Careful readings for a flash glucose monitoring system in nondiabetic Japanese subjects: individual differences and discrepancy in glucose concentrarion after glucose loading [Rapid Communication]

Sekido, Keiko; Sekido, Takashi; Kaneko, A.; Hosokawa, Manami; Sato, Ai; Sato, Yoshihiko; Yamazaki, Masanori; Komatsu, Mitsuhisa

doi:10.1507/endocrj.ej17-0193

Cited by 17 publications

(23 citation statements)

References 13 publications

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“…changes, as the previous study mentioned [10,13]. In the present case, the glycemic fluctuations were relatively obvious because of the frequent bolus 50% glucose intravenous administrations and changes of continuous infusion rates of 50% glucose via central venous catheter (Fig.…”

Section: Discussionsupporting

confidence: 58%

“…However, according to some reports [9,10,13,14], there remains debate concerning the accuracy of fCGM values under hypoglycemic conditions. It might be difficult to observe frequent hypoglycemic episodes in studies of patients with diabetes [14], and they have been rarely examined in the case of insulinomas, which are instances of inappropriate hyperinsulinemic hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…We previously reported a case in which these features of the Freestyle ® Libre contributed to avoiding episodes of hypoglycemia by detecting unnoticed hypoglycemia, thus improving the patient's health-related quality of life [11]. However, the accuracy of fCGM systems in the hypoglycemic range under chronic hyperinsulinemic hypoglycemia such as that found with insulinoma has not been fully examined [12,13].…”

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confidence: 99%

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Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

et al. 2020

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The accuracy of factory-calibrated continuous glucose monitoring (fCGM) within hypoglycemic ranges, especially under the status of chronic hyperinsulinemic hypoglycemia like insulinomas, remains an issue. Even so, fCGM is known to be useful for detecting hypoglycemia unawareness in insulinoma cases. A 25-year-old woman presenting with sudden unconsciousness was diagnosed with insulinoma; fCGM facilitated diagnosis by continuous monitoring for hypoglycemia. Before surgery, she was treated with continuous and frequent bolus infusions of 50% glucose via central venous catheter. To evaluate the accuracy of fCGM values in this case, a comparison between fCGM and capillary blood glucose (CBG) values was also performed. According to the simultaneously measured values, those of fCGM were largely in accordance with those of CBG. Moreover, compared with the previously reported case not having glucose infusions via central venous catheter, both the mean absolute relative differences (MARDs) and the absolute differences (Δ glucose) between fCGM and CBG values were larger in the present case, although no significant differences of MARDs and Δ glucose between the two cases were observed in several different conditions including fasting, post-meal, hypoglycemia, and others. Therefore, we should note possible increased differences between fCGM and CBG values in cases using frequent intravenous glucose infusions as well as case-dependent differing levels of consistency between them.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

et al. 2020

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“…is difference between venous and sensor glucose may be caused by a time delay for physiological reason, especially in the MTT process when the glucose changed rapidly. On the contrary, Sekido et al [25] reported that FGM was significantly higher than plasma glucose at 30, 60, and 90 minutes after glucose loading. e authors used the immediately scanned data of the FGM system.…”

Section: Discussionmentioning

confidence: 90%

The Accuracy and Precision of the Continuously Stored Data from Flash Glucose Monitoring System in Type 2 Diabetes Patients during Standard Meal Tolerance Test

Yan

Kong

et al. 2020

International Journal of Endocrinology

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Background. The purpose of this study was to investigate the accuracy of the continuously stored data from the Abbott FreeStyle Libre flash glucose monitoring (FGM) system in Chinese diabetes patients during standard meal tests when glucose concentrations were rapidly changing. Subjects and Methods. Interstitial glucose levels were monitored for 14 days in 26 insulin-treated patients with type 2 diabetes using the FGM system. Standard meal tests were conducted to induce large glucose swings. Venous blood glucose (VBG) was tested at 0, 30, 60, and 120 min after standard meal tests in one middle day of the first and second weeks, respectively. The corresponding sensor glucose values were obtained from interpolating continuously stored data points. Assessment of accuracy was according to recent consensus recommendations with median absolute relative difference (MARD) and Clarke and Parkes error grid analysis (CEG and PEG). Results. Among 208 paired sensor-reference values, 100% were falling within zones A and B of the Clarke and Parkes error grid analysis. The overall MARD was 10.7% (SD, 7.8%). Weighted least squares regression analysis resulted in high agreement between the FGM sensor glucose and VBG readings. The overall MTT results showed that FGM was lower than actual VBG, with MAD of 22.1 mg/dL (1.2 mmol/L). At VBG rates of change of -1 to 0, 0 to 1, 1 to 2, and 2 to 3 mg/dl/min, MARD results were 11.4% (SD, 8.7%), 9.4% (SD, 6.5%), 9.9% (SD, 7.5%), and 9.5% (SD, 7.7%). At rapidly changing VBG concentrations (>3 mg/dl/min), MARD increased to 19.0%, which was significantly higher than slow changing BG groups. Conclusions. Continuously stored interstitial glucose measurements with the FGM system were found to be acceptable to evaluate VBG in terms of clinical decision during standard meal tests. The continuously stored data from the FGM system appeared to underestimate venous glucose and performed less well during rapid glucose changes.

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“…One report has described that SMBG can serve as the primary comparator for FGMS performance evaluation 13 . Many studies have used the MARD to determine the accuracy of FGMS and CGMS [13][14][15][16][17][18] . However, we applied median ARD instead of MARD, because the distribution of the glucose values measured in the present study was not normal.…”

Section: Discussionmentioning

confidence: 99%

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

Kumagai

Muramatsu

Fujii

et al. 2018

J of Diabetes Invest

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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 ( iP ro2) in patients with diabetes mellitus. Materials and Methods Glucose concentrations were simultaneously measured using the FSL ‐Pro, iP ro2 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 iP ro2 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 iP ro2, respectively. Analysis of 5,555 paired values showed a close correlation between FSL ‐Pro and iP ro2 glucose values (ρ = 0.96, P < 0.01). Notably, 65.3% of all glucose values were lower for the FSL ‐Pro than the iP ro2. Median glucose values also decreased by 3.3% for the FSL ‐Pro compared with the iP ro2 (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 iP ro2 during hypoglycemia was much larger than that during euglycemia and hyperglycemia. Conclusions Both the FSL ‐Pro and iP ro2 systems are clinically acceptable, but glucose values tended to be lower when measured using the FSL ‐Pro than the iP ro2. Agreement was not close between these systems during hypoglycemia.

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Careful readings for a flash glucose monitoring system in nondiabetic Japanese subjects: individual differences and discrepancy in glucose concentrarion after glucose loading [Rapid Communication]

Cited by 17 publications

References 13 publications

Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

Factory-calibrated continuous glucose monitoring and capillary blood glucose monitoring in a case with insulinoma: usefulness and possible pitfall under chronic hyperinsulinemic hypoglycemia

The Accuracy and Precision of the Continuously Stored Data from Flash Glucose Monitoring System in Type 2 Diabetes Patients during Standard Meal Tolerance Test

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

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