Comparison of the FreeStyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing in Hospitalized Patients With Type 2 Diabetes Treated With Basal-Bolus Insulin Regimen

Rodolfo J Galindo, Alexandra L Migdal, Georgia M Davis, Maria A Urrutia, Bonnie Albury, Cesar Zambrano, Priyathama Vellanki, Francisco J Pasquel, Maya Fayfman, Limin Peng, Guillermo E Umpierrez, Rodolfo J Galindo, Alexandra L Migdal, Georgia M Davis, Maria A Urrutia, Bonnie Albury, Cesar Zambrano, Priyathama Vellanki, Francisco J Pasquel, Maya Fayfman, Limin Peng, Guillermo E Umpierrez

Abstract

Objective: We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care capillary glucose testing (POC) among insulin-treated hospitalized patients with type 2 diabetes (T2D).

Research design and methods: This was a prospective study in adult patients with T2D admitted to general medicine and surgery wards. Patients were monitored with POC before meals and bedtime and with CGM during the hospital stay. Study end points included differences between POC and CGM in mean daily blood glucose (BG), hypoglycemia <70 and <54 mg/dL, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), ±15%/15 mg/dL, ±20%/20 mg/dL, and ±30%/30 mg/dL and error grid analysis between matched glucose pairs.

Results: Mean daily glucose was significantly higher by POC (188.9 ± 37.3 vs. 176.1 ± 46.9 mg/dL) with an estimated mean difference of 12.8 mg/dL (95% CI 8.3-17.2 mg/dL), and proportions of patients with glucose readings <70 mg/dL (14% vs. 56%) and <54 mg/dL (4.1% vs. 36%) detected by POC BG were significantly lower compared with CGM (all P < 0.001). Nocturnal and prolonged CGM hypoglycemia <54 mg/dL were 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4% and 16.7% for glucose values between 70 and 250 mg/dL and higher for 51-69 mg/dL (MARD 28.0%). The percentages of glucose readings within ±15%/15 mg/dL, ±20%/20 mg/dL, and ±30%/30 mg/dL were 62%, 76%, and 91%, respectively. Error grid analysis showed 98.8% of glucose pairs within zones A and B.

Conclusions: Compared with POC, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM's accuracy was lower in the hypoglycemic range.

© 2020 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Mean hospital daily glucose as measured by POC (circles) and CGM (squares). The overall mean daily glucose was significantly higher as measured by POC BG compared with CGM (188.9 ±37.3 vs. 176.1 ± 46.9 mg/dL), with an estimated mean glucose difference of 12.8 mg/dL (CI 8.3–17.2 mg/dL) (P < 0.001).
Figure 2
Figure 2
Hypoglycemia detection by POC (filled bars) and CGM (open bars).

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