Measures of Accuracy for Continuous Glucose Monitoring and Blood Glucose Monitoring Devices
Open accessAbstract
Currently, patients with diabetes may choose between two major types of system for glucose measurement: blood glucose monitoring (BGM) systems measuring glucose within capillary blood and continuous glucose monitoring (CGM) systems measuring glucose within interstitial fluid. Although BGM and CGM systems offer different functionality, both types of system are intended to help users achieve improved glucose control. Another area in which BGM and CGM systems differ is measurement accuracy. In the literature, BGM system accuracy is assessed mainly according to ISO 15197:2013 accuracy requirements, whereas CGM accuracy has hitherto mainly been assessed by MARD, although often results from additional analyses such as bias analysis or error grid analysis are provided. The intention of this review is to provide a comparison of different approaches used to determine the accuracy of BGM and CGM systems and factors that should be considered when using these different measures of accuracy to make comparisons between the analytical performance (ie, accuracy) of BGM and CGM systems. In addition, real-world implications of accuracy and its relevance are discussed.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
SMBG systems tend to be more accurate than CGM systems.
“It should be kept in mind that SMBG systems tend to be more accurate than CGM systems [16] and that there can be differences between the glucose concentration in interstitial fluid and BG concentrations due to physiological processes [17].”
From Self-Monitoring of Blood Glucose as an Integral Part in the Management of People with Type 2 Diabetes Mellitus (2022) · cites this paper as [16]
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
Evaluating clinical accuracy of systems for self-monitoring of blood glucose
Clarke, W. L., Cox, D., Gonder-Frederick, L. A., Carter, W., & Pohl, S. L. (1987) · Diabetes Care · doi:10.2337/diacare.10.5.622 · Cited by 1,435 · see citing works
Bolinder, J., Antuna, R., Geelhoed-Duijvestijn, P., Kröger, J., & Weitgasser, R. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31535-5 · Cited by 893 · see citing works
The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System
Bailey, T., Bode, B. W., Christiansen, M. P., Klaff, L. J., & Alva, S. (2015) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2014.0378 · Cited by 685 · see citing works
Beck, R. W., Riddlesworth, T. D., Ruedy, K., Ahmann, A., Haller, S., Kruger, D., McGill, J. B., Polonsky, W., Price, D., Aronoff, S., et al. (2017) · Annals of Internal Medicine · doi:10.7326/m16-2855 · Cited by 635 · see citing works
Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J.-P., & Rayman, G. (2017) · Diabetes Therapy · doi:10.1007/s13300-016-0223-6 · Cited by 623 · see citing works
Miller, K. M., Beck, R. W., Bergenstal, R. M., Goland, R. S., Haller, M. J., McGill, J. B., Rodriguez, H., Simmons, J. H., Hirsch, I. B., & for the T1D Exchange Clinic Network (2013) · Diabetes Care · doi:10.2337/dc12-1770 · Cited by 505 · see citing works
Introduction: <i>Standards of Medical Care in Diabetes—2018</i>
(2018) · Diabetes Care · doi:10.2337/dc18-sint01 · Cited by 472 · see citing works
Aleppo, G., Ruedy, K. J., Riddlesworth, T. D., Kruger, D. F., Peters, A. L., Hirsch, I., Bergenstal, R. M., Toschi, E., Ahmann, A. J., Shah, V. N., et al. (2017) · Diabetes Care · doi:10.2337/dc16-2482 · Cited by 329 · see citing works
Evaluating the Accuracy of Continuous Glucose-Monitoring Sensors
Kovatchev, B. P., Gonder-Frederick, L. A., Cox, D. J., & Clarke, W. L. (2004) · Diabetes Care · doi:10.2337/diacare.27.8.1922 · Cited by 312 · see citing works
Assessing Sensor Accuracy for Non-Adjunct Use of Continuous Glucose Monitoring
