Accuracy of a Fourth-Generation Continuous Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes

Robert H. Slover, Jeanie B. Tryggestad, Linda A. Dimeglio, Larry A. Fox, Bruce W. Bode, Timothy S. Bailey, Ronald Brazg, Mark P. Christiansen, Jennifer L. Sherr, Eva Tsalikian, Kevin B. Kaiserman, Ashley Sullivan, Suiying Huang, John Shin, Scott W. Lee, Francine R. Kaufman

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10 Scopus citations


Background: This study evaluated the safety and performance of the Guardian™ continuous glucose monitoring (CGM) system in children and adolescents with type 1 diabetes (T1D). Materials and Methods: Subjects 2-18 years of age (mean ± standard deviation [SD] 13.1 ± 3.9 years) with T1D and duration of diagnosis ≥1 year were enrolled at 11 sites in the United States and wore two Guardian Sensor 3 sensors in the abdomen and/or buttock. Sensors were connected to a transmitter paired with either a Guardian Connect system (i.e., mobile device with software application allowing display of sensor glucose [SG] values) or a Guardian Link 3 transmitter used as a Glucose Sensor Recorder (GSR). There were 145 participants who underwent a 6-h in-clinic frequent sample testing (FST) on day 1 (n = 54), day 3 (n = 48), or day 7 (n = 43) postsensor insertion. During FST, SG values were compared with a Yellow Springs Instrument (YSI) plasma reference every 5-15 min (n = 124, 7-18 years of age; n = 2, 2-6 years of age), or to a self-monitoring of blood glucose (SMBG) reference every 5-30 min (n = 19, 2-6 years of age). Results: The overall mean absolute relative difference (ARD ± SD) between SG and reference values (YSI or SMBG) when calibrating approximately every 12 h, was 10.9% ± 10.7% (3102 paired points) for sensors communicating with the Guardian Connect system and 11.1% ± 10.6% (2624 paired points) for sensors connected to the GSR. The overall percentage of SG values within ±20% of reference values >80 mg/dL or within 20 mg/dL of reference values ≤80 mg/dL was 87.8% for the Guardian Connect system and 86.7% for the GSR, respectively. There was one device-related adverse event of contact dermatitis, but no serious device-related adverse events. Conclusions: The Guardian CGM system demonstrated good accuracy in children and adolescents. These findings support its use in sensor-integrated insulin pump platforms, as well as a standalone technology, for managing diabetes in pediatric populations.

Original languageEnglish (US)
Pages (from-to)576-584
Number of pages9
JournalDiabetes Technology and Therapeutics
Issue number9
StatePublished - Sep 2018


  • Continuous glucose monitoring
  • MARD
  • Pediatrics
  • Sensor accuracy
  • Sensorintegrated pump
  • mobile device

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

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    Slover, R. H., Tryggestad, J. B., Dimeglio, L. A., Fox, L. A., Bode, B. W., Bailey, T. S., Brazg, R., Christiansen, M. P., Sherr, J. L., Tsalikian, E., Kaiserman, K. B., Sullivan, A., Huang, S., Shin, J., Lee, S. W., & Kaufman, F. R. (2018). Accuracy of a Fourth-Generation Continuous Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes. Diabetes Technology and Therapeutics, 20(9), 576-584.