Accuracy of flash glucose monitoring and continuous glucose monitoring technologies: Implications for clinical practice.
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• The accuracy of continuous and flash glucose monitoring technologies is key to effective glycaemic management.
• Accuracy is usually measured using the mean absolute relative difference (MARD) of the interstitial fluid sensor compared to reference blood glucose readings. It does not reflect any non-linear performance over the complete glucose range and does not provide feedback on the precision of the system on which it reports.
• MARD is influenced by glucose distribution and rate of change; it is therefore difficult to compare MARD data from different study systems and conditions.
• The consensus error grid (CEG) has been developed to be used in parallel with MARD to provide additional accuracy reporting. This compares glucose readings of the test device to reference blood glucose readings and visualises the results as a grid, which is divided into zones A–E.
• Using both MARD and CEG improves confidence in the efficacy and safety of interstitial fluid glucose sensing systems for making treatment decisions.
• Readings in the low-glucose zone detected with any interstitial fluid glucose sensing system should be confirmed with a self-monitoring blood glucose test to provide confidence in what action to take.
• Healthcare professionals must understand the factors that influence MARD as a metric for accuracy and look at additional assessments, such as CEG analysis, when evaluating continuous glucose monitoring and flash glucose monitoring systems in diabetes care.
• Although MARD is useful for determining the accuracy of glucose monitoring systems, relying solely on this metric has its drawbacks.
• Combining MARD with CEG analysis improves the mean accuracy and utility of the system for making clinical decisions.