Cited by 114Diabetes Management and ResearchClinical Laboratory Practices and Quality ControlHyperglycemia and glycemic control in critically ill and hospitalized patients

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Glucose Monitoring at the Arm

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Jungheim, Karsten, Koschinsky, Theodor·2002·Diabetes Care

DOI 10.2337/diacare.25.6.956

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Abstract

OBJECTIVE—We have examined whether rapid changes in blood glucose (BG) result in clinically relevant differences between capillary BG values measured at the forearm and the fingertip and whether local rubbing of the skin before blood sampling can diminish such differences. RESEARCH DESIGN AND METHODS—Capillary BG samples were collected every 15 min for 3–5 h from the fingertip and the forearm of 17 insulin-treated diabetic patients and analyzed with different glucose monitors (FreeStyle, One Touch Ultra, and Soft-Sense). In a subgroup of patients (n = 8), local rubbing of the forearm skin was performed before blood sampling. A rapid increase in BG was induced by oral administration of glucose, and subsequently, a rapid decrease in glucose was induced by intravenous administration of insulin. RESULTS—In the fasting state, the BG values at the fingertip and at the forearm were similar (7.8 ± 2.4 vs. 7.2 ± 2.3 mmol/l, P = 0.06). However, during rapid increase in glucose, BG values at the fingertip were consistently higher than at the forearm (maximal difference 4.6 ± 1.2 mmol/l, P < 0.001). During rapid decrease in glucose, lower BG values were recorded at the fingertip (maximal difference to forearm 5.0 ± 1.0 mmol/l, P < 0.001). At the forearm, BG was delayed by a median of 35 min (P < 0.01) in relation to the fingertip. Rubbing of forearm skin decreased the observed differences but with a large intraindividual and interindividual variability. There were no obvious device-specific differences. CONCLUSIONS—To avoid risky delays of hyperglycemia and hypoglycemia detection, BG monitoring at the arm should be limited to situations in which ongoing rapid changes in BG can be excluded.

