Blood glucose– commonly referred to as blood sugar– is typically measured in milligrams per deciliter, or mg/dL. When doctors test for diabetes, they usually perform two blood sugar tests on two separate occasions. Two readings of 126 mg/dL or greater confirm the presence of the chronic, incurable disease, according to the Mayo Clinic. A fasting blood sugar level that’s between 100 and 125 mg/dL is a sign of prediabetes.
In healthy individuals, sugar provides vital energy to cells. But in people with diabetes, elevated blood sugar has the same effect as a slow-acting poison. High blood sugar makes it difficult for the pancreas to function properly.
One of the most important functions that the pancreas performs is produce a hormone called insulin. Insulin is like a delivery service that helps transport the energy contained in the sugar in your blood to your organs. Left untreated, diabetes damages the pancreas– and all the organs in your body suffer as a result.
Since diabetes affects all organs, there are many harmful conditions that can arise as a result of it. Diabetes causes strokes, heart attacks, nerve damage, erectile dysfunction and even blindness. Diabetics with kidneys damage rely on dialysis machines to remove excess waste from their bodies.
If you have diabetes or you’re concerned about your blood sugar levels, a blood glucose meter will let you check your blood health on your own. Keep reading to learn about the best blood glucose meters that are available online.
- Here are the best blood glucose meters you can buy:
- The most user-friendly blood glucose meter
- The most accurate blood glucose meter
- The best talking blood glucose meter
- The best portable blood glucose meter
- The best blood glucose meter that works with smartphones
- Buying guide for blood glucose meters
- Price ranges
- Frequently asked questions
- Tips and tricks
- Are Blood Glucose Meters Accurate? New Data on 18 Meters
- Blood Glucose Meter Accuracy: 10 Meters Put to the Test!
- Are Blood Glucose Meters Accurate?
- The Test
- The Results
- What does this mean for A1C?
- My Own Experience With Self-Measured BG Averages & A1C
- What about the post that started all this? Why were those results so off?
- It may be the test strips…
- So, where does this leave us?
- The Best Blood Sugar Monitors to Help You Manage Diabetes
- 10 Best Glucose Meters – February 2020
- Comparison of Five Glucose Meters for Self-Monitoring of Blood Glucose by Diabetic Patients
- Diabetes Blog Bytes
- 2016 Blood Glucose Meter Comparisons
- Choose Your Blood Glucose Meter Wisely!
Here are the best blood glucose meters you can buy:
- The Care Touch Blood Glucose Monitoring System is simple, affordable and easy to use.
- Accu-Chek’s Aviva Plus is one of the most accurate blood glucose meters on the market, according to Consumer Reports.
- The Prodigy Diabetes Testing Kit delivers audio blood sugar readings in four different languages.
- The OneTouch UltraMini is small enough to fit into your pocket and comes with everything you need to track your blood glucose level while on the go.
- If you have an Android smartphone or an iPhone, you may want to consider getting a Dario Blood Glucose Meter Starter Kit. Dario is one of the few glucometers that has its own app.
The most user-friendly blood glucose meter
Care Touch Blood Glucose Monitoring System
Self-testing for blood sugar can be a pain in more ways than one. Some glucometers are a hassle to use and require the purchase of expensive test strips. The Care Touch Blood Glucose Monitoring System addresses both of these concerns with ease of use features and inexpensive test strip refills.
- Inexpensive. This glucometer is not only cheap compared to other similar products, its test strips are also reasonably priced.
- Easy to use. There’s a built-in test strip ejector that’s quite handy and a code scanner that saves you the hassle of having to enter in new codes every time you insert a new batch of test strips.
- Quick results. Five seconds is all the time that’s required to find out the status of your blood health with this device.
- Data annotation. You can add a “post meal” or “pre-meal” flag to any test result.
- Complete kit. Along with the monitor itself, you also get 100 test strips, a lancing device, 30 lancelets, and even a carrying bag and a battery.
- Small blood sample. This device only requires 0.5 microliters of blood. That’s a very small amount. The average drop of blood measures roughly 50 microliters.
- Not as accurate as some glucometers. The main downside to consider is that this glucometer isn’t as accurate as some. Readings obtained with this unit may show blood glucose levels that are up to 20% higher or lower than they actually are. While this range falls within the FDA’s standards, competing blood glucose meters provide more accurate readings.
In a nutshell
If you’re looking for an inexpensive basic glucometer that’s easy to use, this one is worth considering. However, it may make sense to invest in a blood glucose meter that has more features and is more precise– especially if your health care plan will cover your expenses.
