Plasma Glucose Concentrations in Different Sampling Tubes Measured on Different Glucose Analysers

Abstract

Introduction The German Diabetes Association recommends using sampling tubes with citrate and fluoride additives to diagnose diabetes by oral glucose tolerance test to inhibit glycolysis. The effect of different tubes on measurement results was assessed.

Materials and Methods In a first study, an oral glucose tolerance test was performed on 41 participants without anamnestically known diabetes. Venous blood was sampled in two different tubes with citrate/fluoride additives from different manufacturers and one with only lithium-heparin additive. A second study with 42 participants was performed to verify the initial results with an adapted design, in which a third tube with citrate buffer was used, and glucose measurements were performed on two additional devices of another analyser model. Samples were centrifuged either immediately (<5 min incubation time) or after 20 min or 4 h. All glucose measurements were performed in plasma. Glucose concentrations in lithium-heparin tubes with<5 min incubation time served as baseline concentrations.

Results In the first study, glucose concentrations in one of the citrate/fluoride tubes were similar to the baseline. In the other citrate/fluoride tube, markedly lower concentrations (approximately − 5 mg/dL (− 0.28 mmol/L)) were measured. This was reproduced in the verification study for the same analyser, but not with the other analyser model. Lithium-heparin tubes centrifuged after 20 and 240 min showed systematically lower glucose concentrations.

Conclusions The results confirm that glycolysis can be effectively inhibited in citrate/fluoride-containing sampling tubes. However, glucose measurement results of one analyser showed a relevant negative bias in tubes containing liquid citrate buffer.

Keywords

oral glucose tolerance test - glycolysis inhibition - diabetes diagnosis - interference

Publication History

Received: 13 July 2023
Received: 18 January 2024

Accepted: 31 January 2024

Accepted Manuscript online:
02 February 2024

Article published online:
10 April 2024

• References

• 1 Orth M, Hawran H, Ulloor J. et al. Effects of different tube types on patient classification using current diabetes decision limits. Pract Lab Med 2019; 17: e00134 DOI: 10.1016/j.plabm.2019.e00134.
• 2 Bonetti G, Giavarina D, Carta M. Clinical impact of citrate-containing tubes on the detection of glucose abnormalities by the oral glucose tolerance test. Diagnosis (Berl) 2019; 6: 377-383 DOI: 10.1515/dx-2018-0100.
• 3 Gupta S, Gupta AK, Verma M. et al. A study to compare the plasma glucose levels obtained in sodium fluoride and citrate buffer tubes at a tertiary care hospital in Punjab. Int J Appl Basic Med Res 2016; 6: 50-53 DOI: 10.4103/2229-516X.174010.
• 4 Ridefelt P, Akerfeldt T, Helmersson-Karlqvist J. Increased plasma glucose levels after change of recommendation from NaF to citrate blood collection tubes. Clin Biochem 2014; 47: 625-628 DOI: 10.1016/j.clinbiochem.2014.02.022.
• 5 Toro-Crespo M, Maesa-Marquez JM, Sanchez-Margalet V. et al. Comparison of citrate buffer with sodium fluoride as additives in determining glycemia. Clin Lab 2017; 63: 1939-1944 DOI: 10.7754/Clin.Lab.2017.170621.
• 6 Fobker M. Stability of glucose in plasma with different anticoagulants. Clin Chem Lab Med 2014; 52: 1057-1060 DOI: 10.1515/cclm-2013-1049.
• 7 Carey R, Lunt H, Heenan HF. et al. Collection tubes containing citrate stabiliser over-estimate plasma glucose, when compared to other samples undergoing immediate plasma separation. Clin Biochem 2016; 49: 1406-1411 DOI: 10.1016/j.clinbiochem.2016.05.017.
• 8 Fischer MM, Hannemann A, Winter T. et al. Relative efficacy of different strategies for inhibition of in vitro glycolysis. Clin Chem 2021; 67: 1032-1034 DOI: 10.1093/clinchem/hvab071.
• 9 Freckmann G, Schauer S, Beltzer A. et al. Continuous glucose profiles in healthy people with fixed meal times and under everyday life conditions. J Diabetes Sci Technol 2022; 0(0) DOI: 10.1177/19322968221113341.
• 10 Nauck M, Petermann A, Müller-Wieland D. et al. DDG praxisempfehlung. definition, klassifikation und diagnostik des diabetes mellitus. Diabetologie und Stoffwechsel 2017; 12: 94-100
• 11 Petersmann A, Nauck M, Muller-Wieland D. et al. Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes 2018; 126: 406-410 DOI: 10.1055/a-0584-6223.
• 12 Schleicher E, Gerdes C, Petersmann A. et al. Definition, classification and diagnosis of diabetes mellitus. Exp Clin Endocrinol Diabetes 2022; 130: S1-S8 DOI: 10.1055/a-1624-2897.
• 13 Roche Diagnostics GmbH. Package insert GLUC3 glucose HK Gen.3 for cobas c 303, cobas c 503 (0108057800190c503.V5). 2022
• 14 Roche Diagnostics GmbH. Package insert GLUC 2 glucose HK for Cobas Integra 400 plus (0120767131322COIN.V13). 2022
• 15 Beckman Coulter. GLUC-S glucose-stat instructions for use (BLOSR6X40 06). 2021
• 16 Abbott. Alinity c glucose reagent kit (G73144R04). 2018
• 17 Siemens Healthineers. Atellica CH Analyzer Glukose-Hexokinase_3 (GluH_3) (11110155_DE Rev. 04). 2020
• 18 Bonetti G, Carta M, Montagnana M. et al. Effectiveness of citrate buffer-fluoride mixture in Terumo tubes as an inhibitor of in vitro glycolysis. Biochem Med (Zagreb) 2016; 26: 68-76 DOI: 10.11613/BM.2016.006.
• 19 Sarstedt AG & Co. KG. S-Monovette GlucoEXACT – Information für das Labor. Available at: https://www.sarstedt.com/fileadmin/user_upload/99_Broschueren/NEU/628/10_628_0100_100_glucoexact_labor_0918.pdf Date Accessed: 2023-Jun-21
• 20 Sarstedt AG & Co. S-Monovette GlucoEXACT – Information für die Arztpraxis. Available at: https://www.sarstedt.com/fileadmin/user_upload/99_Broschueren/Deutsch/633_GlukoEXACT_Arztpraxis_A4_0812.pdf Date Accessed: 2023-Jun-21
• 21 Bundesärztekammer. Richtlinie der Bundesärztekammer zur Qualitätssicherung laboratoriumsmedizinischer Untersuchungen. Deutsches Ärzteblatt Online. 2023 DOI: 10.3238/arztebl.2023.rili_baek_QS_Labor