Diabetes Testing

The Most Accurate Blood Glucose Meter

Credit: Accu-chek.com

The Accu-Chek Aviva was first in an evaluation of a dozen meters conducted by a team of testing experts at Germany’s University of Ulm led by Guido Freckmann, M.D. It led the field in accuracy and precision.

Few studies of meter accuracy have appeared in the more than 20 years that I have been writing about diabetes. Dr. Freckmann and his team of researchers have been the most relevant, reliable, and prolific in testing our meters. But some of the meters that they evaluated aren’t available in the United States.

The leading diabetes journal that evaluates our meters just released the full text of this meter accuracy study. The editors tell me that the study will be free online only until March 31.

Most Relevant Info

So don’t wait too long if you want to review the whole thing. Meanwhile, I summarize below what I think is the most relevant information.

The journal is Diabetes Technology & Therapeutics, and the study is “Evaluation of 12 Blood Glucose Monitoring Systems for Self-Testing: System Accuracy and Measurement Reproducibility.” The journal published it two years ago, but until now only the abstract has been freely available to us.

Dr. Freckmann and his colleagues rated the meters against both the current and proposed standards. The current standard can be met more easily. It requires that at least 95 percent of the results fall within plus or minus 15 mg/dl at blood glucose levels below 75 mg/dl and within plus or minus 20 mg/dl at levels greater than or equal to 75 mg/dl. The International Organization for Standardization (ISO) set this level back in 2003, and it is the standard not only in Europe but also in the United States because the U.S. Food and Drug Administration uses it.

The Tighter Standard

ISO’s 2013 standard is tighter, but is still pending approval both in the U.S. and Europe. To be acceptable at least 95 percent of the results have to be within plus or minus 15 mg/dl at blood glucose levels below 100 mg/dl and within plus or minus 15 percent at blood glucose levels greater than or equal to 100 mg/dl.

Ten of the 12 meters that Dr. Freckmann and his team evaluated met the higher standard. Two meters, which they didn’t name, failed the test. The FDA hasn’t approved six others for sale in the United States.

But four of the five top meters are available in the United States. While the Accu-Chek Aviva got the best score in this evaluation, the Contour XT, sold here as the Contour Next EZ, is the next most accurate and precise meter tested that is available here. Numbers four and five are the GE100 and GE200, also available here.

Dr. Bernstein’s Recommendation

Of course, I am aware that Richard K. Bernstein, M.D., recommends the Abbott FreeStyle Freedom Lite meter as “the most accurate.” He is the author of Dr. Bernstein’s Diabetes Solution and the leading exponent of the very low-carb diet for people with diabetes.

In fact, I tested the Abbott FreeStyle Freedom Lite when it first came on the market. My results were so variable that I immediately threw it away. Now that I’ve read the results of the evaluation by Dr. Freckmann’s team, I’m glad that I still test with one of the Accu-Chek Aviva meters that I started using more than 10 years ago.

This article is based on an earlier version of my article published by HealthCentral.

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28 Comments

  • Reply Diane April 10, 2017 at 4:07 am

    David,

    I went and looked at the study. Just wanted to point out that the Accu-Chek is number one on their charts because it starts with an “A”. Not because it is the most accurate. The meters are listed alphabetically, not by rank!

    Actually the GE200 appears to be the most accurate meter, especially when reading BG concentrations of >100 mg/dL.

  • Reply Rob June 6, 2016 at 3:09 am

    I am having some huge variables with this new Aviva I just picked up. Still looking for more consistent accuracy. Up to about a 9-14% variance. I need accuracy.

  • Reply Clayton May 22, 2016 at 5:11 am

    I recently (3 months ago) was given an Accu-chek Aviva Connect by my endocrinologist. Initially I compared the reslts from the one touch mini that I have used for 8 years and found the results close but not exactly the same. In the last month my numbers have been testing higher and I was beginning to get to the level of concern to call my doctor as to why my medications were no longer effective. At the suggestion of a friend, I tried testing with my OTM at the same time and discovered that the Accu-chek was 40-60 points higher consistently! Do I just have a bad meter? Or is the Accu-chek Connect a bad model? Should I revert to the OTM and give up the convenience of the automatic logging to my phone?

