Alternative site testing of blood glucose in children and adolescents with type 1 diabetes

Several previous studies in adults with type 1 diabetes have documented that glucose levels obtained at alternative sites and at fingertip are not the same, a difference was noticed after a meal, after insulin application or during and after exercise. This study was done specifically to look at alternative site testing (AST) to determine if the site differences previously observed in adults are also found in children and adolescents. Glucose measurements were made using OneTouch Ultra System at fingertip and forearm sites, before breakfast and dinner, but at least two hours after insulin application and two hours after a meal. Twenty-four diabetics attending a summer camp in Dalmatia participated in the testing. At the completion of the camp, the children were questioned about their experience with AST A total of 217 forearm measurements were made. Linear regression analysis showed that forearm glucose values were highly correlated with fingertip values (p<0.001, R=0.96). Using Clarke Error Grid analysis with fingertip readings as the reference values, 89.9% of values fell in zone A, 8.3% in zone B, 2% fell in zone D. Parkes Error Grid analysis showed 90.3% of values in zone A, 10% in zone B and none in zone C and D. Although 37% of the diabetics examined had a slight subjective feeling of pain, 46% did not feel pain using AST, 25% emphasized the simplicity of measuring blood glucose using AST and only 29% will use AST more frequently at home in regards to using it at the summer camp. 71% will periodically or rarely use AST (41% because it requires more time and 58% because it was harder to obtain blood for measurement or visible stab wounds were present). Glucose values obtained from forearm sites in children and adolescents studied in real life at the diabetic camp correlated closely with fingertip values. This suggests that when children follow the current guidlines for AST largely developed in adults, the results are reliable and can safely be utilized.