt systems for use in pregnancy.