scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Hospitalized Patients ◽  
Matched Pair ◽  
Patients With Diabetes ◽  
Clarke Error Grid ◽  
Error Grid

<b>Background: </b>Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational with limited data on its accuracy in the hospital setting. <p><b>Methods: </b>To analyze the accuracy of Dexcom G6 CGM,<b> </b>we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within ±15, 20 and 30% or ±15, 20 and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (?/15, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses.</p> <p><b>Results: </b>A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL).</p> <p><b>Conclusion: </b>Our results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes. </p>

scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

2021 ◽  
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Hospitalized Patients ◽  
Matched Pair ◽  
Patients With Diabetes ◽  
Clarke Error Grid ◽  
Error Grid

<b>Background: </b>Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational with limited data on its accuracy in the hospital setting. <p><b>Methods: </b>To analyze the accuracy of Dexcom G6 CGM,<b> </b>we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within ±15, 20 and 30% or ±15, 20 and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or ≤100 mg/dL, respectively (?/15, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses.</p> <p><b>Results: </b>A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL).</p> <p><b>Conclusion: </b>Our results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes. </p>

scholarly journals Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

Diabetes Care ◽  
2021 ◽  
pp. dc202856
Author(s):  
Georgia M. Davis ◽  
Elias K. Spanakis ◽  
Alexandra L. Migdal ◽  
Lakshmi G. Singh ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Critically Ill ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Patients With Diabetes

The Accuracy of Continuous Glucose Monitoring in the Medical Intensive Care Unit

2021 ◽  
pp. 193229682110275
Author(s):  
Wannita Tingsarat ◽  
Patinut Buranasupkajorn ◽  
Weerapan Khovidhunkit ◽  
Patchaya Boonchaya-anant ◽  
Nitchakarn Laichuthai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Medical Intensive Care Unit ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Risk Zone ◽  
Medical Intensive Care ◽  
Vasopressor Use ◽  
Error Grid

Objective: To assess the accuracy of continuous glucose monitoring (CGM) in medical intensive care unit (MICU) patients. Methods: A Medtronic Enlite® sensor accuracy was assessed versus capillary blood glucose (CBG) and plasma glucose (PG) using the mean absolute relative difference (MARD), surveillance error grid (SEG) analysis and modified Bland-Altman plots. Results: Using CBG as a reference, MARD was 6.6%. Overall, 99.7% of the CGM readings were within the “no risk” zone. No significant differences in accuracy were seen within vasopressor subgroups. Using PG as the reference, MARD was 8.8%. The surveillance error grid analysis showed 95.2% of glucose readings were within the “no risk” zone. There were no device-related adverse events. Conclusion: The CGM sensor showed acceptable accuracy in MICU patients, regardless of vasopressor use.

scholarly journals Practical implementation of remote continuous glucose monitoring in hospitalized patients with diabetes

2021 ◽  
Author(s):  
Matt Baker ◽  
Megan E Musselman ◽  
Rachel Rogers ◽  
Richard Hellman
Keyword(s):  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Practical Implementation ◽  
Management Decisions ◽  
Grid Analysis ◽  
Inpatient Diabetes ◽  
Inpatient Diabetes Management ◽  
Error Grid

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates. Methods Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values. Results A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations. Conclusion rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.

scholarly journals Accuracy of Flash Glucose Monitoring During Postprandial Rest and Different Walking Conditions in Overweight or Obese Young Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Fenghua Sun ◽  
Waris Wongpipit ◽  
Wendy Y. J. Huang ◽  
Stephen H. S. Wong
Keyword(s):  
Young Adults ◽  
Glucose Monitoring ◽  
Postprandial Glucose ◽  
Relative Difference ◽  
Flash Glucose Monitoring ◽  
Grid Analysis ◽  
Crossover Studies ◽  
Freestyle Libre ◽  
Clarke Error Grid ◽  
Error Grid

Aims: To investigate the accuracy of FreeStyle LibreTM flash glucose monitoring (FGM) relevant to plasma glucose (PG) measurements during postprandial rest and different walking conditions in overweight/obese young adults.Methods: Data of 40 overweight/obese participants from two randomized crossover studies were pooled into four trials: (1) sitting (SIT, n = 40); (2) walking continuously for 30 min initiated 20 min before individual postprandial glucose peak (PPGP) (20iP + CONT, n = 40); (3) walking continuously for 30 min initiated at PPGP (iP + CONT, n = 20); and (4) accumulated walking for 30 min initiated 20 min before PPGP (20iP + ACCU, n = 20). Paired FGM and PG were measured 4 h following breakfast.Results: The overall mean absolute relative difference (MARD) between PG and FGM readings was 16.4 ± 8.6% for SIT, 16.2 ± 4.7% for 20iP + CONT, 16.7 ± 12.2% for iP + CONT, and 19.1 ± 6.8% for 20iP + ACCU. The Bland–Altman analysis showed a bias of −1.03 mmol⋅L–1 in SIT, −0.89 mmol⋅L–1 in 20iP + CONT, −0.82 mmol⋅L–1 in iP + CONT, and −1.23 mmol⋅L–1 in 20iP + ACCU. The Clarke error grid analysis showed that 99.6–100% of the values in all trials fell within zones A and B.Conclusion: Although FGM readings underestimated PG, the FGM accuracy was overall clinically acceptable during postprandial rest and walking in overweight/obese young adults.

