Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices
Background: Sensors for continuous glucose monitoring (CGM) are now commonly used by people with type 1 and type 2 diabetes. However, the response of these devices to potentially interfering nutritional, pharmaceutical, or endogenous substances is barely explored. We previously developed an in vitro...
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2025-03-01
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| author | Hendrick Jensch Steven Setford Nicole Thomé Geethan Srikanthamoorthy Lea Weingärtner Mike Grady Elizabeth Holt Andreas Pfützner |
| author_facet | Hendrick Jensch Steven Setford Nicole Thomé Geethan Srikanthamoorthy Lea Weingärtner Mike Grady Elizabeth Holt Andreas Pfützner |
| author_sort | Hendrick Jensch |
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| description | Background: Sensors for continuous glucose monitoring (CGM) are now commonly used by people with type 1 and type 2 diabetes. However, the response of these devices to potentially interfering nutritional, pharmaceutical, or endogenous substances is barely explored. We previously developed an in vitro test method for continuous and dynamic CGM interference testing and herein explore the sensitivity of the Abbott Libre2 (L2) and Dexcom G6 (G6) sensors to a panel of 68 individual substances. Methods: In each interference experiment, L2 and G6 sensors were exposed in triplicate to substance gradients from zero to supraphysiological concentrations at a stable glucose concentration of 200 mg/dL. YSI Stat 2300 Plus was used as the glucose reference method. Interference was presumed if the CGM sensors showed a mean bias of at least ±10% from baseline with a tested substance at any given substance concentration. Results: Both L2 and G6 sensors showed interference with the following substances: dithiothreitol (maximal bias from baseline: L2/G6: +46%/−18%), galactose (>+100%/+17%), mannose (>+100%/+20%), and N-acetyl-cysteine (+11%/+18%). The following substances were found to interfere with L2 sensors only: ascorbic acid (+48%), ibuprofen (+14%), icodextrin (+10%), methyldopa (+16%), red wine (+12%), and xylose (>+100%). On the other hand, the following substances were found to interfere with G6 sensors only: acetaminophen (>+100%), ethyl alcohol (+12%), gentisic acid (+18%), hydroxyurea (>+100%), <span style="font-variant: small-caps;">l</span>-cysteine (−25%), <span style="font-variant: small-caps;">l</span>-Dopa (+11%), and uric acid (+33%). Additionally, G6 sensors could subsequently not be calibrated for use after exposure to dithiothreitol, gentisic acid, <span style="font-variant: small-caps;">l</span>-cysteine, and mesalazine (sensor fouling). Conclusions: Our standardized dynamic interference testing protocol identified several nutritional, pharmaceutical and endogenous substances that substantially influenced L2 and G6 sensor signals. Clinical trials are now necessary to investigate whether our findings are of relevance during routine care. |
| format | Article |
| id | doaj-art-cc17957fe45d4fae8a2ccc45ee916bea |
| institution | DOAJ |
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| spelling | doaj-art-cc17957fe45d4fae8a2ccc45ee916bea2025-08-20T03:08:59ZengMDPI AGSensors1424-82202025-03-01257198510.3390/s25071985Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring DevicesHendrick Jensch0Steven Setford1Nicole Thomé2Geethan Srikanthamoorthy3Lea Weingärtner4Mike Grady5Elizabeth Holt6Andreas Pfützner7Pfützner Science & Health Institute, Haifa-Allee 20, 55128 Mainz, GermanyLifeScan Scotland Ltd., Inverness IV2 2ED, UKPfützner Science & Health Institute, Haifa-Allee 20, 55128 Mainz, GermanyPfützner Science & Health Institute, Haifa-Allee 20, 55128 Mainz, GermanyPfützner Science & Health Institute, Haifa-Allee 20, 55128 Mainz, GermanyLifeScan Scotland Ltd., Inverness IV2 2ED, UKLifeScan Global Corp., Malvern, PA 19355, USAPfützner Science & Health Institute, Haifa-Allee 20, 55128 Mainz, GermanyBackground: Sensors for continuous glucose monitoring (CGM) are now commonly used by people with type 1 and type 2 diabetes. However, the response of these devices to potentially interfering nutritional, pharmaceutical, or endogenous substances is barely explored. We previously developed an in vitro test method for continuous and dynamic CGM interference testing and herein explore the sensitivity of the Abbott Libre2 (L2) and Dexcom G6 (G6) sensors to a panel of 68 individual substances. Methods: In each interference experiment, L2 and G6 sensors were exposed in triplicate to substance gradients from zero to supraphysiological concentrations at a stable glucose concentration of 200 mg/dL. YSI Stat 2300 Plus was used as the glucose reference method. Interference was presumed if the CGM sensors showed a mean bias of at least ±10% from baseline with a tested substance at any given substance concentration. Results: Both L2 and G6 sensors showed interference with the following substances: dithiothreitol (maximal bias from baseline: L2/G6: +46%/−18%), galactose (>+100%/+17%), mannose (>+100%/+20%), and N-acetyl-cysteine (+11%/+18%). The following substances were found to interfere with L2 sensors only: ascorbic acid (+48%), ibuprofen (+14%), icodextrin (+10%), methyldopa (+16%), red wine (+12%), and xylose (>+100%). On the other hand, the following substances were found to interfere with G6 sensors only: acetaminophen (>+100%), ethyl alcohol (+12%), gentisic acid (+18%), hydroxyurea (>+100%), <span style="font-variant: small-caps;">l</span>-cysteine (−25%), <span style="font-variant: small-caps;">l</span>-Dopa (+11%), and uric acid (+33%). Additionally, G6 sensors could subsequently not be calibrated for use after exposure to dithiothreitol, gentisic acid, <span style="font-variant: small-caps;">l</span>-cysteine, and mesalazine (sensor fouling). Conclusions: Our standardized dynamic interference testing protocol identified several nutritional, pharmaceutical and endogenous substances that substantially influenced L2 and G6 sensor signals. Clinical trials are now necessary to investigate whether our findings are of relevance during routine care.https://www.mdpi.com/1424-8220/25/7/1985continuous glucose monitoringAbbott Libre 2dynamic interference testingDexcom G6interferents |
| spellingShingle | Hendrick Jensch Steven Setford Nicole Thomé Geethan Srikanthamoorthy Lea Weingärtner Mike Grady Elizabeth Holt Andreas Pfützner Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices Sensors continuous glucose monitoring Abbott Libre 2 dynamic interference testing Dexcom G6 interferents |
| title | Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices |
| title_full | Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices |
| title_fullStr | Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices |
| title_full_unstemmed | Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices |
| title_short | Dynamic Interference Testing—Unexpected Results Obtained with the Abbott Libre 2 and Dexcom G6 Continuous Glucose Monitoring Devices |
| title_sort | dynamic interference testing unexpected results obtained with the abbott libre 2 and dexcom g6 continuous glucose monitoring devices |
| topic | continuous glucose monitoring Abbott Libre 2 dynamic interference testing Dexcom G6 interferents |
| url | https://www.mdpi.com/1424-8220/25/7/1985 |
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