Comparison of Two Continuous Glucose Monitoring Systems, Dexcom G4 Platinum and Medtronic Paradigm Veo Enlite System, at Rest and During Exercise

Taleb, Nadine; Emami, Ali; Suppère, Corinne; Messier, Virginie; Legault, Laurent; Chiasson, Jean‐Louis; Rabasa‐Lhoret, Rémi; Haidar, Ahmad

doi:10.1089/dia.2015.0394

Cited by 58 publications

(60 citation statements)

References 28 publications

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“…This type of event is expected to be decreased or eliminated in the future with the use of glucose sensors with better performance. However, glucose sensor performance is reduced during exercise, leading to an overall overestimation of glucose values compared with rest: in our study the mean absolute relative difference (MARD) for Dexcom measurements of plasma glucose was 13.8 ± 12.0% at rest, which increased to 22.5 ± 17.2% during exercise [27]. A similar MARD difference between rest and exercise has been observed with other sensors (e.g.…”

Section: Discussionsupporting

confidence: 82%

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Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

et al. 2016

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Aims/hypothesis The aim of this study was to assess whether the dual-hormone (insulin and glucagon) artificial pancreas reduces hypoglycaemia compared with the single-hormone (insulin alone) artificial pancreas during two types of exercise. Methods An open-label randomised crossover study comparing both systems in 17 adults with type 1 diabetes (age, 37.2 ± 13.6 years; HbA 1c, 8.0 ± 1.0% [63.9 ± 10.2 mmol/mol]) during two exercise types on an ergocycle and matched for energy expenditure: continuous (60% V : O 2peak for 60 min) and interval (2 min alternating periods at 85% and 50% V : O 2peak for 40 min, with two 10 min periods at 45% V : O 2peak at the start and end of the session). Blocked randomisation (size of four) with a 1:1:1:1 allocation ratio was computer generated. The artificial pancreas was applied from 15:30 hours until 19:30 hours; exercise was started at 18:00 hours and announced 20 min earlier to the systems. The study was conducted at the Institut de recherches cliniques de Montréal. Results During single-hormone control compared with dualhormone control, exercise-induced hypoglycaemia (plasma glucose <3.3 mmol/l with symptoms or <3.0 mmol/l regardless of symptoms) was observed in four (23.5%) vs two (11.8%) interventions (p = 0.5) for continuous exercise and in six (40%) vs one (6.25%) intervention (p = 0.07) for interval exercise. For the pooled analysis (single vs dual hormone), the median (interquartile range) percentage time spent at glucose levels below 4.0 mmol/l was 11% (0.0-46.7%) vs 0% (0-0%; p = 0.0001) and at glucose levels between 4.0 and 10.0 mmol/l was 71.4% (53.2-100%) vs 100% (100-100%; p = 0.003). Higher doses of glucagon were needed during continuous (0.126 ± 0.057 mg) than during interval exercise (0.093 ± 0.068 mg) (p = 0.03), with no reported side-effects in all interventions.A. Haidar and R. Rabasa-Lhoret are joint senior authors.Electronic supplementary material The online version of this article (doi:10.1007/s00125-016-4107-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.* Rémi Rabasa-Lhoret

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Section: Discussionsupporting

confidence: 82%

“…A similar MARD difference between rest and exercise has been observed with other sensors (e.g. Enlite Veo) [27]. Following dual-hormone interventions, a more favourable overnight glycaemic profile was also noted compared with single-hormone interventions.…”

Section: Discussionsupporting

confidence: 78%

Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

et al. 2016

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“…6,7 Improved accuracy of CGM There has been steady improvement in the accuracy of glucose sensors. [20][21][22][23][24][25][26][27] The best sensors now have an accuracy of approximately -10% MARD. This has led to greater acceptance by patients and physicians and has enabled users of CGM to reduce the number of measurements of capillary blood glucose (CBG).…”

Section: Part I: Open-loop Controlmentioning

confidence: 99%

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

Rodbard¹

2017

Diabetes Technology & Therapeutics

367

267

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Continuous Glucose Monitoring (CGM) has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life for a wide range of patient populations and clinical indications. Use of CGM can help reduce HbA1c and mean glucose. One CGM device, with accuracy (%MARD) of approximately 10%, has recently been approved for selfadjustment of insulin dosages (nonadjuvant use) and approved for reimbursement for therapeutic use in the United States. CGM had previously been used off-label for that purpose. CGM has been demonstrated to be clinically useful in both type 1 and type 2 diabetes for patients receiving a wide variety of treatment regimens. CGM is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). CGM is used both in retrospective (professional, masked) and real-time (personal, unmasked) modes: both approaches can be beneficial. When CGM is used to suspend insulin infusion when hypoglycemia is detected until glucose returns to a safe level (low-glucose suspend), there are benefits beyond sensor-augmented pump (SAP), with greater reduction in the risk of hypoglycemia. Predictive low-glucose suspend provides greater benefits in this regard. Closed-loop control with insulin provides further improvement in quality of glycemic control. A hybrid closed-loop system has recently been approved by the U.S. FDA. Closed-loop control using both insulin and glucagon can reduce risk of hypoglycemia even more. CGM facilitates rigorous evaluation of new forms of therapy, characterizing pharmacodynamics, assessing frequency and severity of hypo-and hyperglycemia, and characterizing several aspects of GV.

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“…However, if there is an undetected malfunction, missing data transfer, or the algorithms do not handle the CGM data adequately, a clinically relevant adverse event can clearly ensue [3a]. As with CGM, there are likely to be rapid improvements in AID systems from one generation to the next that will challenge the pace of clinical evaluation (see above) and demand standardized outcome measures (19)(20)(21) [1c].…”

Section: Combination Of Cgm With Insulin Pumps: Automated Insulin Delmentioning

confidence: 99%

Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations

et al. 2017

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The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre-and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

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Comparison of Two Continuous Glucose Monitoring Systems, Dexcom G4 Platinum and Medtronic Paradigm Veo Enlite System, at Rest and During Exercise

Abstract: Dexcom and Enlite demonstrated comparable overall performances during rest and physical activity. However, a lower accuracy was observed during exercise for both sensors, necessitating a fine-tuning of their performance with physical activity.

Cited by 58 publications

References 28 publications

Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations

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