Importance of the pre-analytical phase in blood glucose analysis.

Blood glucose levels are characterized by a relatively large intra-individual biological variability due to food intake, physical activity and the body's homeostatic response. Careful attention to the pre-analytical phase is essential to ensure accurate glucose measurements. Blood samples should be drawn in the morning after an overnight fast. Proper sample processing after blood collection is crucial. When fast separation of the cells is not possible, blood should be collected into a tube containing a glucose preservative. Glucose concentrations may also differ according to the blood sampling site (venous, arterial or capillary blood). Plasma and whole blood glucose values are not interchangeable. The International Federation of Clinical Chemistry and Laboratory Medicine recommends reporting the glucose concentration in plasma to avoid clinical misinterpretations irrespective of the sample type and method of measurement. Point-of-care testing (POCT) glucose meters are widely used by both health professionals and diabetic patients to monitor blood glucose levels. However, one should take into account that the reliability of POCT glucose measurements depends upon a variety of factors including underlying disease, patient drug regimens and interfering substances as well as instrument analytical performance and user proficiency. It is recommended to perform a laboratory blood glucose analysis if the POCT glucose value is in the critical hypoglycaemic or hyperglycaemic range.