Evaluation of a flash glucose monitoring system in nondiabetic dogs with rapidly changing blood glucose concentrations

Background A flash glucose monitoring system (FGMS; FreeStyle Libre) is useful for monitoring hypoglycemic dogs with diabetes. Objective To assess the utility of this FGMS in dogs with induced hypoglycemia and rapid fluctuations in blood glucose (BG) concentrations. Animals Twenty-four apparently healthy research (n = 10) and teaching (n = 14) dogs. Methods Prospective, observational study performed in tandem with a teaching laboratory. Regular insulin was administered to dogs and resulting hypoglycemia was corrected. Before insulin administration and every 10 minutes over a 90-minute period, serial measurements of interstitial glucose (IG) with FGMS and BG with a portable blood glucose meter (PBGM) and clinical chemistry analyzer concentrations were made. Portable blood glucose meter and FGMS readings were compared to that of the clinical chemistry analyzer. Analytical and clinical accuracy were assessed using ISO 15197:2013 criteria, including Parkes error grid analysis. Results The proportions of readings in the low BG range (BG <100 mg/dL) for which the test method measurement was within +/- 15 mg/dL of the reference BG for the PBGM and FGMS were 81.7% (161/197) and 39.1% (72/184), respectively. The proportions of readings for the PBGM and FGMS, which were not likely to affect clinical outcome according to Parkes error grid analysis, were 97.9% (233/238) and 80.1% (177/221), respectively. Conclusions and Clinical Importance In this model, there was limited agreement between the FGMS and reference standard BG measurements. The FGMS (measuring IG concentrations) was compared to peripheral BG concentrations, not brain-tissue glucose concentrations, and failed to reliably detect hypoglycemia.