Stabilization of glucose in blood samples: why it matters
Open accessAbstract
In this issue of Clinical Chemistry , Gambino et al. (1) describe careful studies of a blood-collection container that stabilizes the concentration of glucose in blood samples. At a time of an increasing disease burden attributable to diabetes and the use of lower glucose concentrations than in the past for the diagnosis of diabetes, this study and its findings are especially important. Measurements of glucose are used worldwide to diagnose diabetes and to identify patients at risk of developing diabetes [e.g., (2)(3)]. For both diagnosis and risk assessment, fixed cutpoints of plasma glucose concentrations are used to classify patients and to make decisions regarding management. For this reason, all steps in the analytical process require careful attention. Clinical chemists in hospital laboratories and diagnostic companies have made great strides in improving the measurement of glucose. With the use of enzymatic methods and sophisticated analyzers with stable optics, electronics, fluid handling, and other components, central clinical laboratories routinely achieve an astoundingly low within-laboratory imprecision (CV) of 1%–2%. [Glucose meters do not fare so well and are not recommended for diagnosis of diabetes (4).] By contrast, the preanalytical issues surrounding glucose measurements have not been solved. The loss of glucose in blood samples has been studied for many years (5). Glucose is lost through glycolysis at a rate of 5%–7%/h at concentrations near the reference interval. In absolute terms, a loss in glucose of about 0.67 mmol/L (12 mg/dL) occurs at a concentration of 5.55 mmol/L (100 mg/dL) after 2 h at room temperature (6). Higher rates of loss occur commonly, such as with increased ambient temperature and in samples with high white blood cell counts. In 1923, Major introduced potassium fluoride as a potent inhibitor of glycolysis (7), and fluoride, usually as NaF, has been used for decades to …
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Decrease in glucose concentration in the sample due to glycolysis is a serious and underappreciated problem.
“Decrease in glucose concentration in the sample due to glycolysis is a serious and underappreciated problem (62,63).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [63]
Loss of glucose from sample containers is a serious and underappreciated problem.
“Loss of glucose from sample containers is a serious and underappreciated problem (58).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [58]
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- Authors
- Bruns, D. E., & Knowler, W. C.
- Affiliations
- University of Virginia (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- ORCID
- Knowler, William C
- Venue
- Clinical Chemistry
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-05-01
- Volume
- 55
- Issue
- 5
- Pages
- 850-852
- ISSN
- 0009-9147 (ISSN-L)
- 1530-8561
- PMC
- PMC2956743
- OpenAlex
- W2111541302
- Semantic Scholar
- 3ca817c8f2f1deef73d71009f4d66a5cb410827f
- Cited by
- 125
- References
- 11
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 8 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 7 · 2016: 9 · 2015: 10 · 2014: 8 · 2013: 11 · 2012: 8
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Chemistry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Physical Sciences › Chemistry › Analytical Chemistry › Analytical chemistry methods development
- Keywords
- blood glucose stabilization, pre-analytical variables, glycolysis, potassium fluoride, sodium fluoride, diabetes diagnosis, pre-analytical errors
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Humans, Specimen Handling, Reproducibility of Results
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