Comparison between a flash glucose monitoring system and a portable blood glucose meter for monitoring dogs with diabetes mellitus

Abstract

Background: Flash glucose monitoring system (FGMS; FreeStyle Libre) was recently validated for use in diabetic dogs (DD). It is not known if this system is clinically useful in monitoring DD. Objective: To compare the clinical utility of FGMS against blood glucose curves (BGCs) obtained with a portable blood glucose meter (PBGM) in monitoring DD. Animals: Twenty dogs with diabetes mellitus. Methods: Prospective study. Dogs with diabetes mellitus on insulin treatment for at least 1 month were included. Comparisons of insulin dose recommendations based on the in-hospital GCs acquired using FGMS and a PBGM, consecutive-day interstitial GCs (IGCs) acquired at home using the FGMS, and consecutive-day, home vs hospital IGCs acquired using the FGMS were made using concordance analysis. Results: There was good concordance between insulin dose recommendations based on FGMS and PBGM generated GCs and IGCs obtained in the 2 different environments on 2 consecutive days, but almost absent concordance between IGCs obtained on 2 consecutive days at home. Glucose nadirs were detected in 34/43 (79%) of Ambulatory Glucose Profile (AGP) reports of the FGMS. In comparison, concordant glucose nadirs were identified in 14/34 (41%) BGCs using PBGM. The individual FGMS scans and PBGM identified 60% and 9% of low IG/hypoglycemic episodes, respectively. Conclusions and Clinical Importance: Insulin dose adjustments based on BGCs can be suboptimal. The FGMS allows a more accurate identification of the glucose nadirs and hypoglycemic episodes compared to the use of a PBGM and assessment of dayto-day variations in glycemic control.

Accuracy of a flash glucose monitoring system in cats and determination of the time lag between blood glucose and interstitial glucose concentrations

“…31 In diabetic dogs, a recent study showed that use of FGMS allowed better identification of BG nadirs and hypoglycemic episodes compared to the use of a PBGM. 32 The FGMS also allows the assessment of BG variations during consecutive days, enabling the clinician to make a more informed decision about the appropriate insulin dose, taking into account day-to-day variations in glycemic control. 32 Although the sensor might not remain on the cat for the full 14 days, using a simple application method, in most cats data can be obtained over a few days and nights.…”

“…32 The FGMS also allows the assessment of BG variations during consecutive days, enabling the clinician to make a more informed decision about the appropriate insulin dose, taking into account day-to-day variations in glycemic control. 32 Although the sensor might not remain on the cat for the full 14 days, using a simple application method, in most cats data can be obtained over a few days and nights. Additional studies are needed to investigate whether long-term use of FGMS during follow-up examination improves glycemic control in diabetic cats.…”

“…In human medicine, the use of FGMS significantly improves glycemic control 31 . In diabetic dogs, a recent study showed that use of FGMS allowed better identification of BG nadirs and hypoglycemic episodes compared to the use of a PBGM 32 . The FGMS also allows the assessment of BG variations during consecutive days, enabling the clinician to make a more informed decision about the appropriate insulin dose, taking into account day‐to‐day variations in glycemic control 32 .…”

Validation of a flash glucose monitoring system in outpatient diabetic cats

“…The FGMS has been validated in dogs with DM treated on an outpatient basis as well as in dogs hospitalized for diabetic ketoacidosis. 18 , 19 , 20 , 21 , 22 One study also has validated the FGMS in hospitalized diabetic cats. 23 In this study, the investigators used 8 sutures to attach the sensor to mostly nonsedated cats, a technique that could be unacceptable to some veterinarians and owners.…”

“…A newer flash glucose monitoring system (FGMS; FreeStyle Libre, Abbott, Alameda, California) is appealing for use in cats because of its small size, ease of use, affordability, intuitive computer software, and factory calibration which eliminates the need for venipuncture and calibration with blood glucose concentration. The FGMS has been validated in dogs with DM treated on an outpatient basis as well as in dogs hospitalized for diabetic ketoacidosis 18‐22 . One study also has validated the FGMS in hospitalized diabetic cats 23 .…”