Abstract
BACKGROUND: The use of continuous glucose monitors (CGM) in scuba diving for patients with type 1 diabetes (T1DM) shows potential but faces challenges related to accuracy. Previous research has highlighted the poor accuracy of the Dexcom G7 (DG7) in repetitive diving contexts. This study investigates the impact of calibration on the accuracy of DG7, providing valuable insights for patients and clinicians. MATERIALS AND METHODS: In August 2024, 'Diabete Sommerso' organised a 4-day diving cruise around Elba Island (Italy) with 15 participants, including individuals with T1DM. Each participant with diabetes wore two DG7 sensors (one on the arm and one on the abdomen), calibrated daily and compared the results to capillary glucose (Beurer GL50Evo as the reference). Accuracy was assessed using mean absolute relative difference (MARD)/median ARD, Food and Drug Administration (FDA) integrated continuous glucose monitoring (iCGM) criteria and Surveillance Error Grid (SEG) analysis. Hypoglycaemia detection and trends were also evaluated. RESULTS: Eight participants with T1DM completed the study using 16 DG7 sensors with no detachments or skin reactions. Analysis of 765 sensor-capillary glucose pairs during 68 dives showed an overall MARD of 13.7%, with arm sensors (11% MARD) outperforming abdomen sensors (16%, p=0.0001). SEG analysis revealed that more than 97% of readings fell within the no-risk zone; however, the FDA's iCGM criteria for non-adjunctive use were not met. CONCLUSIONS: Calibration improved the accuracy of DG7 in repetitive diving for patients with T1DM. However, capillary glucose checks remain essential, as non-adjunctive criteria were not met.