BACKGROUND: Sodium fluoride is the preferred agent to inhibit glycolysis. Its action is not immediate, however, and complete inhibition is delayed for up to 4 hours. A more effective method is needed. Acidification of blood combined with the addition of NaF and EDTA appears to be such a method. We studied whether acidification was indeed more effective than NaF. METHODS: We conducted 6 independent studies over a 10-month period at 3 Quest Diagnostics laboratory sites. In each study, we drew venous blood from 6-24 nonfasting employee volunteers into 3 or 4 different serum- or plasma-collection tubes, which were stored under different conditions and aliquoted at different times. We analyzed the aliquots in duplicate by means of a hexokinase-based enzymatic method. RESULTS: The mean glucose concentration decreased by 0.3% at 2 h and by 1.2% at 24 h when blood was drawn into tubes containing citrate buffer, NaF, and EDTA. In contrast, the mean glucose concentration decreased by 4.6% at 2 h and by 7.0% at 24 h when blood was drawn into tubes containing NaF and sodium oxalate. CONCLUSIONS: Acidification should replace NaF alone as the recommended method for obtaining an accurate glucose concentration. Diagnostic cut points based on blood samples collected into tubes containing NaF as the only inhibitor of glycolysis are likely to be too low.
BACKGROUND:Sodium fluoride is the preferred agent to inhibit glycolysis. Its action is not immediate, however, and complete inhibition is delayed for up to 4 hours. A more effective method is needed. Acidification of blood combined with the addition of NaF and EDTA appears to be such a method. We studied whether acidification was indeed more effective than NaF. METHODS: We conducted 6 independent studies over a 10-month period at 3 Quest Diagnostics laboratory sites. In each study, we drew venous blood from 6-24 nonfasting employee volunteers into 3 or 4 different serum- or plasma-collection tubes, which were stored under different conditions and aliquoted at different times. We analyzed the aliquots in duplicate by means of a hexokinase-based enzymatic method. RESULTS: The mean glucose concentration decreased by 0.3% at 2 h and by 1.2% at 24 h when blood was drawn into tubes containing citrate buffer, NaF, and EDTA. In contrast, the mean glucose concentration decreased by 4.6% at 2 h and by 7.0% at 24 h when blood was drawn into tubes containing NaF and sodium oxalate. CONCLUSIONS: Acidification should replace NaF alone as the recommended method for obtaining an accurate glucose concentration. Diagnostic cut points based on blood samples collected into tubes containing NaF as the only inhibitor of glycolysis are likely to be too low.
Authors: David B Sacks; Mark Arnold; George L Bakris; David E Bruns; Andrea Rita Horvath; M Sue Kirkman; Ake Lernmark; Boyd E Metzger; David M Nathan Journal: Diabetes Care Date: 2011-06 Impact factor: 19.112