  • Reply Jason W May 21, 2016 at 7:43 am

    I just got the new Accu-chek Aviva connect it’s Bluetooth and you can send the results to your smartphone and you can send/share to whoever you want to and you can also add notes to after each test and it also has a graphs too it’s quite amazing I definitely recommend it.

  • Reply Brennan May 18, 2016 at 9:25 am

    From the research I’ve combed through on PubMed, the Bayer Contour XT/EZ appears to be consistently the best and most accurate meter. The XT/EZ also has the highest ratings for hematocrit compensation, whereas the Freedom Freestyle Lite failed the hematocrit interference test in this study : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC369223

    It’s also worth nothing the Contour Next EZ has relatively cheap test strips – 300 for $64 on Amazon currently. The odd thing is that the other meters in Bayer’s Contour Next line do not fair nearly as well using the same test strips. The Contour Next USB does pretty terrible in some studies.

    In all the studies I could find that tested the Contour Next EZ, it performed at the highest level for both ISO 2013 conformance and Mean Absolute Relative Difference compared to the Yellow Springs Instruments analyzer.

    Another study showed the lowest MARD value for real-life conditions on the contour Next EZ.

  • Reply Beatrice Flaming May 7, 2016 at 9:37 am

    History on Dr. Bernstein’s switch from recommending Accu-chek Aviva to Freestyle Freedom Lite – our government (US) mandated that test strips be changed because of a medical condition a few folks have (can’t remember the name). The strips were not accurate for folks with that condition. When the new mandated strips came out (if you use Accu-chek, you may remember when the strip container changed sometime between 2011 and 2013 – can’t remember exactly when), Dr. Bernstein found that his Accu-chek was no longer so accurate. He tests all meters against a meter used by doctors that uses a different method and it is quite costly, though I know at least one of the folks from his forum bought one and tested against it). Dr. B encouraged all folks who listened to his webinar to do a testing procedure which he described for us. He wanted to convince the company that the new strips were not accurate and to improve the strips. In the meantime he discovered the German study about meters and the only ones with tight accuracy (which is what he is after) is the Freestyle meters, though the Lite is most accurate. Here is a link to the study: http://dst.sagepub.com/content/6/5/1060.full.pdf
    He got and tested the Freestyle himself and found it most accurate.
    Hope this helps. 🙂

  • Reply Marcus Valdes April 19, 2016 at 1:53 pm

    Has anyone else noticed that the Aviva Connect chews through batteries? I guess all that “wireless” comes at a battery cost.

  • Reply Sue T April 11, 2016 at 8:18 am

    I did do that (my poor fingers) and they were all within 3 points, including test strips from different batches. I just wasn’t sure that meant it was accurate….or consistently wrong 🙂
    I chose this meter and strips because of the price of the strips, since I need to pay my own. I saw some that the strips were almost $100 for 100 strips versus my 18 for 100. Shocking prices!!!

  • Reply Sue T April 11, 2016 at 7:55 am

    I’ve been using the TrueResult/TrueTest for a couple of weeks now, including doing the control tests. Each control test with two different solution strngths fell smack dab in the middle of the reading range posted on the strip vial. But since the range is so much (31-61, 92-124, 241-325) how do I know where my BS reading is?

    • Reply David Mendosa April 11, 2016 at 8:02 am

      Not easy, Sue! If you had lots of meters you could compare them and hope that the results that you current meter returns is close to the average. Or you might want to switch to one of the more standard meters, like the Freestyle Lite that Dr. Bernstein recommends or the Accu-Chek Aviva Plus that I use. They are likely to be more accurate. But actually you can at least check the consistency of your current meter, which is likely to be even more important. This check of your meter means taking at least 5 readings as close together as possible and seeing if they come out really close.