Kovatchev, B. P., Patek, S. D., Ortiz, E. A., & Breton, M. D. (2015) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2014.0272 · Cited by 234 · see citing works
Wadwa, R. P., Laffel, L. M., Shah, V. N., & Garg, S. K. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0150 · Cited by 197 · see citing works
Klonoff, D. C., Lias, C., Vigersky, R. A., Clarke, W. L., Parkes, J. L., Sacks, D. B., Kirkman, M. S., Kovatchev, B. P., Panel, T. E. G., Aurand, L. A., et al. (2014) · Journal of Diabetes Science and Technology · doi:10.1177/1932296814539589 · Cited by 175 · see citing works
Thennadil, S. N., Rennert, J. L., Wenzel, B. J., Hazen, K. H., Ruchti, T. L., & Block, M. B. (2001) · Diabetes Technology & Therapeutics · doi:10.1089/15209150152607132 · Cited by 166 · see citing works
Time Lag of Glucose From Intravascular to Interstitial Compartment in Type 1 Diabetes
Basu, A., Dube, S., Veettil, S., Slama, M. Q., Kudva, Y. C., Peyser, T. A., Carter, R. E., Cobelli, C., & Basu, R. (2014) · Journal of Diabetes Science and Technology · doi:10.1177/1932296814554797 · Cited by 165 · see citing works
Schmelzeisen‐Redeker, G., Schoemaker, M., Kirchsteiger, H., Freckmann, G., Heinemann, L., & del Re, L. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815590154 · Cited by 162 · see citing works
Self-citationSignificance and Reliability of MARD for the Accuracy of CGM Systems
Reiterer, F., Polterauer, P., Schoemaker, M., Schmelzeisen‐Redeker, G., Freckmann, G., Heinemann, L., & del Re, L. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816662047 · Cited by 124 · see citing works
Self-citationHirsch, I. B., Bode, B. W., Childs, B. P., Close, K. L., Fisher, W. A., Gavin, J. R., Ginsberg, B. H., Raine, C. H., & Verderese, C. A. (2008) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0104 · Cited by 119 · see citing works
Breton, M. D., & Kovatchev, B. P. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400309 · Cited by 103 · see citing works
Laffel, L. M. (2016) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2015.0380 · Cited by 86 · see citing works
Rate-of-Change Dependence of the Performance of Two CGM Systems During Induced Glucose Swings
Pleus, S., Schoemaker, M., Morgenstern, K., Schmelzeisen‐Redeker, G., Haug, C., Link, M., Zschornack, E., & Freckmann, G. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815578716 · Cited by 84 · see citing works
Self-citationNew, J. P., Ajjan, R., Pfeiffer, A. F. H., & Freckmann, G. (2015) · Diabetic Medicine · doi:10.1111/dme.12713 · Cited by 81 · see citing works
Self-citationZisser, H., Bailey, T. S., Schwartz, S. L., Ratner, R. E., & Wise, J. K. (2009) · Journal of Diabetes Science and Technology · doi:10.1177/193229680900300519 · Cited by 77 · see citing works
Plasma glucose measurement with the Yellow Springs Glucose 2300 STAT and the Olympus AU640
Twomey, P. J. (2004) · Journal of Clinical Pathology · doi:10.1136/jcp.2003.013417 · Cited by 75 · see citing works
Freckmann, G., Pleus, S., Link, M., Zschornack, E., Klötzer, H.-M., & Haug, C. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700406 · Cited by 73 · see citing works
Self-citationAnalysis of Time Lags and Other Sources of Error of the DexCom SEVEN Continuous Glucose Monitor
Kamath, A., Mahalingam, A., & Brauker, J. H. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0060 · Cited by 69 · see citing works
Freckmann, G., Link, M., Pleus, S., Westhoff, A., Kamecke, U., & Haug, C. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0105 · Cited by 64 · see citing works
Self-citationContinuous glucose monitoring: quality of hypoglycaemia detection
Zijlstra, E., Heise, T., Nosek, L., Heinemann, L., & Heckermann, S. (2012) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12001 · Cited by 61 · see citing works