scholarly journals Comparative Accuracy Analysis of a Real-time and an Intermittent-Scanning Continuous Glucose Monitoring System

2019 ◽  
pp. 193229681989502
Author(s):  
Manuela Link ◽  
Ulrike Kamecke ◽  
Delia Waldenmaier ◽  
Stefan Pleus ◽  
Arturo Garcia ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Comparison Method ◽  
Freestyle Libre ◽  
Glucose Meter ◽  
Error Grid ◽  
Blood Glucose Meter

Background: Currently, two different types of continuous glucose monitoring (CGM) systems are available: real time (rt) CGM systems that continuously provide glucose values and intermittent-scanning (is) CGM systems. This study compared accuracy of an rtCGM and an isCGM system when worn in parallel. Methods: Dexcom G5 Mobile (DG5) and FreeStyle Libre (FL) were worn in parallel by 27 subjects for 14 days including two clinic sessions with induced glucose excursions. The percentage of CGM values within ±20% or ±20 mg/dL of the laboratory comparison method results (YSI 2300 STAT Plus, YSI Inc., Yellow Springs, OH, United States; glucose oxidase based) or blood glucose meter values and mean absolute relative difference (MARD) were calculated. Consensus error grid and continuous glucose error grid analyses were performed to assess clinical accuracy. Results: Both systems displayed clinically accurate readings. Compared to laboratory comparison method results during clinic sessions, DG5 had 91.5% of values within ±20%/20 mg/dL and a MARD of 9.5%; FL had 82.5% of scanned values within ±20%/20 mg/dL and an MARD of 13.6%. Both systems showed a lower level of performance during the home phase and when using the blood glucose meter as reference. Conclusion: The two systems tested in this study represent two different principles of CGM. DG5 generally provided higher accordance with laboratory comparison method results than FL.

scholarly journals Measures of Accuracy for Continuous Glucose Monitoring and Blood Glucose Monitoring Devices

2018 ◽  
Vol 13 (3) ◽  
pp. 575-583 ◽  
Author(s):  
Guido Freckmann ◽  
Stefan Pleus ◽  
Mike Grady ◽  
Steven Setford ◽  
Brian Levy
Keyword(s):  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Measurement Accuracy ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Glucose Measurement ◽  
Bias Analysis ◽  
Patients With Diabetes ◽  
Monitoring Devices ◽  
Error Grid

Currently, patients with diabetes may choose between two major types of system for glucose measurement: blood glucose monitoring (BGM) systems measuring glucose within capillary blood and continuous glucose monitoring (CGM) systems measuring glucose within interstitial fluid. Although BGM and CGM systems offer different functionality, both types of system are intended to help users achieve improved glucose control. Another area in which BGM and CGM systems differ is measurement accuracy. In the literature, BGM system accuracy is assessed mainly according to ISO 15197:2013 accuracy requirements, whereas CGM accuracy has hitherto mainly been assessed by MARD, although often results from additional analyses such as bias analysis or error grid analysis are provided. The intention of this review is to provide a comparison of different approaches used to determine the accuracy of BGM and CGM systems and factors that should be considered when using these different measures of accuracy to make comparisons between the analytical performance (ie, accuracy) of BGM and CGM systems. In addition, real-world implications of accuracy and its relevance are discussed.

scholarly journals A Multicenter Evaluation of the Performance and Usability of a Novel Glucose Monitoring System in Chinese Adults With Diabetes

2016 ◽  
Vol 11 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Linong Ji ◽  
Xiaohui Guo ◽  
Lixin Guo ◽  
Qian Ren ◽  
Nan Yu ◽  
...  
Keyword(s):  
Glucose Monitoring ◽  
Relative Difference ◽  
Glucose Sensing ◽  
Chinese Patients ◽  
Chinese Adults ◽  
Flash Glucose Monitoring ◽  
Glucose Levels ◽  
Patients With Diabetes ◽  
Interstitial Glucose ◽  
Error Grid

Objective: Flash glucose monitoring is a new glucose sensing technique that measures interstitial glucose levels for up to 14 days and does not require any calibration. The aim of this study is to evaluate the performance of the new system in Chinese patients with diabetes. Methods: A multicenter, prospective, masked study was performed in a total of 45 subjects with diabetes. Subjects wore 2 sensors at the same time, for up to 14 days. The accuracy was evaluated against capillary blood glucose (BG) and venous Yellow Springs Instrument (YSI; Yellow Springs, OH) measurements. During all 14 days, subjects were asked to perform at least 8 capillary BG tests per day. Each subject attended 3 days of 8-hour clinic sessions to measure YSI and sensor readings every 15 minutes. Results: Forty subjects had evaluable glucose readings, with 6687 of 6696 (99.9%) sensor and capillary BG pairs within consensus error grid zones A and B, including 5824 (87.0%) in zone A. The 6969 sensor and venous YSI pairs resulted in 6965 (99.9%) pairs within zones A and B, including 5755 (82.6%) in zone A. The sensor pairs with BG and YSI result in mean absolute relative difference (MARD) of 10.0% and 10.7%, respectively. Overall between-sensor coefficient of variation (CV) was 8.0%, and the mean lag time was 3.1 (95% confidence interval 2.54 to 4.29) minutes. Conclusions: The system works well for people with diabetes in China, and it is easy to wear and use.

