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Eichenlaub M, Pleus S, Freckmann G. A Proposal for the Clinical Characterization of Continuous Glucose Monitoring Trend Arrow Accuracy. J Diabetes Sci Technol 2024; 18:800-807. [PMID: 38415676 DOI: 10.1177/19322968241232679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The assessment and characterization of trend accuracy, that is, the ability of a continuous glucose monitoring (CGM) system to correctly indicate the direction and rate of change (RoC) of glucose levels, has received comparatively little attention in the overall evaluation of CGM performance. As such, only few approaches that examine the trend accuracy have been put forward. In this article, we review existing approaches and propose the clinical trend concurrence analysis (CTCA) which is an adaptation of the conventional trend concurrence analysis. The CTCA is intended to directly evaluate the trend arrows displayed by the CGM systems by characterizing their agreement to suitably categorized comparator RoCs. Here, we call on manufactures of CGM systems to provide the displayed trend arrows for retrospective analysis. The CTCA classifies any deviations between the CGM trend and comparator RoC according to their risk for an adverse clinical event arising from a possibly erroneous treatment decision. For that, the existing rate error grid analysis and a specific set of trend arrow-based insulin dosing recommendations were used. The results of the CTCA are presented in an accessible graphical display and exemplified on data from three CGM systems. With this article, we hope to increase the awareness for the importance and challenges of assessing the accuracy of trend information displayed by CGM systems.
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Affiliation(s)
- Manuel Eichenlaub
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Plebani M, Nichols JH, Luppa PB, Greene D, Sciacovelli L, Shaw J, Khan AI, Carraro P, Freckmann G, Dimech W, Zaninotto M, Spannagl M, Huggett J, Kost GJ, Trenti T, Padoan A, Thomas A, Banfi G, Lippi G. Point-of-care testing: state-of-the art and perspectives. Clin Chem Lab Med 2024; 0:cclm-2024-0675. [PMID: 38880779 DOI: 10.1515/cclm-2024-0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
Point-of-care testing (POCT) is becoming an increasingly popular way to perform laboratory tests closer to the patient. This option has several recognized advantages, such as accessibility, portability, speed, convenience, ease of use, ever-growing test panels, lower cumulative healthcare costs when used within appropriate clinical pathways, better patient empowerment and engagement, and reduction of certain pre-analytical errors, especially those related to specimen transportation. On the other hand, POCT also poses some limitations and risks, namely the risk of lower accuracy and reliability compared to traditional laboratory tests, quality control and connectivity issues, high dependence on operators (with varying levels of expertise or training), challenges related to patient data management, higher costs per individual test, regulatory and compliance issues such as the need for appropriate validation prior to clinical use (especially for rapid diagnostic tests; RDTs), as well as additional preanalytical sources of error that may remain undetected in this type of testing, which is usually based on whole blood samples (i.e., presence of interfering substances, clotting, hemolysis, etc.). There is no doubt that POCT is a breakthrough innovation in laboratory medicine, but the discussion on its appropriate use requires further debate and initiatives. This collective opinion paper, composed of abstracts of the lectures presented at the two-day expert meeting "Point-Of-Care-Testing: State of the Art and Perspective" (Venice, April 4-5, 2024), aims to provide a thoughtful overview of the state-of-the-art in POCT, its current applications, advantages and potential limitations, as well as some interesting reflections on the future perspectives of this particular field of laboratory medicine.
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Affiliation(s)
- Mario Plebani
- Department of Medicine, University of Padova, Padova, Italy
| | - James H Nichols
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter B Luppa
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Dina Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Laura Sciacovelli
- Laboratory Medicine Unit, University Hospital of Padova, Padova, Italy
| | - Julie Shaw
- Eastern Ontario Regional Laboratories Association (EORLA), Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Canada
| | - Adil I Khan
- Department of Pathology & Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Paolo Carraro
- Department of Laboratory Medicine, Venice Hospital, Venice, Italy
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Wayne Dimech
- National Serology Reference Laboratory, Melbourne, Australia
| | | | - Michael Spannagl
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jim Huggett
- National Measurement Laboratory, LGC, Teddington, UK
| | - Gerald J Kost
- POCT - CTR, Pathology and Laboratory Medicine, School of Medicine, University of California, CA, USA
| | - Tommaso Trenti
- Laboratory Medicine and Pathology Department AUSL e AOU Modena, Modena, Italy
| | - Andrea Padoan
- Department of Medicine, DIMED, University of Padova, Padova, Italy
| | - Annette Thomas
- National PoCT Clinical Lead, National Pathology Programme, NHS Wales Executive, Cardiff, Wales, UK
| | - Giuseppe Banfi
- IRCCS Galeazzi-Sant'Ambrogio and Università Vita e Salute San Raffaele, Milan, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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3
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Pleus S, Eichenlaub M, Waldenmaier D, Freckmann G. Even Head-to-Head Comparison Studies of Continuous Glucose Monitoring System Performance Can be Biased. J Diabetes Sci Technol 2024; 18:743-744. [PMID: 38400714 PMCID: PMC11089854 DOI: 10.1177/19322968241235218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Affiliation(s)
- Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Manuel Eichenlaub
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Moser O, Pemberton JS. Rethinking the safety and efficacy assessment of (Hybrid) Closed Loop systems: Should we promote the need for a minimum of exercise data within the regulatory approval? Diabet Med 2024; 41:e15305. [PMID: 38332559 DOI: 10.1111/dme.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Othmar Moser
- Department of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's, and Children's NHS Foundation Trust, Birmingham, UK
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