An insulin-dose error assessment grid: A new tool to evaluate glucose meter performance

Objective: To develop a tool to assess the clinical accuracy of glucose meter performance using an insulin dosing protocol to assess the frequency and extent of error in insulin dose categories. Methods: Retrospective comparison of 1815 glucose meter and central laboratory glucose results obtained from 1698 critically ill patients was conducted using the Parkes error grid, Surveillance error grid and an insulin dose error assessment grid with a sliding scale insulin dosing protocol used to manage critically ill patients. Results: Parkes error grid and Surveillance error grid analyses indicated little risk conferred with the glucose meter results. Insulin dose error assessment grid complemented the aforementioned consensus error grids by determining quantifiable metrics, insulin dose category errors. Insulin dose error analysis indicated that 76.8% (1395/1815) would not have any change in insulin dose, 99.2% (1800/1815) within +/- 1 insulin dose category, 99.9% (1814/1815) within +/- 2 categories and 100% within +/- 3 insulin dose categories. Conclusions: Analysis with an insulin dose error grid provides information about the frequency and extent of insulin dose category errors with a specific insulin dosing protocol and describes potential clinical impact of glucose meter error.