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The Diabetes Technology Society Error Grid and Trend Accuracy Matrix for Glucose Monitors
DC. Klonoff, G. Freckmann, S. Pleus, BP. Kovatchev, D. Kerr, CC. Tse, C. Li, MSD. Agus, K. Dungan, B. Voglová Hagerf, JS. Krouwer, WA. Lee, S. Misra, SY. Rhee, A. Sabharwal, JJ. Seley, VN. Shah, NK. Tran, K. Waki, C. Worth, T. Tian, RE. Aaron, K....
Language English Country United States
Document type Journal Article
Grant support
P30 DK111024
NIDDK NIH HHS - United States
R03 DK138255
NIDDK NIH HHS - United States
I01 CX001825
CSRD VA - United States
K23 DK123384
NIDDK NIH HHS - United States
UL1 TR002378
NCATS NIH HHS - United States
Wellcome Trust - United Kingdom
- MeSH
- Diabetes Mellitus * blood diagnosis MeSH
- Blood Glucose * analysis MeSH
- Humans MeSH
- Reproducibility of Results MeSH
- Blood Glucose Self-Monitoring * instrumentation standards MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: An error grid compares measured versus reference glucose concentrations to assign clinical risk values to observed errors. Widely used error grids for blood glucose monitors (BGMs) have limited value because they do not also reflect clinical accuracy of continuous glucose monitors (CGMs). METHODS: Diabetes Technology Society (DTS) convened 89 international experts in glucose monitoring to (1) smooth the borders of the Surveillance Error Grid (SEG) zones and create a user-friendly tool-the DTS Error Grid; (2) define five risk zones of clinical point accuracy (A-E) to be identical for BGMs and CGMs; (3) determine a relationship between DTS Error Grid percent in Zone A and mean absolute relative difference (MARD) from analyzing 22 BGM and nine CGM accuracy studies; and (4) create trend risk categories (1-5) for CGM trend accuracy. RESULTS: The DTS Error Grid for point accuracy contains five risk zones (A-E) with straight-line borders that can be applied to both BGM and CGM accuracy data. In a data set combining point accuracy data from 18 BGMs, 2.6% of total data pairs equally moved from Zones A to B and vice versa (SEG compared with DTS Error Grid). For every 1% increase in percent data in Zone A, the MARD decreased by approximately 0.33%. We also created a DTS Trend Accuracy Matrix with five trend risk categories (1-5) for CGM-reported trend indicators compared with reference trends calculated from reference glucose. CONCLUSION: The DTS Error Grid combines contemporary clinician input regarding clinical point accuracy for BGMs and CGMs. The DTS Trend Accuracy Matrix assesses accuracy of CGM trend indicators.
1st Medical Faculty Charles University Prague Czech Republic
American Diabetes Association Arlington VA USA
Barbara Davis Center for Diabetes University of Colorado Aurora CO USA
Cedars Sinai Health Systems Los Angeles CA USA
Center for Diabetes Technology University of Virginia Charlottesville VA USA
Centers for Disease Control and Prevention Atlanta GA USA
Children's Mercy Kansas City Kansas City MO USA
College of Nursing Florida State University Tallahassee FL USA
Department of Biomedical Engineering Oregon Health and Science University Portland OR USA
Department of Biomedical Informatics Graduate School of Medicine The University of Tokyo Tokyo Japan
Department of Clinical Medicine Aalborg University Hospital Aalborg Denmark
Department of Computer Science and Engineering Shanghai Jiao Tong University Shanghai China
Department of Diabetes and Endocrinology Guy's and St Thomas' NHS Foundation Trust London UK
Department of Diabetes King's College London London UK
Department of Lab Medicine University of California San Francisco San Francisco CA USA
Department of Medical Sciences School of Medicine Örebro University Örebro Sweden
Department of Medicine Duke University Medical Center Durham NC USA
Department of Medicine The University of Melbourne Melbourne VIC Australia
Department of Medicine University of Padua Padua Italy
Department of Paediatric Endocrinology Royal Manchester Children's Hospital Manchester UK
Devision of Diabetes Endocrinology and Metabolism University of Nebraska Medical Center Omaha NE USA
Diabetes Center Berne Berne Switzerland
Diabetes Center São Paulo Federal University São Paulo Brazil
Diabetes Centre Institute for Clinical and Experimental Medicine Prague Czech Republic
Diabetes Research Institute Mills Peninsula Medical Center San Mateo CA USA
Diabetes Technology Society Burlingame CA USA
