Page 73 - Glucose Monitoring Devices

References 71

therapeutic choices. To better understand the effect and relevance of accuracy, it is
necessary to understand how patients behave in response to the information that is
available to them.
Commonly used definitions and metrics of clinical accuracy have been critical in
guiding the community toward better systems. Tools like the EGA, in its various
incarnations, have provided the first line of defense in understanding consequences
of inaccuracy. Unfortunately, these tools have the limitation of not accounting for the
environment in which a certain error is committed. The question that perhaps should
be asked is: what is the best use of noisy information, given the patient’s unique
behavioral traits and particular goals? In other words, we need to understand how
contextual and behavioral inaccuracy interacts with BGM system inaccuracy to
create a true clinical or therapeutical accuracy.
One final comment was related to the almost exclusive use of HbA1c as a surro-
gate for glycemic control. In understanding the long-term effects of inaccuracy,
other metrics are necessary. For example, there are indications of the relationship
of glucose variability on retinopathy [95,96]. It is time for the industry to move to
a more comprehensive assessment of glycemic control, which includes indices of
glycemic variabilities, such as high and low blood glucose risk indices. Character-
izing the relationship between BGM system accuracy and these additional glucose
control metrics, as well as the relationship between these metrics and long-term
complications is a necessary next step.

Disclosure
E. Campos-Na ´n ˜ez received no financial or resource support for the production of this manu-
script as an employee of Dexcom, Inc. The views expressed here are exclusively his own.

References
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[2] Klonoff DC, et al. Consensus report: the current role of self-monitoring of blood
glucose in non-insulin-treated type 2 diabetes. Journal of Diabetes Science and Technol-
ogy 2011;5(6):1529e48.
[3] Barnard KD, Young AJ, Waugh NR. Self monitoring of blood glucose - a survey of dia-
betes UK members with type 2 diabetes who use SMBG. BMC Research Notes Nov.
2010;3(1):318.
[4] Poolsup N, Suksomboon N, Jiamsathit W. Systematic review of the benefits of self-
monitoring of blood glucose on glycemic control in type 2 diabetes patients. Diabetes
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