Buy The Care Touch Blood Glucose Monitoring System from Amazon
The most accurate blood glucose meter
Accu-Chek’s Aviva Plus
The FDA specifies that all glucometers that are designed for home readings must fall within 20% of blood glucose readings obtained in the lab. That 20% variance can make it difficult to accurately check your blood glucose with some home glucometers. That’s where The Accu-Chek Aviva Plus Blood Glucose Meter comes in. It is one of the most accurate blood glucose meters you’ll find.
- Easy to configure. Like most modern glucometers, this one is equipped with an electronic code reader which saves you the trouble of entering the test strip codes in yourself.
- Highly accurate. Accuracy is one of this device’s best features. Both Consumer Reports and the diaTribe Foundation awarded the Aviva Plus high marks for accuracy when they put it to the test.
- Data transfer. With the Aviva Plus, you can download your test results to your computer. This is useful for tracking your blood sugar fluctuations over time.
- All-inclusive kit. Like most glucometers, this one comes with a lancelet and some testing strips.
- Adjustable lancelets. The depth of Accu-Chek’s patented Softclix lancelet is adjustable. If you’re sensitive to lancelet pricks and you dread taking a reading, this feature alone may convince you to try out this glucometer.
- Data annotation. You can use markers to indicate if you’ve taken a test before or after a meal.
- Pricey test strips. The old adage “you get what you pay for” applies here. This glucometer test strips are somewhat expensive.
The Accu-Chek Aviva Plus is very accurate and the device itself is reasonably priced. The test strips, however, are a bit pricey. If your health care plan will cover that expense, this glucometer might be your best option.
Buy Accu-Chek Aviva Plus Blood Glucose Meter from Amazon
The best talking blood glucose meter
Prodigy Diabetes Testing Kit
The O’Well Prodigy Diabetes Testing Kit is one of just a handful of blood glucose meters that delivers audio test results in more than one language. In addition to the built-in speaker, there’s also a headphone jack you can use if you need more volume or need to use the device discreetly. This makes the Prodigy one of the best blood glucose meters to use if you’re visually impaired.
- Delivers audio test results. This talking blood glucose meter from O’Well supports not only spoken English blood test results, but also in Spanish, French and Arabic.
- Headphone jack. In addition to a small speaker, there’s an audio jack that you can use to listen to the voice interface through a pair of headphones.
- Stores hundreds of test results. You can save up to 450 blood sugar test results with this device. Each test result is time stamped.
- Excellent value. The starter kit that you get when you buy the Prodigy has 100 test strips, 100 lancelets and even a handy carrying case.
- Data transfer. All you have to do is connect your Prodigy to your computer via USB and transfer a file if you want to analyze your test results or give them to your doctor.
- Doesn’t come with a USB cable. If you don’t already have a USB cable, you’ll need to buy one separately if you intend to download your test results to your computer.
The O’Well’s Prodigy glucometer’s main feature is the fact that it talks. Other features like data transfer and its large data storage capacity add extra value.
Buy The Prodigy Diabetes Testing Kit from Amazon
The best portable blood glucose meter
The OneTouch UltraMini Glucose Monitoring System is ultra-slim and pocket-sized. It is one of the smallest and most portable products of its kind. If you’re traveling and you need to check your blood glucose while on vacation, this glucometer is a space saver. You can even download your data to your computer with a USB cable.
- You can take it anywhere. The makers of the OneTouch UltraMini have gone out of their way to design a blood glucose meter that is extremely portable.
- It comes with a carrying case. The handy carrying case that comes with the kit is useful for staying organized on the go.
- Supports data transfer. You can plug the UltraMini into a computer and download your test results through a USB cable.
- Fast test results. Given its small size, you may assume that the UltraMini is slow compared to larger glucometers– but this isn’t the case. It only requires 5 seconds to perform the calculation.
- Lacks an autocode feature. Even though the UltraMini has many convenient features, there is one potential hassle: you have to recode the UltraMini every time you insert a new batch of test strips. Other glucose meters will scan your test strip code for you.
- Doesn’t come with test strips. The UltraMini comes with 10 lancelets, but doesn’t come with any testing strips. You’ll need to buy those separately if you decide to get this glucometer.
When it comes to portability features, this glucometer is hard to beat. The kit comes with everything you need to test your blood sugar on the go. If you rely on a different glucometer when at home, you won’t need to recode the device much because you probably won’t be changing the test strips that often.
Buy The OneTouch UltraMini from Amazon
The best blood glucose meter that works with smartphones
Dario Blood Glucose Meter Starter Kit
The Dario Blood Glucose Meter Starter kit provides a look at what the future of at-home blood glucose testing might look like. The kit comes with everything you need to turn your smartphone into a glucometer, plus all the lancing devices and testing strips you need to get started. If you’re looking for a portable blood sugar meter with advanced analytical features, this glucometer is worth a look.