Clinical Implications of Accuracy Measurements of Continuous Glucose Sensors
Bailey, T. S. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.0050 · Cited by 60 · see citing works
The Accuracy and Efficacy of the Dexcom G4 Platinum Continuous Glucose Monitoring System
Nakamura, K., & Balo, A. K. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815577812 · Cited by 46 · see citing works
Performance Comparison of CGM Systems
Kirchsteiger, H., Heinemann, L., Freckmann, G., Lodwig, V., Schmelzeisen‐Redeker, G., Schoemaker, M., & del Re, L. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815586013 · Cited by 45 · see citing works
Self-citationOverview of a Novel Sensor for Continuous Glucose Monitoring
Schmelzeisen‐Redeker, G., Staib, A., Strasser, M., Müller, U., & Schoemaker, M. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700402 · Cited by 43 · see citing works
Freckmann, G., Pleus, S., Link, M., Baumstark, A., Schmid, C., Högel, J., & Haug, C. (2015) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2015.0043 · Cited by 38 · see citing works
Self-citationCharleer, S., Mathieu, C., Nobels, F. R. E., & Gillard, P. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13239 · Cited by 35 · see citing works
Basu, A., Pieber, T. R., Hansen, A. K., Sach‐Friedl, S., Erichsen, L., Basu, R., & Haahr, H. L. (2018) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13270 · Cited by 33 · see citing works
Performance Evaluation of Three Blood Glucose Monitoring Systems Using ISO 15197
Bedini, J. L., Wallace, J. F., Pardo, S. A., & Petruschke, T. (2015) · Journal of Diabetes Science and Technology · doi:10.1177/1932296815609368 · Cited by 29 · see citing works
(2016) · doi:10.1177/1932296816634356 · Cited by 23 · see citing works
Pardo, S. A., & Simmons, D. A. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816644468 · Cited by 19 · see citing works
MacLeod, K., Katz, L. B., & Cameron, H. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818790228 · Cited by 19 · see citing works
Freckmann, G., Link, M., Westhoff, A., Kamecke, U., Pleus, S., & Haug, C. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0112 · Cited by 18 · see citing works
Self-citationSeven-Year Surveillance of the Clinical Performance of a Blood Glucose Test Strip Product
Setford, S. J., Grady, M., Phillips, S., Miller, L., Mackintosh, S., Cameron, H., & Corrigall, K. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817703133 · Cited by 15 · see citing works
Self-citationKropff, J., van Steen, S. C. J., deGraaff, P., Chan, M. W., van Amstel, R. B. E., & DeVries, J. H. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.0189 · Cited by 14 · see citing works
How Much Accuracy of Interstitial Glucose Measurement Is Enough? Is There a Need for New Evidence?
Hermanns, N., Ehrmann, D., & Kulzer, B. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816677578 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Continuous glucose monitoring and metrics for clinical trials: an international consensus statement
Battelino, T., Alexander, C. M., Amiel, S. A., Arreaza-Rubin, G., Beck, R. W., Bergenstal, R. M., Buckingham, B. A., Carroll, J., Ceriello, A., Chow, E., et al. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00319-9 · Cited by 831 · see citing works
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
Continuous glucose monitors and automated insulin dosing systems in the hospital consensus guideline
Galindo, R. J., Umpierrez, G. E., Rushakoff, R. J., Basu, A., Lohnes, S., Nichols, J. H., Spanakis, E. K., Espinoza, J., Palermo, N. E., Awadjie, D. G., et al. (2020) · Journal of Diabetes Science and Technology · doi:10.1177/1932296820954163 · Cited by 170 · see citing works
