Veterinary Clinical Pathology ISSN 0275-6382

B R I E F C O M M U N I C AT I O N

Evaluation of a portable glucose meter for use in cattle and sheep

Panagiotis D. Katsoulos1, Anastasios Minas2, Maria A. Karatzia3, Konstantinos Pourliotis3, Georgios
Christodoulopoulos1
1
Clinic of Medicine, School of Veterinary Medicine, University of Thessaly, Karditsa, Greece; 2Laboratory of Microbiology, Department of Medical
Laboratories, Technological Educational Institution of Larissa, Larissa, Greece; and 3Clinic of Farm Animals, School of Veterinary Medicine, Aristotle
University of Thessaloniki, Thessaloniki, Greece

Key Words Background: In farm animal practice, determination of blood glucose

Buiatrics, glucometer, hypoglycemia, ketosis,
point-of-care testing, ruminants
Correspondence
Panagiotis D. Katsoulos, Kallipoleos 20,
57200, Lagadas, Thessaloniki, Greece
E-mail: pkatsoul@vet.uth.gr
DOI:10.1111/j.1939-165X.2011.00309.x
concentration under field conditions is often necessary.
Objective: As there is no portable glucose meter device developed for use
in farm animals, the analytical accuracy of a portable glucometer designed
for people was evaluated for its use in cattle and sheep.
Methods: Blood samples from 90 cattle and 101 sheep were used in the
study. Glucose concentration was determined in whole blood immediately
after blood collection from the jugular vein with the One Touch Vita por-
table glucometer and in serum with an enzymatic colorimetric method.
The agreement between methods was assessed by Passing and Bablok re-
gression analysis. The precision and the accuracy of the measurements
were determined using the concordance correlation coefficient.
Results: There was a strong linear relationship between the glucose values
obtained using the portable glucometer and those obtained by the bench
method in both cattle and sheep. Precision was 95% for cattle and 88% for
sheep, whereas accuracy was 92% and 99%, respectively. The mean glu-
cose values obtained using the portable glucometer were significantly
lower by 8.3% in cattle and 3.2% in sheep than those determined by the
bench method.
Conclusion: The One Touch Vita portable glucometer can be used in
clinical practice to determine blood glucose concentrations in cattle
and sheep, but reference intervals (RI) must be corrected to allow for neg-
ative bias. Based on these equations the RI for blood glucose in cattle
and sheep using the portable glucometer were corrected to 1.84–4.17 and
2.41–4.35 mmol/L, respectively.

In farm animal practice it is often necessary to determine
blood glucose concentrations under field conditions.
Owing to the lower renal threshold for glucose in rumi-
nants, determination of blood glucose levels is regarded
as necessary before intravenous injection of a glucose
solution.1 Furthermore, blood glucose determination can
be used to detect neonatal hypoglycemia or for diagno-
sing and differentiating types I and II ketosis.1 Use of a
portable glucometer would be beneficial in these cases.
As there is no portable glucose meter developed for use in
farm animals, we evaluated the analytical accuracy of a
portable glucometer designed for measuring glucose in
people for use in cattle and sheep.
Blood samples from 90 cattle and 101 sheep, ob-
tained for various diagnostic investigations from ani-
mals evaluated during 2009 at the Clinic of Medicine
of the School of Veterinary Medicine of the University
of Thessaly, were used in the present study following
institutional guidelines for the care and use of animals.
Samples were collected directly into vacuum glass
tubes (BD, Franklin Lakes, NJ, USA) without antico-
agulant by jugular vein puncture with an 18 G needle.
Glucose concentrations were determined in whole
blood immediately after venipuncture using a One
Touch Vita portable glucometer (Lifescan, High
Wycombe, UK) and were expressed in mmol/L. Ac-
cording to the manufacturer, the glucometer uses a
glucose oxidase biosensor and is designed to determine
glucose in human fresh capillary whole blood with
hematocrits that range from 30% to 55%.2 All samples

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c 2011 American Society for Veterinary Clinical Pathology 245
 1939165x, 2011, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-165X.2011.00309.x by Ufrgs - Universidade Federal Do Rio Grande Do Sul, Wiley Online Library on [26/06/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Portable glucometer for cattle and sheep Katsoulos et al

