Efficacy and Clinical Utility of Sodium Fluoride Tubes Versus Serum Tubes for Blood Glucose Estimation

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Nov 29

PMID 39610588

Authors

Disha Daimane

Sharbari Basu

Affiliations

Soon will be listed here.

Abstract

Introduction: Precise and accurate measurement of blood glucose is the key factor in both the diagnosis and effective management of diabetes mellitus. The blood glucose levels are influenced by the time interval between sample collection and measurement as glycolysis continues to take place in the blood cells. Laboratories make efforts to minimize this change. This study aimed to analyze the differences in blood glucose levels between routine serum tubes and sodium fluoride (NaF) tubes over time intervals.

Methods: The study included 50 participants from whom blood was collected in both serum and NaF tubes. The blood glucose values between the two were compared using the Wilcoxon signed-rank sum test at time intervals of one, two, and six hours and the level of agreement in measuring the blood glucose levels by the Bland-Altman plot.

Results: There were statistically significant variations in median glucose values between serum and NaF tubes across all the time intervals. The study found that 62%, 70%, and 100% of patients showed decreased glucose values in serum tubes at the end of one, two, and six hours, respectively, compared to NaF tubes. The Bland-Altman plot analysis indicated high agreement at all three time points. However, the difference in blood glucose levels varied from 5.6 mg/dL to 18.74 mg/dL from one to six hours, which was clinically very significant. All the values are clinically very significant as it would lead to underdiagnosing of diabetes mellitus and gestational diabetes mellitus.

Conclusion: The study demonstrated that NaF tubes may offer better preservation of glucose levels, especially over extended periods implying that NaF tubes will help prevent under-diagnosis of diabetes mellitus.

References

Gambino R . Glucose: a simple molecule that is not simple to quantify. Clin Chem. 2008; 53(12):2040-1. DOI: 10.1373/clinchem.2007.094466. View

Bruns D, Knowler W . Stabilization of glucose in blood samples: why it matters. Clin Chem. 2009; 55(5):850-2. PMC: 2956743. DOI: 10.1373/clinchem.2009.126037. View

Turchiano M, Nguyen C, Fierman A, Lifshitz M, Convit A . Impact of blood sample collection and processing methods on glucose levels in community outreach studies. J Environ Public Health. 2013; 2013:256151. PMC: 3556871. DOI: 10.1155/2013/256151. View

Chan A, Swaminathan R, Cockram C . Effectiveness of sodium fluoride as a preservative of glucose in blood. Clin Chem. 1989; 35(2):315-7. View

Sacks D, Arnold M, Bakris G, Bruns D, Horvath A, Kirkman M . Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011; 34(6):e61-99. PMC: 3114322. DOI: 10.2337/dc11-9998. View

Waring W, Evans L, Kirkpatrick C . Glycolysis inhibitors negatively bias blood glucose measurements: potential impact on the reported prevalence of diabetes mellitus. J Clin Pathol. 2007; 60(7):820-3. PMC: 1995804. DOI: 10.1136/jcp.2006.039925. View

Holtkamp H, Verhoef N, Leijnse B . The difference between the glucose concentrations in plasma and whole blood. Clin Chim Acta. 1975; 59(1):41-9. DOI: 10.1016/0009-8981(75)90216-8. View

MEITES S . Preservation, distribution, and assay of glucose in blood, with special reference to the newborn. Clin Chem. 1979; 25(4):531-4. View

Bonetti G, Cancelli V, Coccoli G, Piccinelli G, Brugnoni D, Caimi L . Which sample tube should be used for routine glucose determination?. Prim Care Diabetes. 2015; 10(3):227-32. DOI: 10.1016/j.pcd.2015.11.003. View

10.

Fernandez L, Jee P, Klein M, Fischer P, Perkins S, Brooks S . A comparison of glucose concentration in paired specimens collected in serum separator and fluoride/potassium oxalate blood collection tubes under survey 'field' conditions. Clin Biochem. 2012; 46(4-5):285-8. DOI: 10.1016/j.clinbiochem.2012.11.027. View

11.

Steffes M, Sacks D . Measurement of circulating glucose concentrations: the time is now for consistency among methods and types of samples. Clin Chem. 2005; 51(9):1569-70. DOI: 10.1373/clinchem.2004.044867. View

12.

Uchida K, Matuse R, Toyoda E, Okuda S, Tomita S . A new method of inhibiting glycolysis in blood samples. Clin Chim Acta. 1988; 172(1):101-8. DOI: 10.1016/0009-8981(88)90125-8. View

13.

Tirosh A, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T . Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med. 2005; 353(14):1454-62. DOI: 10.1056/NEJMoa050080. View

14.

Giavarina D . Understanding Bland Altman analysis. Biochem Med (Zagreb). 2015; 25(2):141-51. PMC: 4470095. DOI: 10.11613/BM.2015.015. View

15.

Shi R, Seeley E, Bowen R, Faix J . Rapid blood separation is superior to fluoride for preventing in vitro reductions in measured blood glucose concentration. J Clin Pathol. 2009; 62(8):752-3. DOI: 10.1136/jcp.2008.062547. View