scholarly journals Self-measurement of Blood Glucose and Continuous Glucose Monitoring – Is There Only One Future?

2018 ◽  
Vol 14 (2) ◽  
pp. 24 ◽  
Author(s):  
Lutz Heinemann ◽  
Andreas Stuhr
Keyword(s):  
Blood Glucose ◽  
Continuous Glucose Monitoring ◽  
Subcutaneous Tissue ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Management Options ◽  
Measurement Quality ◽  
Glucose Levels ◽  
Wide Range ◽  
Patients With Diabetes

Monitoring glycaemic control in patients with diabetes has evolved dramatically over the past decades. The introduction of easy-to-use systems for self-monitoring of blood glucose (SMBG) utilising capillary blood samples has resulted in the availability of a wide range of systems, providing different measurement quality. Systems for continuous glucose monitoring (CGM) – used mainly in patients with type 1 diabetes (T1D) – were made possible by the development of glucose sensors that measure glucose levels in the interstitial fluid (ISF) in the subcutaneous tissue of the skin. CGM readings might not correspond exactly to SMBG measurement results taken at the same time, especially during rapid changes in either blood glucose or ISF glucose levels. The mean absolute relative difference is the most popular method used for characterising the measurement performance of CGM systems. Unlike the International Organization for Standardization 15197:2013 criteria for SMBG systems, no accuracy standards for CGM systems exist. Measurement quality of CGM systems can vary based on several factors, limiting their safety and effective use in managing diabetes. Patients have to be trained adequately to make safe and efficient use of CGM systems (like with SMBG systems). Also, systems for CGM must be evaluated in terms of patient safety and the ability to provide accurate measurements regardless of the fluctuation of glucose levels. As new technological advancements in glucose monitoring are essential for improved management options of diabetes, such as automated insulin dosing systems, there is a need for a critical view of all such developments. It is likely that both, SMBG and CGM systems, will play important future roles in the treatment of diabetes.

scholarly journals Use of continuous glucose monitoring system in patients with type 2 mellitus diabetic during hemodialysis treatment

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Marcelo Rocha Nasser Hissa ◽  
Priscilla Nogueira Gomes Hissa ◽  
Sérgio Botelho Guimarães ◽  
Miguel Nasser Hissa
Keyword(s):  
Continuous Glucose Monitoring ◽  
Clinical Decision Making ◽  
Glucose Monitoring ◽  
Clinical Decision ◽  
Relative Difference ◽  
Fluid Loss ◽  
Freestyle Libre ◽  
Stage Renal Disease ◽  
End Stage ◽  
Error Grid

Abstract Background Studies highlight the inaccuracy of glycated hemoglobin (HbA1c) for the assessment of glycemic control in dialysis diabetics and suggest the use of continuous glucose monitoring (CGM) as an alternative. Of the CGMs, FreeStyle Libre® is the most used in worldwide, but there is still no consensus on its use in dialysis. Method A 3-week prospective study was performed with 12 patients comparing capillary and interstitial glucose during dialysis. Results Comparing capillary and interstitial measurements, similar values were observed in pre-dialysis in the 1st week (184.1 ± 69.5 mg/dl and 173.1 ± 78.9 mg/dl, respectively, p = 0.303), in patients with body mass index less than 24.9 kg/m2 (214.2 ± 72.2 mg/dl and 201.3 ± 77.0 mg/dl respectively, p = 0.466), in those dialysis fluid loss less than 2 l (185.5 ± 82.6 mg/dl and 183.1 ± 94.0 mg/dl respectively and p = 0.805) and in those with hemoglobin greater than 12 g/dl (152.0 ± 35, 5 mg/dl and 129.5 ± 47.4 mg/dl respectively, p = 0.016). In the correlation of the capillary measurement with the interstitial sensor, it was observed that the proportions in the Clarke Error Grid of zone A, zone B, zone C, zone D and zone E were 62.5%, 27.1%, 0.0%, 10.4% and 0.0% respectively and in the Parkes error grid in zone A, zone B, zone C, zone D and zone E were 80.6%, 9.7%, 9.7% 0.0% and 0.0%, respectively. Conclusion The mean absolute relative difference in dialysis patients is higher than the general population without end-stage renal disease. However, clinical decision-making based on the values measured by the system can be made with a good margin based on the correlation between interstitial and capillary measurements.

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