- Works with smartphones. This handy blood sugar meter snaps right onto the bottom of your phone.
- Saves space. Instead of two devices, all you need is one– your smartphone.
- Compatible with both iOS and Android. Dario makes two different kits: one for iPhone and one for Android.
- All-in-one kit. The kit comes with a lancing device, and testing strips– all of which fit neatly into the glucometer itself, which in turn attaches to the bottom of your iPhone or Android phone.
- Advanced data analysis. Dario’s app lets you do things like count carbs, share your results with your doctor, monitor your physical activities and more.
- Emergency alerts. You can configure the Dario to send out alerts automatically if your blood sugar reaches a critical level.
- Pricey test strips. If your health care plan doesn’t cover test strips, you may save money by going with one of the other glucometers mentioned above.
The best thing about this next-generation blood glucose meter from Dario Health is that it gives you the ability to monitor your blood with your iPhone or Android. But even though the Dario blood glucose testing system is innovative, other systems are more accurate– and the proprietary test strips are on the pricey side.
Buy Dario Blood Glucose Meter Starter Kit from Amazon
Buying guide for blood glucose meters
All blood glucose meters need to be calibrated. However, different glucose meters use different calibration methods. Some smartphone-compatible glucose meters are equipped with scanners or let you calibrate your device with your smartphone. Other types of glucose meters come with removable code chips, which you can use to calibrate your device.
Test result delivery time
Some glucometers deliver results in just a few seconds, but others require longer wait periods. Even though a few extra seconds of wait time may not seem like a big difference, it may be easier to establish a self-testing routine with a glucometer that delivers quick results.
Blood volume required for sample
The minimum amount required is 0.3 microliters, but most glucometers require 0.4 to 0.5 microliters of blood. Blood glucose meters that require more blood may require you to perform the test all over again if you don’t get a large enough sample the first time.
The Food and Drug Administration requires 95% of all measured blood glucose meter values to be within 15% of a lab measurement and 99% of those same values must fall within the 20% range. However, some glucometers are more accurate than others. Most highly accurate glucometers are more expensive to use over time because their test strips are more expensive.
Before you invest in a glucometer, be sure to check with your insurance to find out what’s covered and what’s not. If your insurance plan includes DME (Durable Medical Equipment) coverage, you may not have to pay for test strips.
Portability vs. accuracy
Most modern electronic blood glucose meters are small enough to travel with, but some are specifically used on the go. These types of glucometers usually come with compartmentalized travel cases, which help you stay organized while traveling. The tradeoff here is that most portable glucometers aren’t quite as accurate as ones that are designed for at-home use.
Different blood glucose meter manufacturers offer different support options. There’s usually some type of toll-free number you can call if you need help. However, some manufacturers only provide support via email.
Test strip replacement expenses
Some test strips– particularly ones that work with more accurate glucometers– are costly to replace. The cheapest test strips cost around 16 cents each, but others are $2 apiece or more.
What’s in the kit?
Most glucometers come with lancelets, which are needed to obtain the blood sample used to test for blood glucose. However, sometimes you have to buy the lancelets separately. Some lancelets can be used multiple times, but some types can only be used once. Most glucometer kits contain at least a few testing strips, but some come with more than others.
The good news about glucometers is that they are all fairly inexpensive. Portable glucometers tend to be the most budget-friendly option. Prices start at around $20.
The next step up are glucometers that are equipped with special features, like a voice narrated interface or enhanced accuracy. Expect to pay around $30 for a glucometer with improved functionality.
The most expensive type of glucometer you can buy is the kind that works with your smartphone. Smart glucometers cost about $40.
Frequently asked questions
Q: What are testing strips?
A: Testing strips are disposable material used for testing blood. Available testing strip types include paper, plastic and cartridge-style. Electrochemical test strips are the most common type today. They use enzymes to convert glucose into electrical currents.
Q: Some blood glucose meters can measure both blood glucose and ketones. What are ketones?
A: Blood glucose meters that can test for ketones are useful to people who are on ketogenic diets. Ketogenic dieters reduce their carbohydrate intake to force their bodies to rely on ketones for energy instead of carbohydrates. Blood meters that can detect ketones help them identify when they’ve made the transition. Unless you are on a ketogenic diet, you probably won’t have much use for this feature.
Q: Do bloodless glucometers really work?
A: Though blood testing is currently the standard when it comes to testing blood sugar levels, there are some devices that don’t require you to prick yourself with a lancelet. Before you invest in a bloodless glucose meter, you should know that this new technology is still in its early stages. The FDA approved the first bloodless glucose meter just two years ago.
