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Discrepancies between methods of continuous glucose monitoring in key metrics of glucose control in children with type 1 diabetes
Author(s) -
Michalak Arkadiusz,
Pagacz Konrad,
Młynarski Wojciech,
Szadkowska Agnieszka,
Fendler Wojciech
Publication year - 2019
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12854
Subject(s) - medicine , glycemic , continuous glucose monitoring , glycated hemoglobin , type 1 diabetes , type 2 diabetes , diabetes mellitus , coefficient of variation , endocrinology , statistics , mathematics
Objective We aimed to compare glycemic control and variability parameters obtained from paired records of real‐time continuous glucose monitoring (RT‐CGM) and flash glucose monitoring (FGM). Methods Ten Polish boys and 11 girls aged 15.3 ± 2.1 years with type 1 diabetes for 7.7 ± 4.5 years and glycated hemoglobin 7.35 ± 0.7% (57 ± 5 mmol/mol) were recruited between August 2017 and June 2018 and equipped with devices for RT‐CGM (iPro2 system with Enlite electrodes) and FGM (FreeStyle Libre) for 1 week. Afterwards, Glyculator 2.0 software was used to calculate and compare key metrics of glycemic control listed in the International Consensus on Use of Continuous Glucose Monitoring, with distinction into all record/night‐time/day‐time blocks when appropriate. Results Agreement between the two systems' measurements across patients ranged from poor ( R 2 = .39) to nearly perfect ( R 2 = .97). Significant differences between RT‐CGM and FGM were observed in five important metrics: coefficient of variation (median difference: −4.12% [25%‐75%: −7.50% to −2.96%], P = .0001), low blood glucose index (−0.88 [−1.88 to −0.18], P = .0004), % of time below 70 mg/dL (3.9 mmol/L) (−4.77 [−8.39 to −1.19], P = .0015) and 54 mg/dL (3 mmol/L) (−1.33 [−4.07 to 0.00], P = .0033) and primary time in range (TIR) 70‐180 mg/dL (8.58 [1.31 to 12.66], P = .0006). Conclusions RT‐CGM and FGM differ in their estimates of clinically important indices of glycemic control. Therefore, such metrics cannot be directly compared between people using different systems. Our result necessitates system‐specific guidelines and targets if TIR and glycemic variability are to be used as an endpoint in clinical trials.