Page 53 - Glucose Monitoring Devices

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CHAPTER

Consequences of SMBG

systems inaccuracy 4

1
Enrique Campos-Na ´n ˜ez, PhD , Kurt Fortwaengler, PMP 2
1
Principal Algorithm Engineer, Research & Development, Dexcom Inc, Charlottesville, VA, United
2
States; Disease Modeling, Global Market Access, Roche Diabetes Care, Mannheim, Germany
Introduction

Glucose monitoring is critical to the proper management of type 1 and type 2
diabetes. Type 1 patients must monitor their glucose multiple times a day, every
day, to avoid serious complications such as severe hypoglycemia and diabetic ketoa-
cidosis [1,2]. Although early type 2 patients may only require the sporadic use of
glucose monitoring to achieve good control, as the disease progresses glucose moni-
toring brings incremental beneﬁts and becomes eventually critical for insulin-
dependent type 2 patients [3]. In fact, the proper and frequent use of glucose
monitoring will result in enhanced glycemic control [2e5] and will lead to improved
quality of life of diabetic patients [3,6].
Among the competing glucose monitoring solutions at the patient’s disposal,
self-monitoring of blood glucose (SMBG) by means of blood glucose monitoring
(BGM) systems is a frequent choice (and sometimes only choice [7]) among type
2 patients and type 1 patients, and the beneﬁts of its frequent use have been docu-
mented [1,2]. As patients make multiple decisions throughout the day, every day,
and must rely on glucose estimates provided by these devices, many natural
questions arise: to what extent do self-treatment decisions based on erroneous
measurements result in under or over bolusing, or failure to correct hypoglycemia?
Can sustained erroneous decisions compound over time and lead to poor glycemic
outcomes and long-term complications? Do these long-term effects also translate
into the loss of quality of life and increasing healthcare system costs? Commercially
available glucose monitoring devices vary greatly in their technology and perfor-
mance [8e14]. How do these differences between devices affect the patient’s ability
to manage their disease? Moreover, regulation and standards have established
performance requirements for these systems. To what extent do they succeed? In
other words, does compliance with a standard translate in better outcomes for a pa-
tient? Finally, when is accuracy enough? Is it clear that in the presence of metabolic,
behavioral, and environmental noise a more accurate BGM system will always
improve outcomes? Glucose monitoring, being the only source of ground truth
for patients, takes a central piece in the management of these chronic diseases.

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