Their moonitoring, often Obesity and health conjunction with blood glucometers, provides Continuuos with a accuraacy of information that Metabolism-boosting breakfast ideas engage them and adopt Citrus aurantium extracts for sports performance more active role in Continouus care. Abbott Diabetes Continuous glucose monitoring accuracy monitoirng its FreeStyle Libre to Continuous glucose monitoring accuracy United Continuou inand since mid the FreeStyle Libre 2 model has been available. Comparative Accuracy of 17 Point-of-Care Glucose Meters. Graphical Abstract View large Download slide. Included were 6, matched pairs, including 2, CGM-POC and 3, CGM-Lab, after exclusion of CGM-POC 4. Sometimes, being somewhat inaccurate but precise is okay, particularly if you know the device has a consistent "bias" i. We measured the real-world accuracy of inpatient CGM in a large, diverse, safety-net hospital, using both POC and Lab glucose as referent values.

Continuous glucose monitoring accuracy -

This is lower than the previously reported MARD of Few studies have evaluated CGM accuracy during critical illness, and almost all have used POC glucose as the referent measure. We analyzed 2, POC-matched pairs and 3, Lab-matched pairs from CI patients and found MARD of CGM accuracy using Lab referent measures was reported for one small study of 84 matched pairs from 10 patients showing MARD of A study of CGM accuracy using Lab referent measures in patients undergoing open cardiac surgery 18 reported very high MARD during surgery In our analysis of data from CI patients in a real-world setting, MARD values for POC-matched pairs were higher than, and MARD values for Lab-matched pairs were similar to, those of prior studies.

Higher MARD in our POC-matched pairs compared with prior reports could reflect higher variability in real-world application of the device or inclusion of patients with conditions associated with lower CGM accuracy therapeutic cooling, ECMO.

Alternatively, this discrepancy may have resulted from our hospital protocol, which required POC glucose checks in situations where higher CGM discordance is expected e. or when discordance with POC was observed. In contrast, Lab glucose was obtained at regularly scheduled times typically with daily laboratory assessments or every 4 h , regardless of glucose pattern.

Future inpatient studies of three-way matched POC, Lab, and CGM are needed to further evaluate accuracy in real-world settings.

While recent recommendations 3 are focused on noncritical care use of CGM, the potential utility and impact of CGM use in the critical care setting could be greater given more intensive monitoring and higher risk management. Continued assessment and greater understanding of CGM benefits and limitations will be necessary for wide-scale implementation of CGM in ICUs.

Strengths of our study include a large cohort, large number of measures from both CI and NCI patients, use of both POC and Lab glucose as reference measures, and the real-world setting. Reliance on encounter-level diagnostic codes to determine diabetes type is an additional limitation.

As this technology continues to progress and eventually becomes integrated into hospitals, continued study and discussion of its benefits and limitations will be crucial. This article is featured in a podcast available at diabetesjournals. was supported by National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases H1RO1DK is a Clinical Scholar supported by the Robert Wood Johnson Foundation Duality of Interest.

No potential conflicts of interest relevant to this article were reported. Author Contributions. acquired the data. and R. conceptualized the study and wrote the manuscript. analyzed the data. All authors contributed to study design and reviewed and edited the manuscript.

is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Sign In or Create an Account.

Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 46, Issue Previous Article Next Article.

Research Design and Methods. Article Information. Article Navigation. Brief Report August 10 Real-world Accuracy of CGM in Inpatient Critical and Noncritical Care Settings at a Safety-Net Hospital Erin Finn ; Erin Finn.

This Site. Google Scholar. Lindsay Schlichting ; Lindsay Schlichting. Laura Grau ; Laura Grau. Ivor S. Douglas ; Ivor S. Rocio I. Pereira Corresponding author: Rocio I. Pereira, rocio. pereira dhha. Diabetes Care ;46 10 — Article history Received:.

Get Permissions. Orianne Villard , Marc D. Breton , Swati Rao , Mary K. Voelmle , Morgan R. Fuller , Helen E. Myers , Ryan K. McFadden , Zander S.

Luke , Christian A. Wakeman , Mary Clancy-Oliveri , Ananda Basu , Meaghan M. Stumpf; Accuracy of a Factory-Calibrated Continuous Glucose Monitor in Individuals With Diabetes on Hemodialysis. Diabetes Care 7 July ; 45 7 : — Continuous glucose monitoring CGM improves diabetes management, but its reliability in individuals on hemodialysis is poorly understood and potentially affected by interstitial and intravascular volume variations.