Q: Some glucometer manufacturers advertise that their devices support data flagging. What does that mean?
A: Some blood glucose meters let you attach notes to your readings. You can indicate when you last ate before you tested yourself, for example. Annotation features are sometimes described as flagging or data flagging.
Q: What’s the difference between an enzyme and a reagent?
A: Both terms mean the same thing. The chemical mixture used to test for blood glucose is often referred to as a reagent or enzyme.
Q: What does BM mean?
A: In the United Kingdom, Boehringer Mannheim was once one of the leading manufacturers of blood sugar testing kits. Even though the company is now part of the Swiss healthcare company Roche, British nurses and other health care professionals often say that they are “taking a BM” when testing a patient’s blood sugar.
Tips and tricks
- Wash your hands. Wash your hands with soap and warm water before you take a blood sample.
- Don’t use alcohol wipes. Alcohol can diffuse the blood sample and make your blood sugar reading seem lower than it actually is.
- Don’t squeeze. Squeezing blood from your fingertip can also skew the results because the fluids under your skin can dilute the sample.
- Brace yourself beforehand. A good practice is to rest your finger against a stationary surface before you prick it with your lancelet.
Are Blood Glucose Meters Accurate? New Data on 18 Meters
By Jeemin Kwon and Adam Brown
Results from the Diabetes Technology Society’s Blood Glucose Meter Surveillance Program identifies only six out of 18 meters that passed. Did yours make the cut?
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The Diabetes Technology Society (DTS) recently revealed long-awaited results from its Blood Glucose Monitor System (BGMS) Surveillance Program. The rigorous study tested the accuracy of 18 popular blood glucose meters (BGM) used in the US. These FDA-cleared meters were purchased through retail outlets and tested rigorously at three study sites in over 1,000 people (including 840 people with diabetes). The results were troubling: only six out of the 18 devices met the DTS passing standard for meter accuracy – within 15% or 15 mg/dl of the laboratory value in over 95% of trials.
The devices that passed were:
Contour Next from Ascensia (formerly Bayer) – 100%
Accu-Chek Aviva Plus from Roche – 98%
Walmart ReliOn Confirm (Micro) from Arkray – 97%
CVS Advanced from Agamatrix – 97%
FreeStyle Lite from Abbott – 96%
Accu-Chek SmartView from Roche – 95%
The devices that failed were:
Walmart ReliOn Prime from Arkray – 92%
OneTouch Verio from LifeScan – 92%
Prodigy Auto Code from Prodigy – 90%
OneTouch Ultra 2 from LifeScan – 90%
Walmart ReliOn Ultima from Abbott – 89%
Contour Classic from Bayer – 89%
Embrace from Omnis Health – 88%
True Result from HDI/Nipro (Trividia) – 88%
True Track from HDI/Nipro (Trividia) – 81%
Solus V2 from BioSense Medical – 76%
Advocate Redi-Code+ from Diabetic Supply of Suncoast – 76%
Gmate Smart from Philosys – 71%
Get the full data and all the accuracy information here.
While all of these meters received FDA clearance at some point, this study shows that not all are equivalent in terms of accuracy. The FDA looks at company-reported trials when it reviews new meters; this study took an independent look, purchasing the meters directly through retailers and testing them rigorously at respected research centers. It should be noted that the study’s standards for accuracy were even higher than FDA standards.
The results may be particularly frustrating for those on Medicare. According to market share data from the US government, about 68% of the Medicare mail orders for BGMs in 2016 were for meters that did not pass the DTS standards. It is not yet clear how the FDA (or even Medicare) will respond to the reports of particularly low-accuracy meters such as the Advocate Redi-Code+ and the GmateSmart, which have been criticized for inaccuracy before.
On the other hand, it is encouraging that two store-brand “value” meters, Walmart’s ReliOn Confirm (Micro) and CVS’ Advanced, showed great accuracy in this study.
This study was funded by Abbott but developed and run independently. (Indeed, Abbott had one meter pass and one meter fail). It’s not clear if DTS will get funding to run this study on an ongoing basis, ensuring the meters on the market are accurate and reliable. Dr. Joan Parkes, a co-author of the study, expressed her hope that manufacturers would support DTS in doing more of these studies.
