The relative accuracy of blood glucose meters has of course been in the spotlight of late, since the FDA held a hearing to "crack down" on this issue last Fall. Funny, but I always assumed this had more to do with the technology inside the meter than the test strips themselves. Silly me.

One of this year's buzzwords at the ADA Conference in Orlando last week was the "PQQ Enzyme" {glucose dehydrogenase (GDH)-pyrroloquino-linequinone (PQQ)} — a gremlin, it seems, that has been on the radar of meter manufacturers since 2003, when a medical device alert was issued in the UK warning that test strips containing the enzyme could could interfere with BG monitoring systems, causing false highs that might lead patients to overdose on insulin. (When test strips with PQQ are used, maltose or icodextrin — which is converted to maltose — galactose, and xylose are misinterpreted as glucose. Read the background on how it works here.)

Last summer, the FDA finally jumped on this, issuing an ultimatum making it clear that blood glucose monitoring companies were going to have to change the enzymes in their strips.  Somewhat surprisingly, analyst Kelly Close writes in her report that the issue has "little impact to most patients."

Now that meter accuracy has become such a burning topic, I might beg to disagree.

J&J jumped on this issue immediately, issuing an upgrade to its OneTouch test strips last fall.  Now Abbott Diabetes has just introduced its newest FreeStyle Lite strips, which the company touting as PQQ-free. What's also new on the strips are pointy little "ZipWik" tabs on each side of the strip, protruding from that dark half-circle where you're supposed to apply the blood. These tabs are designed to make blood absorption easier, and as a longtime FreeStyle customer, I say, hallelujah! The fact that FreeStyle requires such a tiny blood sample is of course the reason I love them, but it often takes a lot of smearing and scraping and switching sides to get their current strips to recognize my blood drop (TMI? If you're reading this blog, you gotta have the stomach for some blood talk, sorry)

Anyhow, surprised myself at how excited I was about the look of these new strips, with that pretty little FreeStyle butterfly right there on each one. And I'm glad know that they've done away with at least one of the major recognized causes of testing inaccuracy. I assure you the Abbott reps in the ADA booth were over the moon about this.

Overheard elsewhere at ADA: some folks from Bayer quietly bashing Roche for not being on top of the PQQ issue. When I reminded them that the Roche Accu-Chek folks had presented a white paper to the FDA recommending industry-wide steps toward improving accuracy, the response I got was:

"'Total system accuracy' doesn't mean anything if you haven't accounted for the PQQ enzyme. We're addressing it. I don't know what they're doing..."

{insert cat fight noises}

The upshot being: the PQQ enzyme is a hot-button that none of the manufacturers can afford to ignore.

Meanwhile, we patients are impatiently awaiting word from the FDA on how much tighter we can expect the acceptable margin of error to become. Current requirements are ± 20% error margin ninety-five percent of the time, which seems unacceptably loose, I'll agree. But we must also understand that there are limitations in the science of measurement, and perfection is not an option.

Bringing this point home exactly was an activity I helped run at the Roche Social Media Summit, which took place the day after ADA concluded. (The activity was conceptualized by the Roche team — all I did was play MC). Using a fun "fact or fiction" format, we were divided into six small groups and tasked with deciding where accuracy is most important for us — at the low or high end of glucose measurement?

Now before you jump on this and say, 'of course we want both!' Remember what I just said about limitations in science: these systems currently can't achieve 100% accuracy. The way I understand it, manufacturers essentially have a choice of where to shift the range they can achieve: either down, toward the lows, so the meter will be ultra-accurate at that end, but less precise on the high end, or vice-versa.

As reported already by David Mendosa and Sara Knicks: "the room was all over the map on this one!"  That is, our group quickly realized how messy this issue is: the type 2 diabetics in the room were generally more concerned about recognizing highs, but some felt that a 190 vs. a 220 reading didn't mean much since they'd address both the same way, while potential lows were scary to them.

The type 1s were really battling it out: instinct says we need killer accuracy for hypoglycemia, BUT false highs lead to insulin overdosing, which causes unnecessary lows. Not good.

Now It's Your Turn: Assuming that the industry can conquer the "PQQ gremlin" and tighten up the range of BG meter accuracy, and assuming that Roche is correct in asserting that we need to "pick a range" to focus on, which of the following would you choose -

In the end, our group pretty much agreed that 15-15, the middle ground, makes the most sense. But you know what they say about compromise: nobody comes away happy.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.