0 mmol/l).c. The number of times that a blood glucose concentration selleck bio below that defining hypoglycemia or severe hypoglycemia is recorded.d. The duration of time that blood glucose is below the concentration defining hypoglycemia or severe hypoglycemia.4. Range and exposure measures:a. The percentage of time the blood glucose concentration is in the target range.b. The percentage of time the blood glucose concentration is outside a nominated target range.c. The area under the curve above the upper target for hyperglycemia (Area A in Figure Figure2,2, where the target is to keep blood glucose <10.0 mmol/l).d. The area above the curve under the target for mild and severe hypoglycemia (Area B in Figure Figure2,2, where the target is to keep blood glucose >4.0 mmol/l).

There are currently few data to guide the choice of appropriate metrics for continuous glucose monitoring. There is a need to define measures that are associated with important patient-centered outcomes such as mortality and major morbidity. The easiest metric to define will be the incidence and severity of hypoglycemia and hyperglycemia; harder to define will be measures of central tendency and dispersion, because these may be influenced by the frequency of measurement.Comparing glycemic control with continuous versus intermittent measurement of blood glucoseComparison of the quality of glycemic control using continuous and intermittent measurement is a crucial first step in determining whether continuous glucose monitoring systems can provide tangible benefit to patients.

As frequent knowledge of the blood glucose concentration has the potential to change a patient’s management, comparison of the glycemic control achieved with continuous versus intermittent monitoring must be evaluated in a randomized controlled trial with both groups of patients having a continuous monitor but the output from the continuous monitor masked in the control group where blood glucose is managed by intermittent monitoring. This will be the only way to accurately compare the relative effect of continuous versus intermittent monitoring on glycemic control.What are acceptable performance standards for continuous glucose monitoring systems? (Table 1)Continuous or automated intermittent glucose monitoring systems (CGMs) should safely and reliably provide an accurate interstitial fluid or blood glucose measurement every 1 to 15 minutes.

They should maintain their accuracy for a period of days and over a wide range of glucose values, rates of change of blood glucose concentration, and patient conditions. Each CGM should demonstrate accuracy in the intended-use GSK-3 critical care population to ensure safety. Point accuracy – the accuracy with which each static blood glucose measurement matches a reference measurement – should be similar to that required of intermittent monitoring systems.