K Number
K052980
Device Name
LIBERTY GLUCOSE CONTROL, MODEL 2120031
Date Cleared
2005-11-30

(37 days)

Product Code
Regulation Number
862.1660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
For in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the Abbott Medisense Optium, Precision, Precision 3, and Precision Xtra Blood Glucose Monitors.
Device Description
The Liberty Glucose Control MID consists of a viscosity-adjusted, aqueous liquid control solution containing a known quantity of qlucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is non-hazardous and contains no human or animal derived materials.
More Information

No
The device description and performance studies focus on the chemical properties and stability of a liquid control solution, with no mention of AI or ML algorithms.

No.
The device is for in vitro diagnostic use to assess the performance of blood glucose monitors, not to treat a medical condition.

No
This device is a control solution used to assess the performance of blood glucose monitors, not to diagnose a medical condition in a patient.

No

The device description clearly states it is a "viscosity-adjusted, aqueous liquid control solution containing a known quantity of glucose," which is a physical substance, not software.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The "Intended Use / Indications for Use" section explicitly states "For in vitro diagnostic use".
  • Device Description: The description details a "control solution" used to "assess the performance of... Blood Glucose Monitors." This is a classic example of an in vitro diagnostic control material used to verify the accuracy of a diagnostic test.

N/A

Intended Use / Indications for Use

The Liberty Glucose Control MID is intended for in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the Abbott Medisense Optium, Precision, Precision 3, and Precision Xtra Blood Glucose Monitors.

Product codes

75 JJX

Device Description

The Liberty Glucose Control MID consists of a viscosity-adjusted, aqueous liquid control solution containing a known quantity of glucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is non-hazardous and contains no human or animal derived materials.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

healthcare professionals and in the home by people with diabetes mellitus

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Tests were performed to verify specific performance characteristics:

  1. Stability (Accelerated and Real-time)
  2. Open Vial
  3. Microbial Stress Stability
  4. Test precision
    Comparison of the performance characteristics, formulation use support the claim of substantial and intended equivalence.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K983504

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 862.1660 Quality control material (assayed and unassayed).

(a)
Identification. A quality control material (assayed and unassayed) for clinical chemistry is a device intended for medical purposes for use in a test system to estimate test precision and to detect systematic analytical deviations that may arise from reagent or analytical instrument variation. A quality control material (assayed and unassayed) may be used for proficiency testing in interlaboratory surveys. This generic type of device includes controls (assayed and unassayed) for blood gases, electrolytes, enzymes, multianalytes (all kinds), single (specified) analytes, or urinalysis controls.(b)
Classification. Class I (general controls). Except when intended for use in donor screening tests, quality control materials (assayed and unassayed) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.

0

NOV 3 0 2005

K05 2980 5. 510(k) Summary

  • According to the requirements of 21 CFR 807.92, the Introduction: following information provides sufficient detail to understand the basis for a determination of substantial equivalence.
  • Liberty Healthcare Group, Inc. Submitter: 10045 S. Federal Highway Port St. Luce, FL 34952
  • John C. Gormley Contact Person: American Biological Technologies, Inc. 940 Crossroads Blvd Sequin, TX 78155 (830) 372-1391 ex. 210 Establishment Registration Number: 1643621
  • Liberty Glucose Control MID Device Name:
  • Single Analyte Control Solution, All Types (Assayed and Common Name: Unassayed)
  • Quality Control Material (assayed and unassayed). Classification Name:
  • Class I per 21 CFR 862.1660 Classification:
  • Product Code: 75 JJX

Panel: Chemistry

Predicate Device: Name: Precision Control Solutions Manufacturer: Abbott Laboratories, Inc. Medisense Products K983504 510(k) No.:

The Liberty Glucose Control MID consists of a viscosity-Device Description: adjusted, aqueous liquid control solution containing a known quantity of qlucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is non-hazardous and contains no human or animal derived materials.

1

  • The Liberty Glucose Control MID is intended for in vitro Intended Use: diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the Abbott Medisense Optium, Precision, Precision 3, and Precision Xtra Blood Glucose Monitors.

Comparison to Predicate Device:

| Characteristic/

AspectPredicate DeviceNew Product
NamePrecision Control SolutionsLiberty Glucose Control MID
510(k), DateK983504, 07/09/1999
Number of
Levels11
AnalytesGlucose/ β-KetoneGlucose
ContainerPlastic bottle with dropper-tipPlastic bottle with dropper tip
Fill Volume3 mL3.6 mL
ColorN/ARed
MatrixBuffered aqueous solution of D-Glucose
and β-hydroxybutyrate, viscosity modifier,
preservatives, and other non-reactive
ingredientsBuffered aqueous solution of D-
Glucose, viscosity modifier,
preservatives, and other non-
reactive ingredients
Indications for
UseUsed to check the performance of
Medisense Blood Glucose and β -Ketone
Systems and can be used for either
glucose or ketone determinationsUsed to check the performance
of Medisense Blood Glucose
Systems only.
Target
PopulationProfessional and home useProfessional and home use

Performance Studies: Tests were performed to verify specific performance characteristics:

    1. Stability (Accelerated and Real-time)
    1. Open Vial
    1. Microbial Stress Stability
    1. Test precision
  • Comparison of the performance characteristics, formulation Conclusion: use support the claim of substantial and intended equivalence.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS) of the United States. The seal features a stylized depiction of an eagle with its wings spread, symbolizing protection and care. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle emblem. The seal is presented in black and white, giving it a formal and official appearance.

Public Health Service

NOV 3 0 2005

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Liberty Healthcare Group, Inc. c/o Mr. John Gormley Vice President Quality Assurance/ Regulatory Affairs American Biological Technologies, Inc. 940 Crossroads Blvd. Seguin, TX 78155

Re: K052980

Trade/Device Name: Liberty Glucose Control MID Regulation Number: 21 CFR 862.1660 Regulation Name: Quality control material (assayed and unassayed) Regulatory Class: Class I Product Code: JJX Dated: October 20, 2005 Received: October 24, 2005

Dear Mr. Gormley:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820).

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Page 2 -

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific information about the application of labeling requirements to your device, or questions on the promotion and advertising of your device, please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (240) 276-0484. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Alberto G
Alberto Gutierrez, Ph.D.

Alberto Gutierrez, Ph.D. Director Division of Chemistry and Toxicology Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

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  1. Indications for Use Statement
    510(k) Number K052980

Liberty Glucose Control MID Device Name:

Indications for Use:

For in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in I of in Vitto diagnound abo (nor or exellitus to assess the performance of the Medisense the home by poople man alabs 3, and Precision Xtra Blood Glucose Monitors.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use X (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division Sign Off

Division Sign-Off

Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K052980