At LifeScan, Inc. we stand by the accuracy and the efficacy of our OneTouch® products – used by more than 20 million people around the world and recommended by more endocrinologists, primary care physicians, and pharmacists than any other brand. These products are continually assessed in our OneTouch® post-market surveillance program, which includes clinical testing as well as complaint capture, to ensure that all products – including those in the DTS study – continue to meet FDA performance requirements and specifications. Both products meet the International Organization for Standardization (ISO) standard for accuracy, with the OneTouch Verio® BGMS designed to meet the requirements of ISO 15197:2013 and the OneTouch® Ultra®2 designed to meet ISO 15197:2003. In fact, the April issue of the Journal of Diabetes Science and Technology features a study detailing the OneTouch Verio® BGMS platform’s seven years of proven accuracy across more than 70,000 clinical data points. As we are always evaluating ways to further ensure product quality, LifeScan’s clinical and R&D teams are working to evaluate and understand the DTS results. Patients who have questions are encouraged to get in touch with OneTouch® Customer Care at 1-800-227-8862 so we can work with them to provide answers.
Global Brand Equity Insights Study, February 2015
Setford, et al. Seven-year surveillance of the clinical performance of a blood glucose test strip product. Journal of Diabetes Science and Technology (2017) 1-8
Blood Glucose Meter Accuracy: 10 Meters Put to the Test!
Are Blood Glucose Meters Accurate?
A few months ago, I read a post on blood glucose meter (in)accuracy that was quite alarming. Chris Hannemann, T1D and OpenAPS’er, tested five popular blood glucose meters for accuracy and found major discrepancies.
The overall variability between the meters was roughly ±11 %, and two of the meters — both from the same manufacturer — showed major bias.
Chris had been using one of those meters to calibrate his CGM and consistently found that his lab-measured A1C would come in a full percentage point higher than his CGM average would predict (e.g., the meter-calibrated CGM data would correspond to an A1C of 6%, but laboratory-measured A1C would actually be 7%).
As someone who wears a CGM and always strives to achieve an A1C of ~6.0% or lower, this post freaked me out.
If I’m calibrating my CGM with a meter whose results are always off by that much… how can I be sure about reaching my targets?!? But I was also skeptical when I saw Chris’ post, because my A1C has always matched my predictions (based on my CGM average). So, I decided to run my own test on 10 popular meters from various manufacturers.
Much to my relief, all 10 meters produced very similar results for each blood sample, with an overall between-meter variability of just under 6%.
Below I describe the test and discuss the results. And, in another post, I explain some reasons why your average BG on your meter might not always correspond with your A1C results. (Key point: It doesn’t necessarily mean your meter is bad!)
- Accu-Chek Aviva Connect
- Contour Next EZ
- OmniPod PDM FreeStyle Meter
- FreeStyle Lite
- Livongo InTouch
- OneTouch Ultra Mini
- One Touch Ultra 2
- Walgreens True Metrix Air
- Walgreens True 2 Go
- Wal-Mart ReliOn Confirm
These 10 meters varied in age and wear. Some were old, some were new… one was my own personal meter that I used to calibrate my CGM and make mission-critical decisions each day.
All of them passed their respective control solution tests, so it’s safe to assume that they were in good working order. I tried to match the testing method employed by Chris (author of the original post) as closely as possible.
Eight rounds of testing were performed over the course of 24 hours according to the following procedure:
- Wash and dry hands
- Arrange meters on table in random order
- Insert new lancet into lancing device
- Remove test strip from each meter’s strip vial and insert strips into meters
- Wipe fingertip with alcohol pad & wait for it to dry
- Prick fingertip & squeeze out large drop of blood
- Apply blood to each test strip in order
- Record results
- Order of meters was randomized for each round.
- Tests were performed only when CGM readings were stable (i.e. no insulin on board and CGM showing a slope of ~0 mg/dL/min).
- I didn’t do anything special to stabilize my blood glucose — just tested as I went about a normal day.
- The test strips used for each meter all came from their own unique vials.
- Before and after completing the eight testing rounds, the meters were checked using their respective control solutions. They all passed the control solution tests.
BG Results For Each Round, Compared
In plain English: My treatment decisions wouldn’t have varied much at all, regardless of the meter I was using.
One unit of rapid-acting insulin brings my BG down by ~80 mg/dL, and I correct whenever I’m over 100 mg/dL. I’ll usually correct down to 70-110 mg/dL, depending on my plans for the next couple hours (big meal = correct to 70; workout = correct to 110).
I was relieved to see that even if I took a correction bolus for the maximum BG of each round, I still would have been brought down to a desirable blood glucose level.
For example, take Round 1. The highest reading I saw was 182 md/dL, and I’d take 1 unit for that. Even if we assume the true glucose was the lowest value from that round, 149 mg/dL, I’m still in good shape taking 1 unit because I’d only go down to ~70 mg/dL.
What does this mean for A1C?
To figure out what this means for A1C estimates, let’s take a look at how each meter’s average value over the 24 hours of testing compares with the overall average across all meters.
(NOTE: I realize that the average across all meters may not accurately represent true A1C, but this comparison is useful to show that, no matter what meter you use, you’re getting roughly the same results for averages and, thus, roughly the same estimated A1C.)
