title: Accuracy and reliability of continuous glucose monitoring systems: a head-to-head comparison.
abstract: OBJECTIVE
  This study assessed the accuracy and reliability of three continuous glucose monitoring (CGM) systems.
  
  
  METHODS
  We studied the Animas® (West Chester, PA) Vibe™ with Dexcom® (San Diego, CA) G4™ version A sensor (G4A), the Abbott Diabetes Care (Alameda, CA) Freestyle® Navigator I (NAV), and the Medtronic (Northridge, CA) Paradigm® with Enlite™ sensor (ENL) in 20 patients with type 1 diabetes mellitus. All systems were investigated both in a clinical research center (CRC) and at home. In the CRC, patients received a meal with a delayed and increased insulin dose to induce a postprandial glucose peak and nadir. Hereafter, randomization determined which two of the three systems would be worn at home until the end of functioning, attempting use beyond manufacturer-specified lifetime. Patients performed at least five reference finger sticks per day. An analysis of variance was performed on all data points ≥15 min apart.
  
  
  RESULTS
  Overall average mean absolute relative difference (MARD) (SD) measured at the CRC was 16.5% (14.3%) for NAV and 16.4% (15.6%) for ENL, outperforming G4A at 20.5% (18.2%) (P<0.001). Overall MARD when assessed at home was 14.5% (16.7%) for NAV and 16.5 (18.8%) for G4A, outperforming ENL at 18.9% (23.6%) (P=0.006). Median time until end of functioning was similar: 10.0 (1.0) days for G4A, 8.0 (3.5) days for NAV, and 8.0 (1.5) days for ENL (P=0.119).
  
  
  CONCLUSIONS
  In the CRC, G4A was less accurate than NAV and ENL sensors, which seemed comparable. However, at home, ENL was less accurate than NAV and G4A. Moreover, CGM systems often show sufficient accuracy to be used beyond manufacturer-specified lifetime.
authors: Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. y.m.luijf@gmail.com
authors: Yoeri M
authors: YM
authors: Luijf
authors: Julia K
authors: JK
authors: Mader
authors: Werner
authors: W
authors: Doll
authors: Thomas
authors: T
authors: Pieber
authors: Anne
authors: A
authors: Farret
authors: Jerome
authors: J
authors: Place
authors: Eric
authors: E
authors: Renard
authors: Daniela
authors: D
authors: Bruttomesso
authors: Alessio
authors: A
authors: Filippi
authors: Angelo
authors: A
authors: Avogaro
authors: Sabine
authors: S
authors: Arnolds
authors: Carsten
authors: C
authors: Benesch
authors: Lutz
authors: L
authors: Heinemann
authors: J Hans
authors: JH
authors: DeVries
mesh_terms: D000005:Abdomen; D000203:Activities of Daily Living; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D005060:Europe; D045604:Extracellular Fluid / Q000187:drug effects / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000517:prevention & control; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008422:Materials Testing; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D015203:Reproducibility of Results; D040521:Subcutaneous Tissue / Q000187:drug effects / Q000378:metabolism*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose
references: J Diabetes Sci Technol. 2012 Nov 01;6(6):1498-502
references: 23294797
references: Diabetes Technol Ther. 2007 Apr;9(2):169-75
references: 17425443
references: Ann Biomed Eng. 2003 Jan;31(1):91-7
references: 12572659
references: Diabetes Care. 2005 Dec;28(12):2871-6
references: 16306547
references: Diabetes Technol Ther. 2010 May;12(5):365-71
references: 20388046
references: Diabetologia. 2010 Apr;53(4):593-6
references: 20225392
references: Cochrane Database Syst Rev. 2012 Jan 18;1:CD008101
references: 22258980
references: Diabetes Technol Ther. 2008 Oct;10(5):385-90
references: 18715215
references: J Diabetes Sci Technol. 2009 Sep 01;3(5):1146-54
references: 20144429
references: J Diabetes Sci Technol. 2012 Sep 01;6(5):1103-6
references: 23063036