FDA-cleared blood glucose monitors were more likely to meet ISO 15197 2013 accuracy standards compared to non-FDA-cleared monitors (48.3% vs 23%; P=0.003), though overall accuracy remains poor.
Do FDA-cleared blood glucose monitor systems perform more accurately according to ISO standards compared to non-FDA-cleared systems?
A significant proportion of cleared blood glucose monitors do not meet international accuracy standards, though FDA-cleared devices perform better than non-cleared ones.
Absolute Event Rate: 48.3% vs 23%
p-value: p=0.003
Cleared blood glucose monitor (BGM) systems do not always perform as accurately for users as they did to become cleared. We performed a literature review of recent publications between 2010 and 2014 that present data about the frequency of inaccurate performance using ISO 15197 2003 and ISO 15197 2013 as target standards. We performed an additional literature review of publications that present data about the clinical and economic risks of inaccurate BGMs for making treatment decisions or calibrating continuous glucose monitors (CGMs). We found 11 publications describing performance of 98 unique BGM systems. 53 of these 98 (54%) systems met ISO 15197 2003 and 31 of the 98 (32%) tested systems met ISO 15197 2013 analytical accuracy standards in all studies in which they were evaluated. Of the tested systems, 33 were identified by us as FDA-cleared. Among these FDA-cleared BGM systems, 24 out of 32 (75%) met ISO 15197 2003 and 15 out of 31 (48.3%) met ISO 15197 2013 in all studies in which they were evaluated. Among the non-FDA-cleared BGM systems, 29 of 65 (45%) met ISO 15197 2003 and 15 out of 65 (23%) met ISO 15197 2013 in all studies in which they were evaluated. It is more likely that an FDA-cleared BGM system, compared to a non-FDA-cleared BGM system, will perform according to ISO 15197 2003 (χ(2) = 6.2, df = 3, P = 0.04) and ISO 15197 2013 (χ(2) = 11.4, df = 3, P = 0.003). We identified 7 articles about clinical risks and 3 articles about economic risks of inaccurate BGMs. We conclude that a significant proportion of cleared BGMs do not perform at the level for which they were cleared or according to international standards of accuracy. Such poor performance leads to adverse clinical and economic consequences.
Klonoff et al. (Tue,) conducted a review in Blood glucose monitoring accuracy (n=98). FDA-cleared blood glucose monitor (BGM) systems vs. Non-FDA-cleared BGM systems was evaluated on Meeting ISO 15197 2013 analytical accuracy standards in all evaluated studies (p=0.003). FDA-cleared blood glucose monitors were more likely to meet ISO 15197 2013 accuracy standards compared to non-FDA-cleared monitors (48.3% vs 23%; P=0.003), though overall accuracy remains poor.