All glucose measurements are not equal

We read with interest the study by Bilotta et al.1 comparing intensive insulin therapy to conventional treatment in two cohorts of neurosurgical patients. When an arterial catheter was not available for glucose determination, capillary blood was measured with the HemoCue point-of-care device (HemoCue, Angelholm, Sweden). This was a wise choice, as this system has been shown to be accurate, even at low glucose concentrations.2 What is not commonly appreciated is that most other point-of-care glucose measurement devices are not sufficiently accurate for critical care use, and that such devices originally approved and regulated for home self-monitoring by patients with diabetes have migrated into the hospital setting without further regulatory scrutiny. In fact, it has been specifically recommended that point-of-care devices designed for patient use at home, yet sometimes used in hospitals, should not be used in critically ill patients.3