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Comparability of blood glucose concentrations measured in different sample systems for detecting glucose intolerance.

Glucose concentrations are usually measured in whole blood or plasma. Plasma values are influenced by the concentration of proteins, especially those with large volumes, such as lipoproteins. Blood values additionally depend on the total volume of the various blood cells, which is usually expressed as the hematocrit (1)(2).

The interconversion of glucose values for venous and capillary blood is further complicated by the arteriovenous difference. In the fasting state, the glucose concentrations in arterial, capillary, and (forearm) venous blood are supposed to be almost indistinguishable. In contrast, arterial blood glucose values may differ by 20% or as much as 70% in the postprandial state (3)(4). The mean arteriovenous differences are largest in lean nondiabetic individuals, smallest in diabetic individuals, and larger in deep veins than in superficial vessels (1)(5). Other factors can influence the differences in glucose concentrations among the various samples (6)(7)(8)(9). Thus, the conversion of concentration values from one system (or sample type) to another is subject to unpredictable errors.

Several authors have already rejected the practice of converting glucose concentrations and have recommended that plasma be used for all glucose determinations (2)(10)(11). In a recent editorial, glucose measurement in whole blood was considered anachronistic (12), but only whole blood is used by home monitoring and near-patient monitoring devices. Many laboratories measure the glucose concentration in whole blood, especially in capillary whole blood, for therapeutic monitoring and for diagnosing hypo-, normo-, and hyperglycemia. However, the applicability of whole blood for determining glucose intolerance is still a matter of …