title: A comparative effectiveness analysis of three continuous glucose monitors: the Navigator, G4 Platinum, and Enlite.
abstract: The effectiveness and safety of continuous glucose monitors (CGMs) is dependent on their accuracy and reliability. The objective of this study was to compare 3 CGMs in adult and pediatric subjects with type 1 diabetes under closed-loop blood-glucose (BG) control. Twenty-four subjects (12 adults) with type 1 diabetes each participated in one 48-hour closed-loop BG control experiment. Venous plasma glucose (PG) measurements obtained every 15 minutes (4657 values) were paired in time with corresponding CGM glucose (CGMG) measurements obtained from 3 CGMs (FreeStyle Navigator, Abbott Diabetes Care; G4 Platinum, Dexcom; Enlite, Medtronic) worn simultaneously by each subject. The Navigator and G4 Platinum (G4) had the best overall accuracy, with an aggregate mean absolute relative difference (MARD) of all paired points of 12.3 ± 12.1% and 10.8 ± 9.9%, respectively. Both had lower MARDs of all paired points than Enlite (17.9 ± 15.8%, P < .005). Very large errors (MARD > 50%) were less common with the G4 (0.5%) than with the Enlite (4.3%, P = .0001) while the number of very large errors with the Navigator (1.4%) was intermediate between the G4 and Enlite (P = .1 and P = .06, respectively). The average MARD for experiments in adolescent subjects were lower than in adult subjects for the Navigator and G4, while there was no difference for Enlite. All 3 devices had similar reliability. A comprehensive head-to-head-to-head comparison of 3 CGMs revealed marked differences in both accuracy and precision. The Navigator and G4 were found to outperform the Enlite in these areas.
authors.affiliation: Department of Biomedical Engineering, Boston University, Boston, MA, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Damiano
authors.affiliation: Department of Biomedical Engineering, Boston University, Boston, MA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: McKeon
authors.affiliation: Department of Biomedical Engineering, Boston University, Boston, MA, USA.
authors.forename: Firas H
authors.initials: FH
authors.lastname: El-Khatib
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.affiliation: Diabetes Research Center, Massachusetts General Hospital, Boston, MA, USA sjrussell@mgh.harvard.edu.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D002940:Circadian Rhythm; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results
keywords: CGM; accuracy; blood glucose; blood glucose meter; continuous glucose monitoring; reliability