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Background
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“The use of SMBG during exercise may also allow improved insulin management and a decreased risk for hypoglycemia during and following exercise (47).”
Background
Assessment and monitoring of glycemic control in children and adolescents with diabetes
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“In the fasting state, glucose readings from the forearm are similar to the fingertip (47) (B).”
Method
Monitoring Glycemic Control
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Evaluation of the appropriateness of using glucometers for measuring the blood glucose levels in mice
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“In humans, blood glucose measured in the forearm is known to lag more than 30 minutes behind the blood glucose measured at the fingertip during the rapid changes in the blood glucose levels induced by oral glucose loading or intravenous insulin administration 13 .”
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“after meals, after exercise and during hypoglycemia), fingertip testing has been shown to more accurately reflect glycemic status than forearm or thigh testing (50,51).”
Method
Minimally invasive capillary blood sampling methods
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“These current results support the previous findings of Jungheim and Koschinsky (3), who demonstrated that local rubbing of the forearm, while reducing variation in results for some patients, was not a predictably reliable method to decrease observed fingertip-forearm BG differences.”
Result
Glucose Sensors and the Alternate Site Testing-Like Phenomenon: Relationship Between Rapid Blood Glucose Changes and Glucose Sensor Signals
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“9,10 Similar findings could be confirmed in daily-life settings.”
Self-citation
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“It has been shown that significant variations in blood glucose levels exist between samples obtained from finger sticks and alternate sites (ie, forearm) when blood glucose levels are changing rapidly.(24,25) It is therefore recommended that patients obtain blood samples from either the fingertips or base of the thumb.”
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BackgroundMethodInfluential
The Effects of Skin Temperature and Testing Site on Blood Glucose Measurements Taken by a Modern Blood Glucose Monitoring Device
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Vahlsing, T., Delbeck, S., Leonhardt, S., & Heise, H. M. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818798347 · Cited by 28
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“Unfortunately, the results from this alternate-site testing do not always equal fingertip values (18).”
Background
Effects of optical clearing agents on noninvasive blood glucose monitoring with optical coherence tomography: a pilot study
He, R., Wei, H., Gu, H., Zhu, Z., Zhang, Y., Guo, X., & Cai, T. (2012) · Journal of Biomedical Optics · doi:10.1117/1.jbo.17.10.101513 · Cited by 24
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“Notably, although some research [25,26] found that the concurrence of glucose measures from CFB and from alternate testing sites is diminished in the postprandial period, other studies [27,28] failed to find that the length of time since last food intake affected this concurrence.”
Lancing: Quo Vadis?
Heinemann, L., & Boecker, D. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500420 · Cited by 25
Alternate site blood glucose testing: do patients prefer it?
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“their effectiveness persists [15, 16].”
Background
Alternative Site Blood Glucose Testing: A Multicenter Study
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“7,8,13 When this study was planned, the initial reports of differences between arm and finger values associated with rapidly changing glucose levels had not yet appeared.”
Influential
Precision and accuracy of two blood glucose meters: FreeStyle Flash versus One Touch Ultra
Rivers, S. M., Kane, M. P., Bakst, G., Busch, R. S., & Hamilton, R. A. (2006) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp050473 · Cited by 22
Methodology for hypoglycaemia detection based on the processing, analysis and classification of the electroencephalogram
Laione, F., & Marques, J. L. B. (2005) · Medical & Biological Engineering & Computing · doi:10.1007/bf02344732 · Cited by 20
“There is also the possibility of a delay in the detection time during rapid changes in glucose (JUNGHEIM and KOSCHINSKY, 2002).”
Background
Alternate-Site Testing Is Reliable in Children and Adolescents With Type 1 Diabetes, Except at the Forearm for Hypoglycemia Detection
Lucidarme, N., Alberti, C., Zaccaria, I., Claude, E., & Tubiana‐Rufi, N. (2005) · Diabetes Care · doi:10.2337/diacare.28.3.710 · Cited by 20
“It should be noted that published studies usually evaluated these differences in individuals experiencing rapid blood glucose variations during oral glucose tolerance testing (4,10).”
BackgroundMethodResultInfluential
Gingival Crevicular Blood as a Potential Screening Tool: A Cross Sectional Comparative Study
Rapone, B., Ferrara, E., Santacroce, L., Topi, S., Converti, I., Gnoni, A., Scarano, A., & Scacco, S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17207356 · Cited by 19
Palm Glucose Readings Compared with Fingertip Readings Under Steady and Dynamic Glycemic Conditions, Using the OneTouch® Ultra® Blood Glucose Monitoring System
Kempe, K. C., Budd, D., Stern, M., Ellison, J. M., Saari, L. A., Adiletto, C. A., Olin, B., Price, D. A., & Horwitz, D. L. (2005) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2005.7.916 · Cited by 19
Capillary and Venous Blood Glucose Concentrations Measured During Intravenous Insulin and Glucose Infusion: A Comparison of Steady and Dynamic States
Kempe, K. C., Price, D. A., Ellison, J., Marhoul, J. C., Morrow, L., Win, K., Kuschma, K., & Hompesch, M. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0023 · Cited by 17
“5,6 For patients who use alternative testing sites, these physiological differences can complicate data interpretation, pattern analysis, and therapy adjustments.”
Patient Perceptions of Different Lancing Sites for Self-Monitoring of Blood Glucose: A Comparison of Fingertip Site with Palm Site Using the OneTouch® Ultra® Blood Glucose Monitoring System
Ito, T., Kamoi, K., Minagawa, S., Kimura, K., & Kobayashi, A. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400420 · Cited by 16
“(2) Did you think it may be frightening to insert?”
Background
Alternative-Site Blood Glucose Measurement at the Abdomen
