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Resistance to data loss from the Freestyle Libre: Impact on glucose variability indices and recommendations for data analysis

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journal contribution
posted on 15.09.2020, 11:20 by Andrew Kingsnorth, Maxine E Whelan, Mark W Orme, Ash C Routen, Lauren Sherar, Dale Esliger
Like many wearables, flash glucose monitoring relies on user compliance and is subject to missing data. As recent research is beginning to utilise glucose technologies as behaviour change tools, it is important to understand whether missing data is tolerable. Complete Freestyle Libre data files were amputed to remove 1-6 hours of data both at random and over mealtimes (breakfast, lunch and dinner). Absolute percent errors (MAPE) and intraclass correlation coefficients (ICC) were calculated to evaluate agreement and reliability. Thirty-two (91%) participants provided at least one complete day (24-hours) of data (age: 44.8±8.6 years, female: 18 (56%); mean fasting glucose: 5.0±0.6 mmol/L). Mean and CONGA (60 minutes) were robust to data loss (MAPE ≤3%). Larger errors were calculated for standard deviation, coefficient of variation (CV) and MAGE at increasing missingness (MAPE 2-10%, 2-9% and 4-18%, respectively). ICC decreased as missing data increased, with most indicating excellent reliability (>0.9) apart from certain MAGE ICC, which indicated good reliability (0.84-0.9). Researchers and clinicians should be aware of the potential for larger errors when reporting standard deviation, CV and MAGE at higher rates of data loss in nondiabetic populations. But where mean and CONGA are of interest, data loss is less of a concern. Novelty:  As research now utilises flash glucose monitoring as behavioural change tools in nondiabetic populations, it is important to consider the influence of missing data.  Glycaemic variability indices of mean and CONGA are robust to data loss, but standard deviation, CV and MAGE are influenced at higher rates of missingness.



  • Sport, Exercise and Health Sciences

Published in

Applied Physiology, Nutrition, and Metabolism


NRC Research Press (Canadian Science Publishing)


AM (Accepted Manuscript)

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© The Authors

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This paper was accepted for publication in the journal Applied Physiology, Nutrition, and Metabolism and the definitive published version is available at https://doi.org/10.1139/apnm-2020-0386.

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Dr Andrew Kingsnorth. Deposit date: 11 September 2020