Accuracy of a flash glucose monitoring system in dogs with diabetic ketoacidosis

Abstract

Background: A factory-calibrated flash glucose monitoring system (FGMS; FreeStyle Libre) recently was evaluated in dogs with uncomplicated diabetes mellitus. It is not known if this system is reliable during diabetic ketoacidosis (DKA). Objectives: To assess the performance of the FGMS in dogs with DKA and to determine the effect of severity of ketosis and acidosis, lactate concentration, body condition score (BCS), and time wearing the sensor on the accuracy of the device. Animals: Fourteen client-owned dogs with DKA. Methods: The interstitial glucose (IG) measurements were compared with blood glucose (BG) measurements obtained using a validated portable glucometer. The influence of changes in metabolic variables (β-hydroxybutyrate, pH, bicarbonate, and lactate) and the effect of BCS and time wearing on sensor performance were evaluated. Accuracy was determined by fulfillment of ISO15197:2013 criteria. Results: Metabolic variables, BCS, and time wearing were not associated with the accuracy of the sensor. Good agreement between IG measurements and BG was obtained both before and after DKA resolution (r = .88 and r = .93, respectively). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% and 99.6% of results in zones A + B of the Parkes consensus error grid analysis before and after DKA resolution, respectively. Conclusions and Clinical Importance: Changes in metabolic variables, BCS, and time wearing do not seem to affect agreement between IG and BG. Despite not fulfilling the ISO requirements, the FGMS provides clinically accurate estimates of BG in dogs with DKA.

Flash glucose monitoring in diabetic dogs: a feasible method for evaluating glycemic control

“…The fact that one dog developed transient Horner syndrome shortly after sensor placement by the pet owner at home suggests, that this procedure, although minimally invasive, should be restricted to veterinarians or well-trained clients. It also supports a more dorsal positioning of the sensor when attached at the neck as demonstrated in the 2 validation studies [5] [12]. Alternatively, a case series suggested that implantation at the waist or back might be advantageous in dogs with less than 10 kg [13].…”

“…Although 42 % of our patients weighed less than 10 kg, we did not observe problems with sensor positioning at the side of the neck in any of these dogs. Nevertheless, dorsal placement as suggested in the 2 validation studies [5] [12] would have been problematic in the smallest dog, a Miniature Pinscher weighing 3.4 kg.…”

The Influence of Skin Thickness on Flash Glucose Monitoring System Accuracy in Dogs with Diabetes Mellitus

“…In all dogs, the skin reaction was self-limiting without the need for any medication. In dogs, the development of a mild erythema at the site of the sensor application has been reported in 50% of dogs [ 1 ] and in 7% of dogs [ 2 ]. In humans, skin reactions to the FGMS have been described in several reports [ 40 , 41 , 42 , 43 , 44 ] and can be irritative or allergic skin lesions.…”

“…The flash glucose monitoring system (FGMS) is a novel continuous glucose monitoring system (CGMS) recently validated for use in dogs with diabetes mellitus and diabetic ketoacidosis [ 1 , 2 ]. It consists of a 35 mm × 5 mm round sensor, which continuously measures the glucose in the interstitial fluid through a small filament inserted under the skin, allowing more rapid glucose monitoring.…”

Veterinary Telemedicine: A literature review

“…After gathering the data from an at-home glucose curve, the client can schedule a virtual visit with the veterinarian and adjustments in the treatment plan can be made as needed. There are studies that have shown the accuracy of the FreeStyle Libre compared to glucose curves, and the clinical accuracy makes continuous glucose monitoring an attractive alternative for pet owners (Corradini et al, 2016;and Malerba et al, 2020).…”