Comparison of glucose monitoring between Freestyle Libre Pro and iPro2 in patients with diabetes mellitus.

AIMS/INTRODUCTION: Flash and continuous glucose monitoring systems are becoming prevalent in clinical practice. We directly compared a flash glucose monitoring system (FreeStyle Libre Pro [FSL-Pro]) with a continuous glucose monitoring system (iPro2) in patients with diabetes mellitus. MATERIALS AND METHODS: Glucose concentrations were simultaneously measured using the FSL-Pro, iPro2 and self-monitoring blood glucose in 10 patients with diabetes mellitus, and agreement among them was assessed. RESULTS: Parkes error grid analysis showed that the 92.9 and 7.1% of glucose values measured using the FSL-Pro fell into areas A and B, respectively, and that 96.3, 2.8 and 0.9% of those determined using iPro2 fell into areas A, B and C, respectively. The median absolute relative differences compared with self-monitoring blood glucose were 8.1% (3.9-12.7%) and 5.0% (2.6-9.1%) for the FSL-Pro and iPro2, respectively. Analysis of 5,555 paired values showed a close correlation between FSL-Pro and iPro2 glucose values (ρ = 0.96, P < 0.01). Notably, 65.3% of all glucose values were lower for the FSL-Pro than the iPro2. Median glucose values also decreased by 3.3% for the FSL-Pro compared with the iPro2 (177.0 [133.0-228.0] vs 183.0 [145.0-230.0] mg/dL, P < 0.01). The difference in glucose values between the two systems was more pronounced in hypoglycemia. The median absolute relative difference between FSL-Pro and iPro2 during hypoglycemia was much larger than that during euglycemia and hyperglycemia. CONCLUSIONS: Both the FSL-Pro and iPro2 systems are clinically acceptable, but glucose values tended to be lower when measured using the FSL-Pro than the iPro2. Agreement was not close between these systems during hypoglycemia.

Glucose Management Indicator (GMI): A New Term for Estimating A1C From Continuous Glucose Monitoring.

While A1C is well established as an important risk marker for diabetes complications, with the increasing use of continuous glucose monitoring (CGM) to help facilitate safe and effective diabetes management, it is important to understand how CGM metrics, such as mean glucose, and A1C correlate. Estimated A1C (eA1C) is a measure converting the mean glucose from CGM or self-monitored blood glucose readings, using a formula derived from glucose readings from a population of individuals, into an estimate of a simultaneously measured laboratory A1C. Many patients and clinicians find the eA1C to be a helpful educational tool, but others are often confused or even frustrated if the eA1C and laboratory-measured A1C do not agree. In the U.S., the Food and Drug Administration determined that the nomenclature of eA1C needed to change. This led the authors to work toward a multipart solution to facilitate the retention of such a metric, which includes renaming the eA1C the glucose management indicator (GMI) and generating a new formula for converting CGM-derived mean glucose to GMI based on recent clinical trials using the most accurate CGM systems available. The final aspect of ensuring a smooth transition from the old eA1C to the new GMI is providing new CGM analyses and explanations to further understand how to interpret GMI and use it most effectively in clinical practice. This Perspective will address why a new name for eA1C was needed, why GMI was selected as the new name, how GMI is calculated, and how to understand and explain GMI if one chooses to use GMI as a tool in diabetes education or management.

Educational Workshop using games improves self-monitoring of blood glucose among children / Oficina educativa baseada em atividades lúdicas melhora o automonitoramento glicêmico entre crianças / Taller educativo que usa juegos mejora el autocontrol de la glucosa en sangre en los niños

ABSTRACT Objective: to evaluate the effectiveness of an educational workshop using games to improve self-monitoring of blood glucose techniques for school children with type 1 diabetes. Method: a quasi-experimental study was conducted with school children who attended two outpatient clinics of a university hospital. Data were collected by systematic observation of the self-monitoring of blood glucose (SMBG) technique before and after the intervention. Data analysis consisted of verifying changes while performing the technique, using pre- and post-intervention compliance rates using statistical tests. The sample consisted of 33 children. Each child participated in one session; 17 educational workshops were conducted in total. Results: we found an increased frequency of SMBG, changing lancets, rotation of puncture sites, as well as calibration and periodic checking of date and time of the glucose meter. Comparisons pre- and post-intervention showed that the average number of steps in accordance with the SMBG technique increased from 5.30 to 6.58, whereas the steps "Changing the lancet of the lancing device", "Pressing the puncture site" and "Disposing of materials used in a needlestick container" showed statistically significant differences. Conclusion: the educational workshop was effective, as it improved children's performance of the SBMG technique.

