(197 days)
The Lingo Glucose System is an over-the-counter (OTC) integrated Continuous Glucose Monitor (iCGM) intended to continuously measure, record, and display glucose values in people 18 years and older not on insulin. The Lingo Glucose System helps to detect euglycemic glucose levels. The Lingo Glucose System may also help the user better understand how lifestyle and behavior modification, including diet and exercise, impact glucose excursion.
The user is not intended to take medical action based on the device output without consultation with a qualified healthcare professional.
The Lingo Glucose System (also referred to as 'System') is Abbott's latest biowearable evolution in health technology for glucose measurement. This system encourages users 18 years and older not on insulin, to understand how glucose impacts their body. The Lingo Glucose System includes the Lingo Glucose Biosensor and the Lingo App.
Lingo Biosensor: The Lingo Glucose Biosensor hardware and technology is based on the FDA-cleared FreeStyle Libre 2 (FSL2) sensor (K222447). The Biosensor is a single use disposable on-body Biosensor that incorporates a subcutaneously implanted electrochemical glucose sensor and associated electronics. The Biosensor can be worn for up for 14 days and transmits data to the Lingo App via Bluetooth Low Energy (BLE). Similar to the predicate device, a disposable Biosensor insertion device, consisting of a Biosensor Applicator and Biosensor Pack is used to assemble and apply the Biosensor to the back of the user's upper arm.
Lingo App (iOS): When downloaded on a compatible smartphone running on iOS, the Lingo App uses Near-Field Communication (NFC) to start a new Biosensor and uses BLE to receive glucose data from the Biosensor. The user can view real-time glucose value, trend arrow, and glucose graph on the app through a glucose range of 55-200 mg/dL. The Lingo App contains on-boarding materials with a self-selection questionnaire that a user must consent prior to using the device. The App does not provide any glucose or system alerts.
The Lingo Glucose System (K233655) is an over-the-counter (OTC) integrated Continuous Glucose Monitor (iCGM) intended for continuous measurement, recording, analysis, and display of glucose values in people 18 years and older not on insulin. It aims to help users detect euglycemic and dysglycemic glucose levels and understand the impact of lifestyle modifications on glucose excursions.
Here's an analysis of its acceptance criteria and the study used to demonstrate fulfillment:
1. Table of Acceptance Criteria and Reported Device Performance
The FDA clearance relies on the substantial equivalence of the Lingo Glucose System to its predicate device, the FreeStyle Libre 2 Flash Glucose Monitoring System (K222447). The clinical performance acceptance criteria for the Lingo Glucose System are tied to meeting the iCGM special controls requirements per 21 CFR 862.1355. While specific numerical acceptance criteria for accuracy (e.g., MARD percentage) are not explicitly stated in the provided text, the documentation states that the device demonstrated accuracy (clinical performance) meeting these iCGM special controls.
| Acceptance Criteria Category | Specific Criteria (Inferred from iCGM Special Controls & document) | Reported Device Performance (Lingo Glucose System) |
|---|---|---|
| Clinical Performance (Accuracy) | Meets iCGM special controls requirements per 21 CFR 862.1355 for glucose accuracy. | Statistical analysis confirmed the device met all specified criteria for glucose data accuracy, supporting compliance with iCGM special controls. (Leveraged clinical data from FSL2 study K222447). |
| Sterility | Meets ISO11137-1 and ISO 11137-2 for electron beam sterilization. | Applicable from predicate FSL2 sensor due to design similarities; predicate met these standards. |
| Shelf-Life, Packaging Integrity, Shipping | 9-month shelf life with storage temp 2°C - 28°C and humidity 10-90% RH non-condensing. | Same as predicate (9 months shelf life, same storage conditions). No additional testing required due to shared design and manufacturing. |
| Electrical Safety | Compliance with IEC 60601-1: 2005(r)2012, IEC 60601-1-6:2010+A1:2013, and IEC 60601-1-11:2015. | Demonstrated compliance for the Biosensor. |
| Electromagnetic Compatibility (EMC) | Withstands electromagnetic interference and emissions (IEC 60601-1-2, IEC CISPR 11). Wireless coexistence with other devices (FDA Guidance, AAMI TIR69, ANSI C63.27). Compliance with FCC Regulations and FAA Advisory Circular RTCA DO-160. | Testing performed; the system is able to withstand EMI/emissions, performs within limits with other devices, and demonstrated compliance with FCC and FAA regulations. |
| Mechanical Engineering | Mechanical, electrical, and functional testing meet acceptance criteria. | Test results showed that mechanical, electrical, and functional testing all met the acceptance criteria. |
| Biocompatibility | Evaluation in accordance with ISO10993-1 and FDA Guidance "Use of International Standard ISO 10993-1..." | Applicable from predicate device due to identical user-contacting materials. |
| Software Verification & Validation | Compliance with established specifications and IEC 62304; documentation per FDA Guidance. | Results met acceptance criteria, supporting that software is acceptable for intended use. |
| Cybersecurity | Risk management documentation per FDA Guidance, including analysis of confidentiality, integrity, availability; appropriate risk mitigation. | Cybersecurity risk management documentation provided; risk assessment performed; appropriate controls implemented and tested. |
| Human Factors | Risk analysis of design differences with predicate and Lingo App per ANSI/AAMI/IEC 62366, IEC 60601-1-6, and FDA Guidance. | User interface found to be adequately designed for intended users, uses, and environments. |
2. Sample Size Used for the Test Set and Data Provenance
The Lingo Glucose System leverages the clinical data from the FreeStyle Libre 2 (FSL2) study (K222447). The text states: "Abbott conducted a statistical analysis to confirm that the clinical data of the FSL2 System (submitted under K222447) can be leveraged to support the Lingo Glucose System."
