Reliability of the Dexcom G6 Continuous Glucose Monitor During Hyperbaric Oxygen Exposure

Enoch Huang, Shaban Demirel, Chanelle Bliss, Davut Savaser, Jessica R Castle, Enoch Huang, Shaban Demirel, Chanelle Bliss, Davut Savaser, Jessica R Castle

Abstract

Background: People with diabetes-related ulcers may benefit from hyperbaric oxygen (HBO2) therapy and from continuous glucose monitors (CGM). Although blood glucose (BG) meters based on glucose oxidase (GO) report erroneously low values at high pO2, BG meters based on glucose dehydrogenase (GD) do not. We therefore examined the performance of a GO-based CGM system in comparison to GO-based and GD-based BG systems in normobaric air (NBAir), hyperbaric air (HBAir), and HBO2 environments. Materials and Methods: Twenty-six volunteers without diabetes mellitus (DM) wore Dexcom G6 CGM systems and provided periodic blood samples before, during, and after a standard HBO2 treatment consisting of three 30-min intervals of HBO2 separated by two 5-min intervals of HBAir. Accuracy of the CGM and GO-based BG meter were assessed by comparisons with the GD-based values. Results: The mean absolute relative difference for the CGM system was 15.96% and for the GO-based meter was 8.52%. Compared to NBAir, HBO2 exposure resulted in significantly higher CGM values (+3.76 mg/dL, P < 0.001) and significantly lower GO-based meter values (-10.38 mg/dL, P < 0.001). Pre-HBO2 and post-HBO2 values obtained in NBAir were also significantly different when measured by CGM (+4.13 mg/dL, P = 0.015) or the GO-based meter (-9.04 mg/dL, P < 0.001). Conclusions: In volunteers without DM, HBO2 exposure results in statistically significant differences in glucose measurements obtained with GO-based devices, but not a GD-based device. Standard HBO2 treatment results in statistically significant effects on glucose concentrations. These differences are of unlikely clinical significance.

Keywords: Continuous glucose monitors (CGM); HBO2; Hyperbaric oxygen therapy; Hypoglycemia.

Conflict of interest statement

The following authors (E.H., S.D., C.B., D.S., and J.R.C.) received salary support during the conduct of this study from a research grant provided by Dexcom, Inc. (IIS-2019-002).

J.R.C. has a financial interest in Pacific Diabetes Technologies, Inc., a company that may have a commercial interest in the results of this type of research and technology. This potential conflict of interest has been reviewed and managed by OHSU. In addition, J.R.C. reports advisory board participation for Zealand Pharma and Novo Nordisk and consulting and research support from Dexcom.

Figures

FIG. 1.
FIG. 1.
Glucose testing protocol. Fingerstick blood glucose sampling was performed at each of the time points during a standard hyperbaric treatment to 2.4 ATA. Yellow circles correlate to breathing NBAir (pO2 = 159.6 mmHg), blue circles correlate with breathing HBAir (pO2 = 383.0 mmHg), and green circles correlate with breathing HBO2 (pO2 = 1824 mmHg). ATA, atmospheres absolute; HBAir, hyperbaric air; NBAir, normobaric air. Color images are available online.
FIG. 2.
FIG. 2.
Box plots of TCOM for each gas+pressure condition. There was a significant change in TCOM between NBAir, HBAir, and HBO2. The notch displays the 95% confidence interval around the median value, the blue dot shows the mean value, the box covers the IQR (25th percentile to 75th percentile), the whiskers add 1.5 times the IQR to the 75 percentile and subtract 1.5 times the IQR from the 25 percentile, and the red dots show outliers. IQR, interquartile range; TCOM, transcutaneous oximetry measurements. Color images are available online.
FIG. 3.
FIG. 3.
Box plots of EGV for each gas+pressure condition by glucometer. There was a significant change between NBAir and HBO2 for the Dexcom and NovaStat, but not the Contour. The notch displays the 95% confidence interval around the median value, the blue dot shows the mean value, the box covers the IQR (25th percentile to 75th percentile), the whiskers add 1.5 times the IQR to the 75 percentile and subtract 1.5 times the IQR from the 25 percentile, and the red dots show outliers. EGV, estimated glucose value. Color images are available online.
FIG. 4.
FIG. 4.
Box plots of EGV for each glucometer by gas+pressure condition. The Dexcom CGM had a positive bias compared to the two POC glucometers at each gas+pressure condition. The notch displays the 95% confidence interval around the median value, the blue dot shows the mean value, the box covers the IQR (25th percentile to 75th percentile), the whiskers add 1.5 times the IQR to the 75 percentile and subtract 1.5 times the IQR from the 25 percentile, and the red dots show outliers. Dex = Dexcom CGM; Nova = Novastat; Cont = Contour. CGM, continuous glucose monitoring; POC, point-of-care. Color images are available online.

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Source: PubMed

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