The use of commercially available continuous glucose monitors for diabetes management requires sensor calibrations, which until recently are exclusively performed by the patient. A new development is the implementation of factory calibration for subcutaneous glucose sensors, which eliminates the need for user calibrations and the associated blood glucose tests. Factory calibration means that the calibration process is part of the sensor manufacturing process and performed under controlled laboratory conditions. The ability to move from a user calibration to factory calibration is based on several technical requirements related to sensor stability and the robustness of the sensor manufacturing process. The main advantages of factory calibration over the conventional user calibration are: (a) more convenience for the user, since no more fingersticks are required for calibration and (b) elimination of use errors related to the execution of the calibration process, which can lead to sensor inaccuracies. The FreeStyle Libre TM and FreeStyle Libre Pro TM flash continuous glucose monitoring systems are the first commercially available sensor systems using factory-calibrated sensors. For these sensor systems, no user calibrations are required throughout the sensor wear duration.

The study shows that a 14-day sensor wear period is achievable. Moreover, sensors using "wired enzyme" technology showed excellent in vivo stability, with no significant sensitivity loss over the 14-day wear period.

Background: Continuous glucose monitoring using subcutaneously inserted sensors currently requires blood glucose tests for sensor calibration. Alternatively, sensors precalibrated during the manufacturing process may eliminate the need for fingerstick calibrations. In this study we evaluated the feasibility of sensor factory calibration in subjects with diabetes. Methods: A total of 33 subjects with diabetes were asked to wear 4 sensors in parallel, 2 on the arm and 2 on the abdomen. Sensors from a lot with low in vitro sensitivity coefficient of variation were used in the study. Based on frequent capillary blood glucose measurements, the average glucose sensitivity of each sensor was determined over a 5-day wear time. The in vivo sensitivities were analyzed for inter-and intrasubject variation. Mean absolute relative difference (MARD) calculation and consensus error grid analysis (EGA) were performed using a single calibration factor for all sensors, to simulate factory calibration and compared against conventional finger-stick calibration. Results: The sensitivity coefficient of variation between sensors increased from 2.9% in vitro to 6.0% in vivo. No difference in sensor response between subjects (P = .069) as well as between insertion sites (arm and abdomen) was detected (P = .104). Applying one calibration factor to all sensors in the study resulted in an MARD of 13.4%, and 83.5% of the values fell in consensus EGA zone A. Multiple fingerstick calibration resulted in an MARD of 12.7% and 84.1% in zone A. Conclusions: Feasibility of factory calibration was demonstrated in subjects with diabetes using sensors based on "wired enzyme" technology, resulting in accuracy metrics similar to sensors calibrated with capillary blood glucose.

Cations of mixed valence at surfaces of metal oxide nanoparticles constitute electrochemical half-cells, with potentials intermediate between those of the dissolved cations and those in the solid. When only cations at surfaces of the particles are electrochemically active, the ratio of electrochemically active/all cations is ~0.1 for 15 nm diameter CeO(2-x) particles. CeO(2-x) nanoparticle-loaded hydrogel films on printed carbon and on sputtered gold constitute reference electrodes having a redox potential similar to that of Ag/AgCl in physiological (0.14 M) saline solutions. In vitro the characteristics of potentially subcutaneously implantable glucose monitoring sensors made with CeO(2-x) nanoparticle reference electrodes are undistinguishable from those of sensors made with Ag/AgCl reference electrodes. Cerium is 900 times more abundant than silver, and commercially produced CeO(2-x) nanoparticle solutions are available at prices well below those of the Ag/AgCl pastes used in the annual manufacture of ~10(9) reference electrodes of glucose monitoring strips for diabetes management.