Ajjan Ramzi A, Cummings Michael H, Jennings Peter, Leelarathna Lalantha, Rayman Gerry, Wilmot Emma G
1 St. James's University Hospital, Leeds Teaching Hospitals NHS Trust and LIGHT Laboratories, University of Leeds, Leeds, UK.
2 Academic Department of Diabetes & Endocrinology, Queen Alexandra Hospital, Portsmouth, UK.
Diab Vasc Dis Res. 2018 May;15(3):175-184. doi: 10.1177/1479164118756240. Epub 2018 Feb 15.
Continuous glucose monitoring and flash glucose monitoring technologies measure glucose in the interstitial fluid and are increasingly used in diabetes care. Their accuracy, key to effective glycaemic management, is usually measured using the mean absolute relative difference of the interstitial fluid sensor compared to reference blood glucose readings. However, mean absolute relative difference is not standardised and has limitations. This review aims to provide a consensus opinion on assessing accuracy of interstitial fluid glucose sensing technologies. Mean absolute relative difference is influenced by glucose distribution and rate of change; hence, we express caution on the reliability of comparing mean absolute relative difference data from different study systems and conditions. We also review the pitfalls associated with mean absolute relative difference at different glucose levels and explore additional ways of assessing accuracy of interstitial fluid devices. Importantly, much data indicate that current practice of assessing accuracy of different systems based on individualised mean absolute relative difference results has limitations, which have potential clinical implications. Healthcare professionals must understand the factors that influence mean absolute relative difference as a metric for accuracy and look at additional assessments, such as consensus error grid analysis, when evaluating continuous glucose monitoring and flash glucose monitoring systems in diabetes care. This in turn will ensure that management decisions based on interstitial fluid sensor data are both effective and safe.
持续葡萄糖监测和闪光葡萄糖监测技术可测量组织间液中的葡萄糖，在糖尿病护理中的应用越来越广泛。其准确性是有效血糖管理的关键，通常通过将组织间液传感器的测量结果与参考血糖读数进行比较，以平均绝对相对差来衡量。然而，平均绝对相对差并未标准化且存在局限性。本综述旨在就评估组织间液葡萄糖传感技术的准确性提供共识性意见。平均绝对相对差受葡萄糖分布和变化率的影响；因此，我们对比较来自不同研究系统和条件下的平均绝对相对差数据的可靠性表示谨慎。我们还回顾了不同葡萄糖水平下与平均绝对相对差相关的陷阱，并探索评估组织间液检测设备准确性的其他方法。重要的是，许多数据表明，目前基于个体化平均绝对相对差结果评估不同系统准确性的做法存在局限性，这具有潜在的临床意义。医疗保健专业人员必须了解影响平均绝对相对差作为准确性指标的因素，并在评估糖尿病护理中的持续葡萄糖监测和闪光葡萄糖监测系统时考虑其他评估方法，如共识误差网格分析。这反过来将确保基于组织间液传感器数据做出的管理决策既有效又安全。
