Blood Glucose Determination: Effect of Tube Additives

Giuseppe Lippi*, Mads Nybo, Janne Cadamuro, Joao T Guimaraes, Edmée van Dongen-Lases, Ana-Maria Simundic

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingBook chapterResearchpeer-review


The measurement of fasting plasma glucose may be biased by a time-dependent decrease of glucose in blood tubes, mainly attributable to blood cell metabolism when glycolysis is not rapidly inhibited or blood cells cannot be rapidly separated from plasma. Although glycolysis inhibitors such as sodium fluoride (NaF) in combination with potassium oxalate (KOx) are currently used for overcoming this drawback, their efficacy for stabilizing blood glucose is seemingly limited, and probably lower than that of newer additives such as the citrate buffer. Therefore, we performed a critical analysis of the current scientific literature aimed to generate evidence-based information about the advantages of using citrate buffer in blood tubes compared to the more conventional NaF additive. The results of our systematic overview of the literature show that citrate blood tubes represent a considerable step forward in achieving more accurate and reliable plasma glucose measurements, thereby limiting the risk of underdiagnosing diabetes due to spurious decrease of glucose concentration in uncentrifuged blood specimens, ensuring higher stability of glucose levels over time, while simultaneously producing less hemolysis compared to NaF blood tubes. Therefore, we suggest that the use of this new mixture should be encouraged for achieving a higher degree of accuracy and standardization of plasma glucose measurements.

Original languageEnglish
Title of host publicationAdvances in Clinical Chemistry
Publication date27. Feb 2018
ISBN (Print)9780128152065
Publication statusPublished - 27. Feb 2018
SeriesAdvances in Clinical Chemistry


  • Diabetes
  • Fasting plasma glucose
  • Glucose
  • Glycolysis
  • Quality
  • Glycolysis/drug effects
  • Humans
  • Blood Glucose/analysis
  • Animals
  • Sodium Fluoride/chemistry
  • Citrates/chemistry
  • Diabetes Mellitus/blood
  • Buffers
  • Blood Specimen Collection/methods


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