Diabetes Trials Unit University of Oxford Oxford UK
Division of Endocrinology and Metabolism School of Medicine Indiana University Indianapolis IN USA
Division of Endocrinology and Metabolism University of California San Francisco San Francisco CA USA
Division of Endocrinology Diabetes and Metabolism Johns Hopkins University Baltimore MD USA
Division of Endocrinology Diabetes and Metabolism Ohio State University Columbus OH USA
Division of Endocrinology Diabetes and Metabolism Weill Cornell Medicine New York NY USA
Division of Endocrinology Los Angeles General Medical Center Los Angeles CA USA
Division of Endocrinology Miller School of Medicine University of Miami Miami FL USA
Division of Endocrinology Walter Reed National Military Medical Center Bethesda MD USA
Division of Metabolism Digestion and Reproduction Imperial College London London UK
Division of Metabolism Endocrinology and Diabetes University of Michigan Ann Arbor MI USA
Electrical and Computer Engineering Rice University Houston TX USA
Headlands AMCR Institute Escondido CA USA
Hospital Universitario San Ignacio Pontificia Universidad Javeriana Bogotá Colombia
Institute of Medicine University of Gothenburg Gothenburg Sweden
International Diabetes Center HealthPartners Institute Minneapolis MN USA
Joint Department of Biomedical Engineering North Carolina State University Chapel Hill NC USA
Keck School of Medicine University of Southern California Los Angeles CA USA
Krouwer Consulting Sherborn MA USA
Li Ka Shing Knowledge Institute St Michael's Hospital University of Toronto Toronto ON Canada
Mary and Dick Allen Diabetes Center Hoag Memorial Hospital Presbyterian Newport Beach CA USA
Mills Peninsula Medical Center San Mateo CA USA
National Institutes of Health Bethesda MD USA
Naval Medical Center San Diego San Diego CA USA
Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
North Kansas City Hospital North Kansas City MO USA
Norwich Medical School University of East Anglia Norwich UK
Pfützner Science and Health Institute Mainz Germany
School of Medicine Case Western Reserve University Cleveland OH USA
School of Medicine Emory University Atlanta GA USA
School of Medicine University of Virginia Charlottesville VA USA
Science Consulting in Diabetes GmbH Düsseldorf Germany
Singapore General Hospital Singapore
Stanford Diabetes Research Center Stanford University Stanford CA USA
Steno Diabetes Center Copenhagen Herlev Denmark
Suburban Hospital Johns Hopkins Medicine Bethesda MD USA
Sutter Health Center for Health Systems Research Santa Barbara CA USA
UC Berkeley UCSF Computational Precision Health Program Berkeley CA USA
University for Digital Technologies in Medicine and Dentistry Wiltz Luxembourg
University Hospitals Cleveland Medical Center UH Diabetes and Metabolic Care Center Cleveland OH USA
University of California Davis Health Sacramento CA USA
University of California San Francisco San Francisco CA USA
University of Virginia Charlottesville VA USA
VA Maryland Health Care System School of Medicine University of Maryland Baltimore MD USA
References provided by Crossref.org
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- $a The Diabetes Technology Society Error Grid and Trend Accuracy Matrix for Glucose Monitors / $c DC. Klonoff, G. Freckmann, S. Pleus, BP. Kovatchev, D. Kerr, CC. Tse, C. Li, MSD. Agus, K. Dungan, B. Voglová Hagerf, JS. Krouwer, WA. Lee, S. Misra, SY. Rhee, A. Sabharwal, JJ. Seley, VN. Shah, NK. Tran, K. Waki, C. Worth, T. Tian, RE. Aaron, K. Rutledge, CN. Ho, AT. Ayers, A. Adler, DT. Ahn, HK. Aktürk, ME. Al-Sofiani, TS. Bailey, M. Baker, L. Bally, RR. Bannuru, EM. Bauer, YM. Bee, JE. Blanchette, E. Cengiz, JG. Chase, K. Y Chen, D. Cherñavvsky, M. Clements, GL. Cote, KK. Dhatariya, A. Drincic, N. Ejskjaer, J. Espinoza, C. Fabris, GA. Fleming, MAL. Gabbay, RJ. Galindo, AM. Gómez-Medina, L. Heinemann, N. Hermanns, T. Hoang, S. Hussain, PG. Jacobs, J. Jendle, SR. Joshi, SK. Koliwad, RA. Lal, LA. Leiter, M. Lind, JK. Mader, A. Maran, U. Masharani, N. Mathioudakis, M. McShane, C. Mehta, SJ. Moon, JH. Nichols, DN. O'Neal, FJ. Pasquel, AL. Peters, A. Pfützner, R. Pop-Busui, P. Ranjitkar, CM. Rhee, DB. Sacks, S. Schmidt, SM. Schwaighofer, B. Sheng, GD. Simonson, K. Sode, EK. Spanakis, NL. Spartano, GE. Umpierrez, M. Vareth, HW. Vesper, J. Wang, E. Wright, AHB. Wu, S. Yeshiwas, M. Zilbermint, MA. Kohn
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