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Cited by 133Diabetes Management and ResearchClinical Laboratory Practices and Quality ControlDiabetes Management and Education

Rapid changes in postprandial blood glucose produce concentration differences at finger, forearm, and thigh sampling sites

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Ellison, John M., Stegmann, Janet M., Colner, Sandra L., Michael, Ragui H., Sharma, Manoj K., Ervin, Kenneth R., Horwitz, David L.·2002·Diabetes Care
DOI 10.2337/diacare.25.6.961
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Abstract

OBJECTIVE—To compare pre- and postmeal capillary blood glucose concentrations measured at the finger, forearm, and thigh in adults with diabetes. RESEARCH DESIGN AND METHODS—For phase 1, capillary blood glucose concentrations were measured at six time points (premeal and at ∼60, 90, 120, 150, and 180 min postmeal) using a blood glucose monitoring system and technician-obtained samples collected from finger, forearm, and thigh sites of 42 adults with diabetes. The finger samples were also tested with a laboratory instrument. For phase 2, ∼14 weeks later, the testing procedures were repeated with 38 subjects from the original study population. RESULTS—Meter finger results were accurate at all time points. Alternate sites tended to produce lower glucose readings compared to finger readings at times when glucose was increasing rapidly (60 and 90 min postmeal). Forearm-to-finger differences correlated with rates of glucose change (r = 0.56, P < 0.001), as did the thigh-to-finger differences (r = 0.52, P < 0.001). Other factors, such as subject age, BMI, diabetes type, and insulin dependence did not have a significant impact on site differences. When the testing procedures were repeated with the same subjects, the pattern of site differences was consistent, although individual results were variable. CONCLUSIONS—Changes in blood glucose immediately after a meal may be identified at finger sites before detection at forearm or thigh sites. Alternate site testing appears to be a useful option for routine self-monitoring before meals; however, patients and clinicians should recognize that results may be different from fingertip results when glucose levels are changing rapidly.

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  • When glucose is rising or has just risen sharply, fingertip capillary glucose is greater than at forearm, thigh, and abdomen, with variable differences in repeated tests.

    “When glucose concentrations are rising or have just risen sharply, fingertip capillary glucose concentrations are greater than those in capillary blood from other sites including forearm, thigh and abdomen (Ellison et al. 2002;Jungheim & Koschinsky, 2002;van der Valk et al. 2002), with variable differences in repeated tests on the same subject (Ellison et al. 2002);”

    From Glycaemic index methodology (2005) · cites this paper as Ellison et al. 2002

    The Abstract reports that forearm and thigh readings tended to be lower than fingertip readings when glucose was increasing rapidly, and that individual results varied when testing was repeated. The paper studied finger, forearm, and thigh sites, but the cited passages do not support the claim about abdomen readings. (LLM, conf=0.87)

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  • The anatomical site from which skin puncture samples are obtained influences results: use of blood from alternate sites (such as forearm or thigh rather than fingertip) may exhibit a temporal lag between the circulating and measured concentrations of glucose when blood glucose is changing in vivo.

    “The anatomical site from which skin puncture samples are obtained influences results: Use of blood from so-called alternate sites (such as forearm or thigh rather than fingertip) for testing may exhibit a temporal lag between the circulating and measured concentrations of glucose when blood glucose is changing in vivo (117).”

    From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [117]

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Authors
Ellison, J. M., Stegmann, J. M., Colner, S. L., Michael, R. H., Sharma, M. K., Ervin, K. R., & Horwitz, D. L.
Affiliations
LifeScan, Milpitas, California
ORCID
Horwitz, David L.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2002-06-01
Volume
25
Issue
6
Pages
961-964
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.25.6.961
OpenAlex
W2154078343
Semantic Scholar
e98ef81443d8253dc4e47cf37f2bfa46dd424c26
Cited by
133
References
12
Citations by year
2026: 2 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 6 · 2018: 4 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 1 · 2013: 9 · 2012: 4
FWCI
8.08
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Diabetes Association
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
postprandial blood glucose, capillary blood glucose, forearm, thigh, self-monitoring of blood glucose, meter accuracy, diabetes mellitus
MeSH terms
Adult, Blood Glucose, Blood Specimen Collection, Capillaries, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Fingers, Forearm, Humans, Leg, Male, Middle Aged, Regression Analysis, Time Factors, Blood Glucose Self-Monitoring, Reproducibility of Results, Postprandial Period

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