RESUMO Objetivo: avaliar a eficácia de uma oficina educativa baseada em atividades lúdicas para melhorar a técnica de automonitoramento glicêmico (AMG) de crianças com diabetes tipo 1. Método: um estudo quase-experimental foi feito com crianças em idade escolar que recebiam tratamento em duas clínicas ambulatoriais de um hospital universitário. Os dados foram coletados através da observação sistemática da prática do automonitoramento glicêmico antes e após a intervenção. A análise dos dados consistiu em verificar mudanças durante a execução da técnica, usando as taxas de conformidade de pré e pós-intervenção em testes estatísticos. A amostra consistiu em 33 crianças. Cada criança participou de uma sessão da oficina, e ao todo foram feitas 17 sessões. Resultados: encontramos uma maior frequência no AMG, na troca da lanceta, na alternância nos locais de punção, na calibração e verificação periódica de data e hora do monitor de glicemia. As comparações entre os períodos pré e pós-intervenção mostraram que o número médio de etapas em conformidade com a técnica de AMG aumentou de 5,30 para 6,58. As etapas "Trocar a lanceta do lancetador", "Pressionar o local puncionado" e "Eliminar corretamente os materiais utilizados" obtiveram diferenças estatisticamente significativas. Conclusão: a oficina educativa foi eficaz, melhorando as práticas de AMG das crianças.

RESUMEN Objetivo: evaluar la efectividad de un taller educativo que usa juegos para mejorar el autocontrol de las técnicas de glucosa en sangre para niños en edad escolar con diabetes tipo 1. Método: se realizó un estudio cuasi experimental con escolares que asistieron a dos clínicas ambulatorias de un hospital universitario. Los datos se recogieron mediante la observación sistemática de la técnica de autocontrol de la glucosa en sangre (AGS) antes y después de la intervención. El análisis de los datos consistió en verificar los cambios mientras se realizaba la técnica, utilizando las tasas de cumplimiento pre- y pos-intervención mediante pruebas estadísticas. La muestra estuvo compuesta por 33 niños. Cada niño participó en una sesión; en total se realizaron 17 talleres educativos. Resultados: encontramos una mayor frecuencia de AGS, cambio de lancetas, rotación de los sitios de punción, así como la calibración y la comprobación periódica de la fecha y la hora del glucómetro. Las comparaciones previas y posteriores a la intervención mostraron que el número promedio de etapas de acuerdo con la técnica AGS aumentó de 5,30 a 6,58, mientras que las etapas "Cambio de la lanceta del dispositivo de punción", "Presión del sitio de punción", y "Eliminación de materiales utilizado en un contenedor de agujas" mostraron diferencias estadísticamente significativas. Conclusión: el taller educativo fue efectivo, ya que mejoró el rendimiento de los niños en la técnica AGS.

Accuracy of handheld blood glucose meters at high altitude.

BACKGROUND: Due to increasing numbers of people with diabetes taking part in extreme sports (e.g., high-altitude trekking), reliable handheld blood glucose meters (BGMs) are necessary. Accurate blood glucose measurement under extreme conditions is paramount for safe recreation at altitude. Prior studies reported bias in blood glucose measurements using different BGMs at high altitude. We hypothesized that glucose-oxidase based BGMs are more influenced by the lower atmospheric oxygen pressure at altitude than glucose dehydrogenase based BGMs. METHODOLOGY/PRINCIPAL FINDINGS: Glucose measurements at simulated altitude of nine BGMs (six glucose dehydrogenase and three glucose oxidase BGMs) were compared to glucose measurement on a similar BGM at sea level and to a laboratory glucose reference method. Venous blood samples of four different glucose levels were used. Moreover, two glucose oxidase and two glucose dehydrogenase based BGMs were evaluated at different altitudes on Mount Kilimanjaro. Accuracy criteria were set at a bias <15% from reference glucose (when >6.5 mmol/L) and <1 mmol/L from reference glucose (when <6.5 mmol/L). No significant difference was observed between measurements at simulated altitude and sea level for either glucose oxidase based BGMs or glucose dehydrogenase based BGMs as a group phenomenon. Two GDH based BGMs did not meet set performance criteria. Most BGMs are generally overestimating true glucose concentration at high altitude. CONCLUSION: At simulated high altitude all tested BGMs, including glucose oxidase based BGMs, did not show influence of low atmospheric oxygen pressure. All BGMs, except for two GDH based BGMs, performed within predefined criteria. At true high altitude one GDH based BGM had best precision and accuracy.

Comparison of first-generation and second-generation blood glucose meters for use in a hospital setting.

This study evaluated and compared a first- and a second-generation blood glucose meter for precision, accuracy, and user preference. Two separate capillary blood glucose fingersticks were performed on 25 outpatients and 60 inpatients with diabetes. Samples were drawn for serum glucose determinations immediately following the capillary fingersticks. Comparison of the Accu-Chek II and Satellite G meters in the outpatient setting gave results similar to the reference laboratory's. When the meters were tested on inpatients, the blood glucose results were significantly higher than those obtained from the hospital laboratory. The Accu-Chek II was more precise than the Satellite G on both normal and high blood glucose samples. Nursing staff indicated preference for the Satellite G because of its quick testing time but not for other preference factors surveyed. Both meters provided more accurate assessments of blood glucose concentration than were obtained from the serum glucose samples routinely processed by our hospital laboratory. Use of a nonfluorinated tube and delayed separation of the sample with resultant glycolysis likely account for this difference.