Looking below at the deviation from the mean — i.e, how much each meter’s average value (solid gray line) differed from the overall average value (dotted gray line down the center) — I like what I see!
The average blood glucose (BG) for each meter (solid gray line) was pretty close to the overall average (dotted line down the center), with the greatest deviation at around 6% (FreeStyle Lite & Walgreens True 2 Go).
(Compare Chris’ results, where max deviation was 14%.)
This means an estimated A1C calculated based on the average value from any of these meters would be roughly the same.
For example: If your average blood glucose on your meter were 154 mg/dL, that would translate to an estimated A1C of 7.0%.
- If you arrived at that average using a Walgreens True 2 Go, which appears to consistently report lower values, your actual A1C might be closer to 7.3%.*
- If you arrived at that result using a FreeStyle Lite, which appears to consistently report higher values, you may be pleasantly surprised by an actual A1C of 6.7%.*
I think most of us would agree that this is an acceptable degree of variation between estimated and actual A1Cs.
* Important note: This is just based on the data I collected for the specific meters I had in my possession. I can’t say whether these trends would be true for all meters of any particular brand that I tested.
My Own Experience With Self-Measured BG Averages & A1C
My CGM averages have always been spot-on when it comes to predicting A1C. Last Summer & Fall, I was using the Omnipod PDM FreeStyle meter (same one tested here) to measure my blood glucose values & calibrate my Dexcom CGM.
For the past 3 months, I’ve been on MDI and using a Freestyle Lite to calibrate my CGM. Right before my latest A1C (~1 week ago) Dexcom’s 30-day average showed 117 mg/dl, which correlates to an A1C of 5.7%. My lab-measured A1C was 5.8%.
And this is pretty much how it’s always been for me. Not the A1Cs — I wish! — but the match between estimates and actuals. 😉 I’ve never had any reason not to trust my BG meter readings, because the results always lined up.
BUT I do want to take some time now to explain that even if the numbers don’t line up, it doesn’t necessarily mean your meter is to blame…
READ: Why Doesn’t My Average Blood Glucose Match My A1C?!
What about the post that started all this? Why were those results so off?
Well, the truth is, I don’t know. I actually own the meter that Chris uses, OneTouch UltraLink — I used it for ~4 years back when I was on a Minimed pump.
Unfortunately, I didn’t have it with me at the time of this experiment, but I’ve tested with it a bit recently, just to see… And the results are generally within 10 mg/dL of my FreeStyle Lite readings!
So, I’m not sure why Chris’ results were so different. He’s been using his OneTouch UltraLink for about 7 years, and mine only got about 4 years of use before being carefully stored at my parents place with all my other diabetes “antiques.” I wouldn’t be surprised if after a significant amount of wear, these things just don’t work as well. However, that doesn’t explain why some of the other meters also deviated significantly from the mean glucose value…
It may be the test strips…
GM Consensus Statement, Endocr Pract. 2016;22(No. 2) The FDA requires that all new meters meet particular standards (shown here in Table 7), but once a meter is approved, the FDA does nothing to monitor accuracy. This is significant because, although the meters may have functioned perfectly when approved by the FDA, that was with a particular set of test strips.
Test strips can vary from batch to batch.
Test strips contain an enzyme that converts glucose into an electrical current that runs through the test strip and is read and displayed on your meter as a glucose concentration.
Enzymes are proteins and can breakdown due to humidity, temperature, and many other factors. So, differences in the environment in which the test strips are manufactured, stored, and used can lead to differences in the blood glucose measurements they provide.
Those differences may be OK — the blood glucose values provided by these strips may still fall within the FDA’s standards — but, when we are comparing one batch of strips to another, things can get hairy…
For example, suppose one batch of test strips yields BG readings that are 10% too high, and another batch (for a different meter, by a different manufacturer, or even for the same meter by the same manufacturer) yields readings are 10% too low.
Even though each of these batches of strips might have an acceptable difference from the true BG value, there is a 20% discrepancy (bias) between them. The differences could be clinically significant, especially when combined with a 7% random error on top of the 10% systemic bias.
So, where does this leave us?
More testing should be done! I feel pretty good about meter accuracy based on my own experiment and personal experience, but I’d feel even better if more people conducted similar experiments and got similar results.
Results like Chris’ are scary — they make us feel like no matter how hard we try we may still be missing the mark. And the consequences go beyond the emotional toll — meter and test strip inaccuracy may lead to results that fool us into thinking everything is A-OK, when it’s really not.
Bottom line: we need to be able to trust the devices we use to make critical decisions about our health every day. If meter accuracy really is an issue, it needs to be addressed right away.