Self-citationHeinemann, L., Schoemaker, M., Schmelzeisen-Redecker, G., Hinzmann, R., Kassab, A., Freckmann, G., Reiterer, F., & Del Re, L. (2020) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819855670 · Cited by 170 · see citing works
Self-citationDavis, G. M., Spanakis, E. K., Migdal, A. L., Singh, L. G., Albury, B., Urrutia, M. A., Zamudio-Coronado, K. W., Scott, W. H., Doerfler, R., Lizama, S., et al. (2021) · Diabetes Care · doi:10.2337/dc20-2856 · Cited by 160 · see citing works
Continuous glucose monitoring in the intensive care unit during the COVID-19 pandemic
Agarwal, S., Mathew, J., Davis, G. M., Shephardson, A., Levine, A., Louard, R., Urrutia, A., Perez-Guzman, C., Umpierrez, G. E., Peng, L., et al. (2021) · Diabetes Care · doi:10.2337/dc20-2219 · Cited by 138 · see citing works
Longo, R. R., Elias, H., Khan, M., & Seley, J. J. (2022) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211008446 · Cited by 89 · see citing works
Freckmann, G., Eichenlaub, M., Waldenmaier, D., Pleus, S., Wehrstedt, S., Haug, C., Witthauer, L., Jendle, J., Hinzmann, R., Thomas, A., et al. (2023) · Journal of Diabetes Science and Technology · doi:10.1177/19322968231190941 · Cited by 86 · see citing works
Self-citationFaulds, E. R., Boutsicaris, A., Sumner, L., Jones, L., McNett, M., Smetana, K. S., May, C. C., Buschur, E., Exline, M. C., Ringel, M. D., et al. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab409 · Cited by 71 · see citing works
Standardization process of continuous glucose monitoring: Traceability and performance
Freckmann, G., Nichols, J. H., Hinzmann, R., Klonoff, D. C., Ju, Y., Diem, P., Makris, K., & Slingerland, R. J. (2021) · Clinica Chimica Acta · doi:10.1016/j.cca.2020.12.025 · Cited by 62 · see citing works
Self-citationPleus, S., Freckmann, G., Schauer, S., Heinemann, L., Ziegler, R., Ji, L., Mohan, V., Calliari, L. E., & Hinzmann, R. (2022) · Diabetes Therapy · doi:10.1007/s13300-022-01254-8 · Cited by 55 · see citing works
Self-citationPemberton, J. S., Wilmot, E. G., Barnard‐Kelly, K., Leelarathna, L., Oliver, N., Randell, T., Taplin, C. E., Choudhary, P., & Adolfsson, P. (2023) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14962 · Cited by 44 · see citing works
Time in range in pregnancy: is there a role?
Wyckoff, J. A., & Brown, F. M. (2021) · Diabetes Spectrum · doi:10.2337/ds20-0103 · Cited by 39 · see citing works
Hochfellner, D. A., Simic, A., Taucher, M. T., Sailer, L. S., Kopanz, J., Pöttler, T., & Mader, J. K. (2022) · Biosensors · doi:10.3390/bios12020106 · Cited by 15 · see citing works
- Authors
- Freckmann, G., Pleus, S., Grady, M., Setford, S., & Levy, B.
- Affiliations
- Universität Ulm (DE)
- LifeScan Scotland Ltd, Inverness, Scotland, UK
- LifeScan Inc, Wayne, PA, USA
- Corresponding author
- Pleus, Stefan
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2018-11-19
- Volume
- 13
- Issue
- 3
- Pages
- 575-583
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC6501529
- OpenAlex
- W2900697170
- Cited by
- 202
- References
- 44
- Citations by year
- 2026: 41 · 2025: 41 · 2024: 35 · 2023: 29 · 2022: 28 · 2021: 17 · 2020: 10 · 2019: 1
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- LifeScan Scotland Ltd.
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- continuous glucose monitoring, blood glucose monitoring, measurement accuracy, accuracy measures, mean absolute relative difference, ISO 15197, bias assessment, error grid analysis, diabetes mellitus, capillary blood glucose, interstitial glucose, analytical performance comparison
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Humans, Sensitivity and Specificity, United States, United States Food and Drug Administration, Blood Glucose Self-Monitoring, Reproducibility of Results, Device Approval, Guideline Adherence, Medical Device Legislation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review