A Big Ol' Discussion About Meter Accuracy.
During the course of the Roche Summit, we had a big ol' activity about meter accuracy. I've written about meter accuracy before - actually, it was way more of a spastic rant - and I have remained frustrated about the lack of accuracy that's in the meters we use every day. So when the Roche people had us talking about meter accuracy and our perceptions and expectations, I had plenty of opinions.
We were at tables of about eight people apiece, and each table gathered together to decide how we wanted to lean. Our choices were 5/30, 10/20, 15/15, and 15/10, meaning that we could chose between a percentage of variability on the low end of the blood sugar range (the first number) and a percentage on the higher side of the range.
EDIT on 7/8: I was wrong. Thanks to Amy at DiabetesMine for clearing this up. The numbers stand for "number of points your meter might be off on the low end, and percentage of total error on the high end."
As a diabetic who was diagnosed as a kid, and also as a recently-pregnant diabetic, I had a very, very tough time deciding on an accuracy pairing. Would I rather take the hit when I'm low or high? During the course of my pregnancy, I was aiming for a fasting blood sugar under 90 mg/dl. With a percentage of error in the double digits, was my 80 mg/dl really an 80, or was I dipping into the 60s? Or the 100s? My decisions for both ends of that small spectrum are different, and the results if my meter is "off" could be really problematic.
In an ideal world - and my table picked this as our initial ratio - we'd want 0/0. Total accuracy. But I know that's not possible, based on the constant fluctuation of a diabetic's blood sugar and the limitations of the technology. For me, I was leaning more towards heightened accuracy on the lower end, because the lower the number, the scarier a "mistake" could become. Also, with my goals set at 100 mg/dl and not 300 mg/dl, my hope was that I'd be dealing with a more accurate meter because my blood sugars would be running tighter. Also, also, I was more willing to take a sharp blood sugar tumble from a high versus from a low. Further to fall, I guess.
My vote was for 5/30.
And then I felt this wave of frustration, because the idea of having to choose heightened accuracy at one end of the scale or the other made me pretty fired up. If you can be more accurate on both ends, why wouldn't you be? Oh wait, is it the cost? Could it be that once again, affordability comes into play? Our group talked about different strips for children (more accurate on both ends of the range) and for pregnant women, but if I were to mention that concept to my mom, she'd say, "You're still my child, and I'd want you to have the most accurate strip." There were comments that a more accurate strip would be a more expensive strip, and insurance companies (who barely want to cover four strips for a type 1 diabetic, never mind the 15 a day that I blow through) would fight endlessly to deny coverage due to the cost. I understand that business is business, but isn't life still ... life?
At this point, I'd just take a meter that gives me the same result twice in a row. (Because in the last 23 years, I've seen some wicked variability that meter companies should hang their heads in shame over.) I'd even allow it to be 5 points off in either direction. Nothing gives me more confidence in a meter result than seeing it line up with my Dexcom. And nothing shakes my confidence more than seeing results that vary - wildly - mere minutes from one another. With those kinds of results, I have just as much faith in a Magic 8 ball. (Ask again later.)
What plays into your decisions on what is "acceptable" for accuracy? Is it once your child sleeps through a low? Once you find out your pregnant? Once you have a seizure? Once you correct down a 300 mg/dl and fall into the 20s? Would you be wiling to pay more for a more accurate strip? Would insurance companies be willing, or would they ever see the benefit of covering preventative care now instead of treating complications later? What is your definition of "accurate?"
And if you had to select one of those accuracy ratios, which would you choose?