The Best Blood Sugar Monitors to Help You Manage Diabetes
- Strips and Lancets Compatibility Some blood sugar monitors use proprietary strips, while others are compatible with different kinds. Take the time to look at the costs and availability of these accessories when comparing blood sugar monitors.
- Portability If you’re prone to testing your sugar levels while out and about, a compact blood sugar monitor is a good choice, although they can be difficult to operate if you have dexterity issues. Some models can hold multiple test strips, but those tend to be bulkier.
- Ease of Use Some monitors are easier to operate than others. Some feature a large display screen, while others require very little blood for testing. For those who test frequently, blood sugar monitors with test readouts of five seconds or less offer convenience.
- Memory Function Look for blood sugar monitors that store at least 360 readings to best track and manage your blood sugar. Some models even allow you to note if a reading was taken before or after a meal or exercise.
- Audible Results For those with visual impairments, audible blood sugar monitors allow for easy monitoring of blood sugar levels.
- Insurance Coverage Always check with your insurance company to see if it will cover a specific unit, as well as how many test strips and needles are included in your coverage each year.
Just how much does a blood sugar monitor cost? You can find units priced anywhere from about $10 up to $75 or more, depending on accuracy, size, and available features. What’s more important than the cost of the monitor, however, is the cost of testing strips and lancets, which can add up to hundreds or even thousands of dollars in annual expenses.
Check out our five picks for the best blood sugar monitors.
10 Best Glucose Meters
– February 2020
Make sure the strips are fresh: It’s important that the test strips that you use to collect blood samples are fresh so that they will give accurate readings. There will be an expiration date on the box of test strips, and it is recommended to use the test strips within 3-6 months after opening the package. Many glucose meters, such as the iHealth Smart glucose meter, will scan your glucose test strips, and display their expiration date. For this reason, it’s advised to use the test strips that are compatible with your glucose meter.
Blood sample size: When glucose meters were first introduced, they required a large drop of blood for an accurate reading. Most meters now will suffice with a blood sample under 1 microliter. It’s preferable to use a glucose meter that can give accurate results with even a small sample size. The Abbott FreeStyle Lite can give accurate results with just 0.3 microliters of blood! Many companies’ meters or phone apps will indicate to you that the sample size was okay.
Wireless and Bluetooth connectivity: There are glucose meters that allow you to upload results to your Smartphone or tablet. Many companies have developed phone apps to use in conjunction with their glucose meter. For example, the iHealth Align glucose meter has an app (“iHealth Gluco-Smart”) for Apple iOS devices, as well as Android smartphones. That way, you can share results with your doctor immediately. The results can be presented as an Excel spreadsheet, a .pdf, or .csv file. There is also the iHealth Smart, which sends the results wirelessly from the glucose meter to your cellular device via Bluetooth.
Tracking results: It’s important to monitor your blood glucose levels over a long time. A glucose meter should store a minimum of 100 readings, that you can show your health professional. This will allow you to chart your response to changes in diet or medication, as well as seeing the benefits of exercise. The True Metrix Air Glucose Meter is able to store 1000 results along with the time and date that the reading was taken. It is also capable of averaging results over 7, 14, 30, 60, and 90 days. (That’s the upper limit on blood glucose level data because red blood cells are refreshed every 90 days.) And there are phone apps, such as iHealth Smart, that integrate information about your meals, treatments, and activities together with the blood readings.
Portability: Some companies have made very impressive strides in creating a very compact, portable glucose meter. One example is the iHealth Align, a device around the size of a quarter(!), which plugs into your Smartphone or iPhone. You use the lancing device to get a drop of blood, which you place on the testing strip. You’ll see the results displayed on your portable device within 5 seconds!
The iHealth Align Glucose Meter, being inserted into a Smartphone’s headphone jack, and being used to take a reading
Glucose meters that provide other information: Some glucose meters can display insulin levels and ketone levels as well. (The ketone levels in the blood are also indications of not enough insulin to properly process sugars.)
