DIAB-6024; No. of Pages 1 diabetes research and clinical practice xxx (2014) xxx.e1–xxx.e1
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Letter to the Editor The ease of falsifying blood glucose measurements
Some adolescent type 1 diabetes patients periodically attempt to hide high blood glucose levels from their diabetes management team. This leads to inappropriately high HbA1c levels in comparison to normoglycaemic diary entries. Such cheating is easily detectable by checking the memory log of the child’s glucometer. However, there are situations when both glucometer memory as well as diary entries appear identical and normoglycaemic, while HbA1c remains inexplicably high. After excluding some reported reasons for this [1,2], a discrepancy is known to persist in some children. We report the case of a 13-year-old adolescent girl who developed a technique for falsifying blood glucose measurements in her glucometer. She began by diluting a drop of blood with water in a small reservoir. In order to avoid suspicious glucose measurement records in her routinely used glucometer, she used then a second back-up glucometer to titrate the diluted solution to the correct level until a normoglycaemic result was obtained. She then set the date and time of her routine glucometer to the time she was pretending to be taking the reading. After each blood glucose measurement, she would re-set the time once again until the next fictional reading. For example, she could set the glucometer’s time to 7:00 and make the measurement, thereafter set the time to 13:00 and repeat the measurement. As a result, she constructed a glucometer history with two normoglycaemic blood glucose values corresponding to her pre-breakfast (7:00) and pre-lunch (13:00) times without any real measurements at that time and on that day. She could continue this process thus creating an extensive record of normoglycaemic readings. We wanted to check how easy this process is with commonly available glucometers. We diluted a 5% dextrose solution with tap water and measured the prepared solution with three different glucometers (Contour TS, Glucocard Xmeter, Caresense N). We found that such artificial blood glucose measurement histories are easy to create without any obstacles. With the present letter, we report a relatively simple way to falsify glucometer readings and create a false blood glucose measurement diary. We hope that our observation can stimulate glucometer manufacturers to develop solutions to this problem, either in their hardware or software, in order to prevent such manipulations.
Author contributions A.P. proposed topic, wrote the manuscript, M.R. tested glucometers and edited the manuscript, V.T. edited the manuscript and made final review.
Conflict of interest No conflict of interest for any author.
references
[1] Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J Diabetes 2009;1:9–17. [2] Randlu˛v J, Poulsen JU. How much do forgotten insulin injections matter to hemoglobin a1c in people with diabetes? A simulation study. J Diabetes Sci Technol 2008;2:229–35.
Aleksandr Peeta,b,* Department of Pediatrics, University of Tartu, Estonia b Department of General Paediatrics, Children’s Clinic of Tartu University Hospital, Tartu, Estonia a
Mart Roosimaaa,b Department of Pediatrics, University of Tartu, Estonia b Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia a
Vallo Tillmanna,b Department of Pediatrics, University of Tartu, Estonia b Department of General Paediatrics, Children’s Clinic of Tartu University Hospital, Tartu, Estonia a
*Corresponding author at: N. Lunini 6, Tartu, 51014 Estonia. Tel.: +372 5532256; fax: +372 7319504 E-mail address: [email protected] (A. Peet) 5 March 2014 http://dx.doi.org/10.1016/j.diabres.2014.03.006 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Peet A. The ease of falsifying blood glucose measurements. Diabetes Res Clin Pract (2014), http://dx.doi.org/ 10.1016/j.diabres.2014.03.006
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Letter to the Editor The ease of falsifying blood glucose measurements
Some adolescent type 1 diabetes patients periodically attempt to hide high blood glucose levels from their diabetes management team. This leads to inappropriately high HbA1c levels in comparison to normoglycaemic diary entries. Such cheating is easily detectable by checking the memory log of the child’s glucometer. However, there are situations when both glucometer memory as well as diary entries appear identical and normoglycaemic, while HbA1c remains inexplicably high. After excluding some reported reasons for this [1,2], a discrepancy is known to persist in some children. We report the case of a 13-year-old adolescent girl who developed a technique for falsifying blood glucose measurements in her glucometer. She began by diluting a drop of blood with water in a small reservoir. In order to avoid suspicious glucose measurement records in her routinely used glucometer, she used then a second back-up glucometer to titrate the diluted solution to the correct level until a normoglycaemic result was obtained. She then set the date and time of her routine glucometer to the time she was pretending to be taking the reading. After each blood glucose measurement, she would re-set the time once again until the next fictional reading. For example, she could set the glucometer’s time to 7:00 and make the measurement, thereafter set the time to 13:00 and repeat the measurement. As a result, she constructed a glucometer history with two normoglycaemic blood glucose values corresponding to her pre-breakfast (7:00) and pre-lunch (13:00) times without any real measurements at that time and on that day. She could continue this process thus creating an extensive record of normoglycaemic readings. We wanted to check how easy this process is with commonly available glucometers. We diluted a 5% dextrose solution with tap water and measured the prepared solution with three different glucometers (Contour TS, Glucocard Xmeter, Caresense N). We found that such artificial blood glucose measurement histories are easy to create without any obstacles. With the present letter, we report a relatively simple way to falsify glucometer readings and create a false blood glucose measurement diary. We hope that our observation can stimulate glucometer manufacturers to develop solutions to this problem, either in their hardware or software, in order to prevent such manipulations.
Author contributions A.P. proposed topic, wrote the manuscript, M.R. tested glucometers and edited the manuscript, V.T. edited the manuscript and made final review.
Conflict of interest No conflict of interest for any author.
references
[1] Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J Diabetes 2009;1:9–17. [2] Randlu˛v J, Poulsen JU. How much do forgotten insulin injections matter to hemoglobin a1c in people with diabetes? A simulation study. J Diabetes Sci Technol 2008;2:229–35.
Aleksandr Peeta,b,* Department of Pediatrics, University of Tartu, Estonia b Department of General Paediatrics, Children’s Clinic of Tartu University Hospital, Tartu, Estonia a
Mart Roosimaaa,b Department of Pediatrics, University of Tartu, Estonia b Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia a
Vallo Tillmanna,b Department of Pediatrics, University of Tartu, Estonia b Department of General Paediatrics, Children’s Clinic of Tartu University Hospital, Tartu, Estonia a
*Corresponding author at: N. Lunini 6, Tartu, 51014 Estonia. Tel.: +372 5532256; fax: +372 7319504 E-mail address: [email protected] (A. Peet) 5 March 2014 http://dx.doi.org/10.1016/j.diabres.2014.03.006 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Peet A. The ease of falsifying blood glucose measurements. Diabetes Res Clin Pract (2014), http://dx.doi.org/ 10.1016/j.diabres.2014.03.006