  • Reply Salomon King April 11, 2016 at 2:04 am

    I second Tom’s notes which clearly show GE200 more accurate. Further the research above does not includes Abbott’s Freesyle (either lite or Insulinx). Howvever – data posted by Bayer at http://goo.gl/vz9GWV (Competitive Meter Comparison Chart) shows Abbott’s meters (as well as well as Bayer’s) to be more accurate than Accu-Check Aviva (GE200 was not included)

  • Reply Tom Wolff April 8, 2016 at 6:27 pm

    I have not heard back from Bionime about the GE100 & GE200, but further inquiry reveals some differences, #1 the GE200 is only available in Canada and Europe; GE100 in the US.
    GE100 GE200
    # readings in mem 500 1000
    averages calculated 1,7,14,30, 90 days + 60 days
    backlit no? yes.
    downloadable to software yes no?
    control solution levels 1 2

  • Reply Tom Wolff April 8, 2016 at 6:20 pm

    I have not heard back from Bionime, but further research about the two top performing meters in the study cited here by David reveals this:
    GE100 GE200
    Memory (# of readings) 500 1000
    Averages 1,7,14, 30, 90 plus 60 days
    Displays mg/dL mmol/L (I don’t know if they can be switched—I would think so, but no mention in settings. Oddly the diagram of the screen in the User
    Manual for the GE200 shows mg/dL—a mistake, I believe.)
    Backlight No? Yes.
    Downloadable to
    Software Yes. No? (However it only works on Windows 7, I think—not 8, 10 or Mac. Cable costs $19.95)
    Control solution 1 level 2 levels

    In the one study I saw which had both, the GE200 seemed to have somewhat better results.

  • Reply Sue T April 3, 2016 at 1:20 pm

    Anyone heard of/tried TruTest?

    Anyway, why is it their is such a fluctuation on accuracy of these things? These ARE medical devices; isn’t their accuracy of utmost importance?

    Interestin (ok, that’s subjective) back when I was on Atkins, but had not yet been diagnosed as diabetic, I used Accu-chek to see how foods affected me so I’d stay in ketosis. Even then, going through on Amazon for purchases, the ratings of various meters hovered around 3 star. Even the priciest meters & strips had negative reviews due to inaccuracy. Is there something about glucose meters that just “can’t be fixed” so that all readings are 100% accurate?

    • Reply David Mendosa April 3, 2016 at 2:16 pm

      Good question, Sue. Our meters can be more accurate, although no medical devices of this type can be perfectly accurate. What’s holding back the accuracy is the low government standards. That can be fixed and promises to get somewhat better in a few years. But I’m not holding my breath.

  • Reply Sherry Masser April 3, 2016 at 12:58 pm

    David, which Aviva meter do you use. I saw three different models at the pharmacy.
    Thanks

  • Reply Steve April 2, 2016 at 7:35 am

    I must agree with Tom above. The Aviva may have been placed at the top of the chart, but the numbers from some of the others are much better.

  • Reply Tom Wolff April 1, 2016 at 1:58 pm

    The ReliOn Prime meter is made by Arkray, who also provide the cable ($35 extra). The ReliOn FastA!c tests, previously made by Bayer (A1c Now), are less accurate in my experience than those from DTI ( http://www.dtilaboratories.com/accubase-a1c-test-kit.html about $33 depending on how many you buy), or LabCorp (EconoLabs.com, “HA1c” $28–don’t pay $7 extra for MBG), but do cost less, and are more convenient. I would add 0.2% to the DTI tests and subtract 0.3% from the LabCorp. The former Bayer A1c Now is all over the map, plus/minus 0.5%, in my experience with multiple comparisons, and referring to my own reading history (hundreds over various time periods 7, 15, 30, 60, 90, 120 days).