We assessed the accuracy of a factory-calibrated CGM by using venous blood glucose measurements vBGM during hemodialysis sessions and self-monitoring blood glucose SMBG at home. Twenty participants completed the protocol. The mean absolute relative difference of the CGM was The overall performance of a factory-calibrated CGM appears reasonably accurate and clinically relevant for use in practice by individuals on hemodialysis and health professionals to improve diabetes management.

The management of diabetes in individuals on hemodialysis is complex due to physiologic changes in glucose and insulin homeostasis as well as limitations in the ability of the patient and clinician to obtain accurate information regarding glucose trends 1.

Consequently, glucose levels in these individuals can be labile, with wide variability easily missed by both health care providers and individuals with diabetes relying only on self-monitoring blood glucose SMBG or HbA 1c 2 for effective glycemic management.

Continuous glucose monitoring CGM has been explored in this population 3 ; however, no studies have specifically assessed the accuracy of a factory-calibrated real-time CGM in the hemodialysis setting, which could potentially be affected by inter- and intraindividual variations in interstitial and intravascular volumes.

Furthermore, a study recently reported improvement in glucose control in participants with diabetes on hemodialysis with automated closed-loop insulin delivery 4.

Such therapeutic possibilities can only be advanced in day-to-day clinical practice with reliable factory-calibrated CGMs.

Therefore, we present a prospective pilot study to assess the accuracy of a factory-calibrated CGM in outpatients on hemodialysis. The study protocol was approved by the University of Virginia Institutional Review Board and registered at ClinicalTrials. gov NCT Participants were required to obtain four to seven SMBG values per day at home while following usual care.

We determined the mean absolute relative difference MARD. We analyzed the reliability with the Parkes error grid PEG 5 and surveillance error grid SEG 6.

Glycemic outcomes and glucose management indicator GMI 7 were computed on CGM records. The statistical analysis was done with MATLAB Ra MathWorks, Natick, MA and GraphPad Prism 9.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Between February and September , 20 participants completed the protocol: 4 with type 1 diabetes, 15 with type 2 diabetes, and 1 with posttransplantation diabetes.

The mean ± SD age was Each participant completed three hemodialysis sessions with a mean duration of 3. Over the 10 days, the number of SMBG values collected was lower than expected, with a median interquartile range [IQR] of No adverse events related to wearing the CGM were reported.

Three devices stopped working between 5 and 7 days. The overall MARD was Not enough reference glucose measurements were collected in the hypoglycemic range to report accuracy metrics.

From PEG analysis Fig. SEG analysis showed The tables below report the MARD for each matched pair regarding glucose range. NA, nonapplicable. The mean coefficient of variation was 34 ± 9.

HbA 1c , known to be inaccurate in this population, was correlated with the GMI correlation coefficient 0. To our knowledge, this is the first study to assess the performance of a factory-calibrated CGM in outpatients on intermittent hemodialysis.

We provide data on the accuracy of the Dexcom G6-Pro CGM compared with SMBG and venous blood samples, including during hemodialysis sessions, a time particularly challenged by rapid perturbations to glucose and its volume of distribution.

A strength of our study is to provide clinicians with practical data comparing CGM to SMBG, currently the standard of care. Our study also confirms HbA 1c is inaccurate in this population 1. The distribution of CGM data in our study reveals the poor glycemic control of the hemodialysis population 8.

Presently, all CGM devices approved by the U. Food and Drug Administration for individuals on hemodialysis require daily calibrations 3. In our study, most participants did not obtain the recommended number of SMBG values per day, underscoring the difficulty clinicians and patients have in using SMBG for glycemic management.

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The data of monigoring were ultimately evaluated. Data Athletes diet the study participants were analyzed. Monotoring overall Citrus aurantium extracts for sports performance was 7. The gluclse was stable over the day wear period. For participants aged 4—5 years, MARD was No serious adverse events were reported. The FSL3 CGM system demonstrated accurate performance across the dynamic glycemic range during the day sensor wear period. Orianne VillardMarc D. Breton minitoring, Swati Citrus aurantium extracts for sports performanceMary K. VoelmleMorgan R. FullerHelen E. MyersRyan K. McFaddenZander S.