van der Valk, P. R., van der Schatte Olivier-Steding, I., Wientjes, K.-J. C., Schoonen, A. J., & Hoogenberg, K. (2002) · Diabetes Care · doi:10.2337/diacare.25.11.2114 · Cited by 15
Evaluation of Portable Blood Glucose Meters. Problems and Recommendations
Slingerland, R. J., & Miedema, K. (2003) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2003.186 · Cited by 13
Self-Monitoring of Blood Glucose with Finger Tip Versus Alternative Site Sampling: Effect on Glycemic Control in Insulin-Using Patients with Type 2 Diabetes
Knapp, P. E., Showers, K. M., Phipps, J. C., Speckman, J. L., Sternthal, E., Freund, K. M., Ash, A. S., & Apovian, C. M. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0060 · Cited by 12
“These findings have been attributed to a delayed equilibration of arm and thigh skin with arterial blood glucose resulting from lesser blood flow.(10) Manufacturers of SMBG devices have recommended preparatory rubbing or heating of AST sites to increase blood flow and mitigate the difference due to equilibration time,…”
Clinical Evaluation of Bionime Rightest GM310 Biosensors with a Simplified Electrode Fabrication for Alternative-Site Blood Glucose Tests
Wu, M., Fang, M.-Y., Jen, L.-N., Hsiao, H.-C., Müller, A., & Hsu, C. (2008) · Clinical Chemistry · doi:10.1373/clinchem.2008.106328 · Cited by 11
“Although commercially available glucose meters have been developed for alternative-site testing, the stabilityofmeasurementshasbeenanongoingtopicof studyinarmtests(18, 19 ).Theaimofthisstudywasto characterize and evaluate the clinical performance of the Bionime Rightest GM310 meter for alternative-site tests (e.g., fi…”
Method
[History, accuracy and precision of SMBG devices].
Dufaitre-Patouraux, L., Vague, P., & Lassmann-Vague, V. (2003) · PubMed · Cited by 11
Precision and Accuracy of Three Blood Glucose Meters: Accu-Chek Advantage, One Touch Horizon and Sensocard
Owiredu, W. K. B. A., Amegatcher, G., & Amidu, N. (2009) · Journal of Medical Sciences(Faisalabad) · doi:10.3923/jms.2009.185.193 · Cited by 10
In Vivo Evaluation of Fine Needle Amperometric Glucose Sensors Implanted in Rabbit's Blood Vessel
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Comparison of Blood Glucose Measurements Using Samples Obtained from the Forearm, Finger Skin Puncture, and Venous Serum
Park, K., Park, M.-S., Cha, Y.-J., Kim, W., Choi, S.-S., Kim, K. O., Cha, E., & Kim, K.-A. (2010) · Annals of Laboratory Medicine · doi:10.3343/kjlm.2010.30.3.264 · Cited by 9
“The ~35-min time delay between GA and GF under rapidly changing glucose concentrations observed by Jungheim and Koschinsky [29] may have been caused by the higher capillary circulation on the fingertip, which is 5-20 times higher than that at the forearm [32-34], thereby leading to a slower glucose dynamics.”
Influential
Verbesserung der Therapiesicherheit durch eine einheitliche Kalibration von POCT-Glukose-Messgeräten auf Plasma Stellungnahme der Arbeitsgruppe POCT der Deutschen Vereinten Gesellschaft für Klinische Chemie und Laboratoriumsmedizin / Improvement of therapeutic safety through standardized plasma calibration of blood glucose test systems at the point-of-care Statement of the POCT Working Group of the German Society for Clinical Chemistry and Laboratory Medicine (DGKL)
Koschinsky, F. D. A. P. T., Junker, R., Luppa, P. B., & Schlebusch, H. (2009) · Journal of Laboratory Medicine · doi:10.1515/jlm.2009.058 · Cited by 9
Continuous glucose monitoring: key challenges to replacing episodic SMBG
Stout, P. J., Racchini, J. R., Hilgers, M. E., & Noujaim, S. E. (2006) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(06)70007-9 · Cited by 9
Oral Glucose Tolerance Test Evaluation With Forearm and Fingertip Glucose Measurements in Pregnant Women
Stavrianos, C., & Anastasiou, E. (2004) · Diabetes Care · doi:10.2337/diacare.27.2.627 · Cited by 9
Noninvasive blood glucose monitoring during oral intake of different sugars with optical coherence tomography in human subjects
Zhang, Y., Wei, H., Yang, H., He, Y., Wu, G., Xie, S., Zhu, Z., & He, R. (2012) · Journal of Biophotonics · doi:10.1002/jbio.201200128 · Cited by 8
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Background
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Method
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“Rather, evidence showed that the palm is a more suitable alternative site in both steady and dynamic glycaemic conditions (Jungheim & Koschinsky 2002a, Bina et al. 2003, Kempe et al. 2005).”
BackgroundMethod
New Developments in Home Glucose Monitoring: Minimizing the Pain
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Self-citation
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Background
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“…in capillary blood glucose, it was observed that capillary glucose obtained at the nonglaborous skin of the forearm, abdomen, and thigh increased more slowly and to a lesser extent than that at the fingertip in the first two hours following an acute oral glucose challenge or meal [34–36].”
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Background
Analysis: Glucose Testing of Blood Samples from Alternate Sites—State of Affairs
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Clinical Usefulness of Glucose Testing from the Forearm in Diabetic Patients
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“이러한 현상에 대해 Jungheim 등[10]은 식후나 인슐린 투여후 등의 혈당의 급속한 변화가 있을 때 전완부의 혈당변화의 반응이 지연 될 가능성을 제시하였다.”
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Self-citation
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Improvement of therapeutic safety through standardized plasma calibration of blood glucose test systems at the point-of-care1 / Statement of the POCT Working Group of the German Society for Clinical Chemistry and Laboratory Medicine (DGKL)
For the POCT Working Group: Theodor Koschinsky, Junker, R., Luppa, P. B., & Schlebusch, H. (2009) · Journal of Laboratory Medicine · doi:10.1515/jlm.2009.058et

Authors: Jungheim, K., & Koschinsky, T.
Affiliations: Deutsches Diabetes-Zentrum e.V. (DE)
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2002-06-01
Volume: 25
Issue: 6
Pages: 956-960
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.25.6.956
OpenAlex: W2082028634
Cited by: 114
References: 22
Citations by year: 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2018: 5 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 9 · 2012: 3
FWCI: 6.93
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords: capillary blood glucose, hyperglycemia detection, hypoglycemia detection, insulin-treated diabetes
MeSH terms: Awareness, Capillaries, Fingers, Forearm, Humans, Hyperglycemia, Hypoglycemia, Insulin, Blood Glucose Self-Monitoring, Reproducibility of Results

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