A head‐to‐head comparison between Guardian Connect and FreeStyle Libre systems and an evaluation of user acceptability of sensors in patients with type 1 diabetes

Abstract

Aims: A user-calibrated real-time continuous glucose monitoring (rt-CGM) system is compared to a factory-calibrated flash glucose monitoring (FGM) system and assessed in terms of accuracy and acceptability in patients with type 1 diabetes (T1D). Methods:Ten participants with T1D were enroled from a specialist diabetes centre in Singapore and provided with the Guardian Connect with Enlite Sensor (Medtronic, Northridge, CA, USA) and first-generation Freestyle Libre System (Abbott Diabetes Care, Witney, UK), worn simultaneously. Participants had to check capillary blood glucose four times per day. At the end of week 1 and week 2, participants returned for data download and were given a user evaluation survey.Results: Accuracy evaluation between Guardian Connect and Freestyle Libre includes the overall mean absolute relative difference value (9.7 � 11.0% vs. 17.5 � 10.9%), Clarke Error Grid zones A + B (98.6% vs. 98.1%), sensitivity (78.9% vs. 63.4%), and specificity (93.4% vs. 81.0%). Notably, time below range (<3.9 mmol/ L) was 10.5% for FGM versus 2% for rt-CGM. From the evaluation survey, 90% of participants perceived rt-CGM to be accurate versus 40% for FGM, although the majority found both devices to be easy to use, educational, and useful in improving glycaemic control. However, due to the cost of sensors, only 30% were keen to use either device for continuous monitoring.Conclusions: Although rt-CGM was superior to FGM in terms of accuracy, the value of glucose trends in both devices is still useful in diabetes self-management. Patients and clinicians may consider either technology depending on their requirements. K E Y W O R D Scapillary blood glucose, continuous glucose monitoring, diabetes mellitus, flash glucose monitoring | INTRODUCTIONA pillar of self-management in type 1 diabetes mellitus (T1D) is selfmonitoring of blood glucose (SMBG). Clinical guidelines have recommended testing frequency of at least 4 times a day, before each meal and at bedtime, and up to 10 times per day if target blood glucose control is not reached. 1 Previous studies have shown an association between higher SMBG frequency and lower glycated haemoglobin (HbA1c) levels. 2 The finger-prick capillary blood glucose (CBG) method has been widely accepted as the gold standard for SMBG, but it has its limitations. While technological advances have reduced the

Accuracy of Abott Freestyle Libre versus Dexcom G6 in a patient with pre-diabetes: a case report and review of literature

“…This investigation was prompted by the subject's suspicion regarding the accuracy of FreeStyle Libre, stemming from observed disparities in glucose values compared to SMBG. This report demonstrates that, following the consumption of carbohydrate-rich diets (typically exceeding 40-50g), FreeStyle Libre consistently yielded higher and inaccurate glucose levels compared to reference SMBG data, while G6 provided more reliable glucose values (Figs 1,4,5)…”

“…In the ndings presented in this report, the peak glucose levels after meal ingestion were also approximately 60 minutes after ingestion (Figs. 1,3,4,5). CGMs may be valuable in comparing the time taken to reach peak glucose levels based on the diet consumed (pasta vs. rice vs. bread).…”

“…. Conversely, pre-meal glucose levels exhibited comparability and accuracy in both devices (Figs 1,2,3,4,5)…”

Clinical Performance Evaluation of Continuous Glucose Monitoring Systems: A Scoping Review and Recommendations for Reporting

“…Finally, a particular strength of studies examining multiple CGM systems worn by the same subjects is the ability to compare various therapy parameters such as the TIR or glucose management indicator among CGM systems. Examples of this analysis can be found in the studies by Bonora et al, 95 Boscari et al, 154 and Yeoh et al, 161 concluding that, in particular, the time below range can be considerably different between CGM systems.…”

Clinical application guidelines for blood glucose monitoring in China (2022 edition)

“…Therefore, glucose metrics generated by CGM only reflects the short‐term glucose control. Furthermore, there is a lack of standardisation across CGM systems, and the data on head‐to‐head comparisons of CGM sensors are limited, 86 , 87 , 88 making it impossible to directly compare the CGM parameters reported by different studies. Finally, the relatively high cost of CGM poses a major obstacle to the utilisation of CGM in clinical practice.…”