  • Reply Tom Wolff April 1, 2016 at 1:45 pm

    I do not understand your conclusion that the Accu-Chek Aviva is the winner of that study. I printed out the article, carefully looked at the data, and to me, if I had to pick one winner, it would be the GE200. If you look at the Table 2 System Accuracy data, below 75 mg/dL the % plus/minus 5 mg/dL is highest for the GE100 at 95, the GE200 at 71. Above 75 the GE 200 is at 81 highest. Looking right at the above and below 100 mg/dL numbers, within 5 mg/dL, the GE 200 is the unambiguous winner. Despite Roche’s sponsorship, their meter is NOT the winner, by any reading of the data. Here is another study (only five meters w/out the GE ones), in which the Aviva was 2nd:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876374/ to the Contour EZ Next (same as the Contour XT), but sponsored by Bayer, maker of the Contour. In my own studies of meters using my own blood vs. the Hemocue, I liked the Bionime GM100 & GM550, the Contour Next meters, and the ReliOn Prime (from Wal-Mart, but only that model). Despite Bernstein, the Abbott meters tested poor. I use a Contour USB Next, myself. The spec’s on the GE100 seem similar to the Bionime GM550. I have an inquiry in to Bionime about how those GE meters compare to their GM model numbers.

  • Reply Stephen Klinger April 1, 2016 at 10:20 am

    I have been using an AccuChek Aviva for years and have found that small blood samples, especially from my pinkie, for some reason, tend to produce outlying readings, compared to large samples from other fingers. I try not to touch the skin when collecting the sample.

    Medicare gives me fits about getting enough test strips to test four times a day, which I prefer to do (and it really saves the government money in the long run, as it gives me better control, and hopefully helps avoid complications). I have to fill out a log and submit it to my endo, who says he doesn’t know what to do with it. In any case, he has to inform Medicare about every six months that yes, I do need four strips I day.
    I mention all this only to say that I bought a ReliOn meter from Walmart so I could keep their much, much cheaper strips on hand in case I run out of AccuChek Aviva Plus strips. But I notice readings from the ReliOn meter seem to be wildly dissimilar to what I get from the AccuChek—sometimes 30 or 40 points. I wonder if you have any comments about the ReliOn meter or any idea if it was made by one of the two companies not named that failed the test. Thanks!

    • Reply David Mendosa April 1, 2016 at 11:56 am

      I haven’t been able to find out who makes Walmart’s ReliOn blood glucose meter, Stephen. I do know that that its ReliOn Fast A1C test is exactly the same product as the standard one that I have been using regularly for years.

  • Reply jdm March 27, 2016 at 9:15 am

    I have used a OneTouch Ultra Smart for many years. It always seemed consistent and reliable with occasional way-too-low readings which are resolved with a re-test.

    Then, I bought an Accu-Chek Go. It seemed to be garbage. Readings were all 5 – 45 points above the OT, average about 30! Discarded.

    Next, I saw some test results and got a FreeStyle Lite. It appeared to be nonsense, too. Always higher than the OT, averaging 11% higher and more erratic (my BG is pretty predictable).

    I was about to throw it, too, when I read something about wiping the first drop and using a second. Well, I haven’t tried THAT, but I did notice that since the FS requires such a TINY sample that I wouldn’t squeeze out much blood and the test strip usually touched my skin inside the drop.

    SO, I started making bigger drops and just touching the strip to the crown of the drop far from the skin. Day and night!

    The FreeStyle was still almost always higher, but now the percentage difference was WAY down. It was very close to the OT. The average percent above for the next ten tests was down from 11.5 for the 40 tests before I changed methods to 2.6 after. Oddly, the OneTouch is no affected by the strip touching the skin which the FreeStyle is in a big way.

    My point is, when sources say a meter is very accurate and you don’t find that at all, before throwing it you might want to look into unexpected factors like this.

  • Reply David Mendosa March 25, 2016 at 7:40 am

    I’m not familiar with that meter, Sue. Sorry.

  • Reply Marie March 25, 2016 at 7:08 am

    Hi! What about the Accu-check Performance Nano?

  • Reply Sue T March 24, 2016 at 9:37 pm

    As it was not part of the experiment, I was wondering if you had any experience with or opinion of the Accu-check Active ? The strips seem much more cost effective….but only if they work, of course.

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