Differences Between Flash Glucose Monitor and Fingerprick Measurements

Freestyle Libre (FL) is a factory calibrated Flash Glucose Monitor (FGM). We investigated Mean Absolute Relative Difference (MARD) between Self Monitoring of Blood Glucose (SMBG) and FL measurements in the first day of sensor wear in 39 subjects with Type 1 diabetes. The overall MARD was 12.3%, while the individual MARDs ranged from 4% to 25%. Five participants had a MARD >= 20%. We estimated bias and lag between the FL and SMBG measurements. The estimated biases range from -1.8 mmol/L to 1.4 mmol/L, and lags range from 2 min to 24 min. Bias is identified as a main cause of poor individual MARDs. The biases seem to persist in days 2-7 of sensor usage. All cases of MARD >= 20% in the first day are eliminated by bias correction, and overall MARD is reduced from 12.3% to 9.2%, indicating that adding support for voluntary user-supplied bias correction in the FL could improve its performance.