were determined to have hematocrits that fell within confidence intervals (CI) for cattle and sheep
this range. Before each measurement, a control solu-
tion (One Touch Vita control solution, Lifescan) was Cattle : y ¼0:965ð95%CI : 1:247  0:719Þ
tested. Serum was separated immediately after clotting þ 1:229ð95%CI : 1:147  1:320Þx
by low speed centrifugation at 1600 g for 10 minutes, Sheep : y ¼0:144 ð95%CI : 0:000  0:453Þ
transferred to plastic vials, and sent to the Laboratory
þ 0:947ð95%CI : 0:839  1:000Þx
in the Clinic of Medicine, School of Veterinary Medi-
cine, University of Thessaly for analysis of serum glu- Based on these equations the RI for blood glucose
cose concentrations. The same individual (P.D.K.) in cattle and sheep using the portable glucometer
performed all analyses using a commercial diagnostic were corrected to 1.84–4.17 and 2.41–4.35 mmol/L,
kit (Glucose Liquid-Fast, Zafiropoulos-Karavitis Ltd., respectively.
Athens, Greece) that utilizes the glucose oxidase- Analysis of Bland–Altman plots for cattle and
peroxidase (GOD-PAP) enzymatic colorimetric method3; sheep (Figure 1) indicated that the 2 methods were
the assay was performed within 30 minutes after blood linear and that the portable glucometer was adequate
collection. The kit was used according to the manufac- for determination of blood glucose in these species.
turer’s instructions: 0.02 mL of serum was mixed with Precision was 95% for cattle and 88% for sheep; such
2 mL of reagent and incubated for 5 minutes at 371C. high precision suggests that there is strong linear rela-
Absorbance of the mixture was measured at 510 nm tionship between the glucose values determined by the
using a spectrophotometer (UV-1601, Shimadzu, 2 methods. Accuracy represents a bias correction
Tokyo, Japan), and serum glucose concentration was
calculated in mmol/L based on absorbance of a stan-
dard solution (5.55 mmol/L). The reference intervals
(RI) for serum glucose established in our clinic using
this bench method were 2.28–4.18 mmol/L for cattle
and 2.39–4.44 mmol/L for sheep.
Analysis of the data were done using MEDCALC
9.2 software (MedCalc Software, Mariakerke,
Belgium). The t-test for paired samples was run
to evaluate the significance of differences between
glucose values determined by the reference method
and the portable glucometer for each animal species.
One-way analysis of variance was used to compare
the mean absolute relative deviations of the
glucose values determined by the glucometer among
3 groups: low (o RI for the bench method), middle
(within RI for the bench method), and high (4 RI for
the bench method) glucose concentrations in both
species. Post hoc multiple comparisons were made
using the Bonferroni test. A significance level of
P o.05 was used for all comparisons. The agreement
between methods was assessed using Passing and
Bablok regression analysis,4,5 and Bland–Altman plots
were created for both species. Precision and accuracy
of the measurements were tested using the concordance
correlation coefficient.6

Results and Discussion

The regression analysis according to Passing and Ba-
blok revealed the following equations between the
glucose values obtained from the portable glucometer
(y) and those from the bench method (x) with 95%
Figure 1. Bland–Altman plots showing the difference between glucose
concentrations obtained with the bench (reference) method and the One
Touch Vita portable glucometer plotted against the mean of the 2 meth-
ods. (A) Blood samples from cattle (n = 90). (B) Blood samples from sheep
(n = 101).

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c 2011 American Society for Veterinary Clinical Pathology

Katsoulos et al
factor, which measures the deviation of the best-fit line
from the 451 line through the origin, and in the present
study was 92% for cattle and 99% for sheep, indicating
that the best-fit line almost fits the 451 line.
The mean glucose concentrations obtained from the
portable glucometer were significantly lower (P =.001
for cattle, P =.008 for sheep) than those from the bench
method in both cattle (mean  SEM: 2.98  0.10
and 3.25  0.08 mmol/L for the portable glucometer
and bench method, respectively, or 8.3%) and sheep
(mean  SEM: 3.06  0.07 and 3.16  0.08 mmol/L for
the portable glucometer and bench method, respec-
tively, or 3.2%), indicating that, compared with the
bench method, the portable glucometer underestimates
blood glucose concentrations in cattle and sheep. As the
hematocrits of the animals used in the study (data not
shown) were within the reference limits for hematocrit
suggested by the manufacturer,2 the exact cause for this
underestimation is currently unknown and should be
further investigated. Possible explanations include the
low precision of the portable glucometer at low blood
glucose concentrations.2 The glucometer was designed
for use in people, who have higher blood glucose con-
centrations than do cattle and sheep. This is confirmed
by the fact that the mean absolute relative deviation at
low glucose concentrations was significantly greater
than at middle and high glucose concentrations in both
cattle (mean  SEM: 23  3%, 12  2%, and 8  2% for
low, middle, and high glucose levels, respectively,
P =.001) and sheep (mean  SEM: 15  3%, 9  2%,
and 10  2% for low, middle, and high glucose levels,
respectively, P =.008).
According to the American Diabetes Association,7
the maximum bias (analytical and user error) com-
pared with a reference method value should not ex-
ceed 10%; however, deviation of more than 10% is
observed in more than a third of the glucose values
when portable glucometers are used to measure glucose
concentrations in human blood.8 Absolute relative de-
viations of more than 10% were observed in 46% of the
values for cattle and in 33% of the values for sheep. De-
viations of more than 20% were seen in the 26% and
10% of obtained values for cattle and sheep, respec-
tively. These biases are considered acceptable with the
methodology used in the present study, given that glu-
cose concentrations for each sample were determined
only once with either the glucometer or the wet labora-
tory method, despite CLSI recommendations.9,10
Based on our results, it can be concluded that One
Touch Vita portable glucometer is sufficiently accurate
to determine blood glucose concentrations in cattle
Vet Clin Pathol 40/2 (2011) 245–247 
c 2011 American Society for Veterinary Clinical Pathology
1939165x, 2011, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-165X.2011.00309.x by Ufrgs - Universidade Federal Do Rio Grande Do Sul, Wiley Online Library on [26/06/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Portable glucometer for cattle and sheep
and sheep in field conditions; however, results are un-
derestimated. Thus, corrected RI should be used.
Disclosure: The authors have indicated that they have
no affiliations or financial involvement with any orga-
nization or entity with a financial interest in, or in
financial competition with, the subject matter or
materials discussed in this article.
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