Resistance to Acetaminophen Interference in a Novel Continuous Glucose Monitoring System

Abstract

Acetaminophen (APAP) can cause erroneously high readings in real-time continuous glucose monitoring (rtCGM) systems. APAP-associated bias in an investigational rtCGM system (G6) was evaluated by taking the difference in glucose measurements between rtCGM and YSI from 1 hour before to 6 hours after a 1-g oral APAP dose in 66 subjects with type 1 or type 2 diabetes. The interference effect was defined as the average post-dose (30-90 minutes) bias minus the average baseline bias for each subject. The clinically meaningful interference effect was defined as 10 mg/dL. The G6 system's overall mean (±SD) interference effect was 3.1 ± 4.8 mg/dL (one-sided upper 95% CI = 4.1 mg/dL), significantly lower than 10 mg/dL. The G6 system's resistance to APAP interference should provide reassurance to those using the drug.

Reply to Argento. Flash forward, with caution

“…In the international XANTUS (XArelto on preveNtion of sTroke and non-central nervoUS system systemic embolism in people with non-valvular atrial fibrillation) registry, which included 6784 participants treated with rivaroxaban from 311 centres in Europe, Israel and Canada, the overall rate of ischaemic stroke/systemic embolism was 0.8 per 100 patient-years [5]. Lower incidence rate of major bleeding on rivaroxaban was also reported by Coleman et al [2] (2.7 per 100 patient-years) than in people with diabetes in the ROCKET-AF trial (3.79 per 100 patientyears) [4]. Major bleeding rates with rivaroxaban treatment were also low, at 2.1 events per 100 patient-years in the XANTUS study [5] and 3.0 per 100 patient-years in the Dresden NOAC registry [6].…”

“…In a recent work published in Diabetic Medicine, Coleman et al [2] reported on their 'real-world' retrospective study which used US national MarketScan claims data. Their study included a large sample size of 11 034 people with AF, with a median 1.5 years of follow-up, and compared the performance of rivaroxaban with that of propensity-score matched warfarin (n=5517 in each arm).…”

“…Interestingly, Coleman et al [2] found that rates of ischaemic stroke/systemic embolism in people with diabetes were lower than those seen in the participants with diabetes in the ROCKET-AF trial (0.87 vs 1.74 per 100 patient-years, respectively) [4]. In the international XANTUS (XArelto on preveNtion of sTroke and non-central nervoUS system systemic embolism in people with non-valvular atrial fibrillation) registry, which included 6784 participants treated with rivaroxaban from 311 centres in Europe, Israel and Canada, the overall rate of ischaemic stroke/systemic embolism was 0.8 per 100 patient-years [5].…”

“…Improvement in sensor accuracy in the hypoglycaemia range, as seen with the Dexcom G5, is particularly welcome and likely to be clinically meaningful, particularly for those with increased hypoglycaemia burden. As announced during the recent Advanced Technologies and Treatment for Diabetes (ATTD) conference, we are also encouraged that the next-generation Dexcom G6 device, like the FreeStyle Libre, will be factory-calibrated and have no interaction with commonly used paracetamol/acetaminophen [2].…”

ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes

“…Additionally, one must exercise caution when taking acetaminophen or acetaminophen‐containing cold medications in persons using certain CGM devices that exhibit interference from these medications . Notably, some newer generations of CGM no longer experience acetaminophen interference …”