Comparison of Five Glucose Meters for Self-Monitoring of Blood Glucose by Diabetic Patients
This study collected data regarding the accuracy of five currently marketed meters for home use of self-monitoring of blood glucose (SMBG). Data regarding ease of operation of each glucose meter as well as cost and availability of meters and necessary materials were compiled. Fasting blood glucose (BG) samples were drawn from patients in the adult and pediatric diabetes clinics at the University of Kansas College of Health Sciences and Hospital. Specimens were tested by a clinical laboratory as well as by each meter. Unadjusted meter readings of whole BG were plotted against laboratory readings of serum glucose and displayed in scattergrams. Scattergrams showed decreased machine accuracy in upper and lower BG ranges. Whole BG values (meter readings) were adjusted to serum glucose levels by multiplication by 1.12. Adjusted values were compared with laboratory serum values using ANOVA for repeated measures and Dunnett’s Multiple Comparisons Test: ANOVA and Dunnett’s Multiple Comparisons Test showed only Glucochek II (Medistron, Ltd., West Sussex, England; distributed in U.S. by Larken Industries, Lenexa, Indiana) using Dextrostix reagent strips (Ames Division, Miles Laboratories, Elkhart, Indiana) having a statistically significant difference from laboratory values (P < 0.01). This meter was recently revised and may show changed accuracy readings. Each meter exhibited inherent advantages and disadvantages regarding price, calibration, strip utilization, and ease of operation, which must be considered before recommendation by the health care provider.
Diabetes Blog Bytes
It is assumed that glucose meters are accurate if they are FDA cleared, but often that is not the case.
The FDA is currently reviewing and updating the guidelines for glucose meter accuracy. The 2016 rules called for +/- 20% accuracy for most blood sugar ranges. Many diabetes advocacy groups appealed to the FDA to demand better accuracy since treatment decisions are based on these readings and can dramatically impact outcomes.
A research study by The Diabetes Technology Society Blood Glucose System Surveillance Program, found that in a recent analysis, only 6 of the top 18 glucose meters met the accuracy standards. They demonstrated this lack of consistent and accurate readings through extensive testing of the top meters at different sites (see partial chart below, click on chart for full table).
The new 2019 FDA drafted rules for personal use glucose meters will require:
- 95% within +/- 15% across the measuring range
- 99% within +/- 20% across the measuring range
This data and chart created by the Diabetes Technology Society outlines the accuracy of the most common meters. This published information will hopefully result in more accurate meters and better insurance coverage for meters that meet the standards. This information is also critical to share with our diabetes participants and colleagues.
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2016 Blood Glucose Meter Comparisons
Choose Your Blood Glucose Meter Wisely!
These days, there is lots of emphasis on accuracy, particularly when it comes to continuous glucose monitors (and their ability to match blood glucose values) and insulin pumps (and their ability to deliver doses with extreme precision). But let’s not forget about that trusty, dusty blood glucose meter that has been a staple of diabetes management.
Why is meter accuracy so important? For those who take rapid-acting insulin to cover meals and “correct” out-of-range blood sugar readings, accurate readings are necessary for determining the right dose. Inaccurate readings can lead to over- or under-dosing, which can produce dangerously high or low blood sugar results. An inaccurate meter can also cause a person to treat hypoglycemia inappropriately (if the meter reads too low) or miss the need for treatment (if the meter reads too high). And finally, with so many people using CGM systems, proper calibration is a must. The more accurate the fingerstick readings, the better the CGM will perform.
Of course, no meter will provide accurate results if the user fails to use proper technique. That means:
- Making sure the finger (or other test area) is clean
- Using the test strips prior to their expiration date
- Keep the strips sealed in their bottle to prevent exposure to light and humidity
- Applying enough blood to fill the test strip completely.
- Never exposing the strips to extreme hot or cold temperatures.
- Coding the meter (if required)
Our team believes that meters should be within 10% of lab values to be considered accurate.
One of the more important things you can do to ensure accurate results is to choose the right meter. Blood glucose meters vary widely in terms of accuracy. Accuracy is determined by comparing measurements obtained in a laboratory to the results obtained at the same time on the blood glucose meter. For example, if the lab generates a value of 100 mg/dl while the meter generates a reading of 110 mg/dl, there is a 10% difference between the results. If the lab result is 200 and the meter reading is 150, there is a 25% difference.
Our team believes that meters should be within 10% of lab values (or within 10 mg/dl of lab values when in a low range) to be considered sufficiently accurate. The more often a meter falls within 10% (or 10 points) of the lab value, the more reliable it will be.
Almost all meter manufacturers document their meter’s performance in the “specifications” section of the user guide.
The chart below contains the accuracy figures for an assortment of commercially-available blood glucose meters, listed in order of how often they generate readings that are within 10% of lab values. Interestingly, “alternate site” monitoring tends to produce significantly less accurate results than fingerstick monitoring. This is likely due to the “lag time” inherent in alternate site testing – similar to that seen with CGM.
n/a = data not available
* Source: Package insert, User guide, and/or company website
** Source: Freckmann G, et al. System Accuracy Evaluation of 43 Blood Glucose Monitoring Systems for Self-Monitoring of Blood Glucose according to DIN EN ISO 15197. J Diab Sci and Tech. vol 6, issue 5, Sept 2012, 1060-71.
For a printable version: < meter-accuracy-sept-2016 >