- Sample Size for Test Set: Not explicitly stated for the FSL2 study in this document.
- Data Provenance: Not explicitly stated in this document. Based on typical FDA submissions for iCGM devices and considering the predicate device (FreeStyle Libre 2), these trials are generally prospective and multi-center, often involving participants from various healthcare systems or regions.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
This information is not provided in the given text. For iCGM studies, ground truth is typically established by laboratory reference methods (e.g., YSI glucose analyzer) rather than expert consensus on images or clinical assessments.
4. Adjudication Method for the Test Set
This information is not provided in the given text. Again, for iCGM studies, the reference method provides the ground truth, so expert adjudication methods (like 2+1 or 3+1 used in imaging studies) are typically not applicable to the establishment of the ground truth itself.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
An MRMC study is not applicable to this device. The Lingo Glucose System is a continuous glucose monitor (CGM) and does not involve human "readers" interpreting medical images or data in a way that would necessitate an MRMC analysis of AI assistance. Its primary function is direct glucose measurement.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done
Yes, the clinical performance assessment of the Lingo Glucose System (by leveraging the FSL2 data) effectively represents a standalone algorithm performance study relative to the reference glucose measurements. The "system accuracy was demonstrated to meet the iCGM special controls requirements." The device continuously measures and reports glucose values, which is an algorithmic output compared against a reference standard. The user interacts with the app to view these values, but the core accuracy is an algorithmic function.
7. The Type of Ground Truth Used
The ground truth for iCGM devices is almost universally established by laboratory reference methods for glucose measurement, such as a YSI glucose analyzer, from blood samples drawn contemporaneously with the interstitial fluid measurements. The text refers to "clinical data" and "sensor performance," implying a comparison against such a gold standard.
8. The Sample Size for the Training Set
The document does not explicitly state the sample size for the training set. It mentions that "ADC Glucose Algorithm established for the predicate device" is used for the Lingo Glucose System. The development and training of such an algorithm would have involved a substantial dataset, but the specifics are not detailed here.
9. How the Ground Truth for the Training Set Was Established
The document states that the "ADC Glucose Algorithm established for the predicate device" is used. For this type of algorithm, the ground truth for its development (training) would have been established through a combination of:
- Laboratory reference glucose measurements: From blood samples.
- Contemporaneous interstitial fluid readings: From prototype or earlier versions of the sensor.
- Extensive data collection: From a diverse population under various physiological conditions (e.g., different glucose levels, meals, exercise).
This data would be used to develop and refine the algorithm that translates the electrochemical signals from the sensor into accurate glucose readings.
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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the FDA name and title on the right. The symbol on the left is a stylized representation of a human figure, while the text on the right reads "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue letters.
May 29, 2024
Abbott Diabetes Care Inc. Juni Sarkar Associate Director, Regulatory Affairs 1360 South Loop Road Alameda, California 94502
Re: K233655
Trade/Device Name: Lingo Glucose System Regulation Number: 21 CFR 862.1355 Regulation Name: Integrated Continuous Glucose Monitoring System Regulatory Class: Class II Product Code: SAF Dated: November 13, 2023 Received: November 14, 2023
Dear Juni Sarkar:
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 (the 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.
If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.
Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).
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Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).
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 Part 801 and Part 809); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safetyreporting-combination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.
Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.
For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely,
Yiduo Wu -S
for Joshua M. Balsam, Ph.D. Branch Chief Division of Chemistry and Toxicology Devices OHT7: Office of In Vitro Diagnostics Office of Product Evaluation and Quality Center for Devices and Radiological Health
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Indications for Use
510(k) Number (if known) K233655
Device Name Lingo Glucose System
Indications for Use (Describe)
The Lingo Glucose System is an over-the-counter (OTC) integrated Continuous Glucose Monitor (iCGM) intended to continuously measure, record, and display glucose values in people 18 years and older not on insulin. The Lingo Glucose System helps to detect euglycemic glucose levels. The Lingo Glucose System may also help the user better understand how lifestyle and behavior modification, including diet and exercise, impact glucose excursion.
The user is not intended to take medical action based on the device output without consultation with a qualified healthcare professional.
| Type of Use (Select one or both, as applicable) |
|---|
| ------------------------------------------------- |
Prescription Use (Part 21 CFR 801 Subpart D)
X Over-The-Counter Use (21 CFR 801 Subpart C)
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Image /page/3/Picture/0 description: The image shows the logo for Abbott Diabetes Care. The logo consists of a blue, stylized "a" on the left, followed by the words "Abbott" in bold, black letters on the top line, and "Diabetes Care" in smaller, black letters on the bottom line. The logo is simple and modern, and the use of blue and black gives it a professional look.
Lingo Glucose System Traditional 510(k)
510(k) Summary
This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of SMDA 1990 and 21 CFR 807.92.
510(k) Number: K233655
Submitter:
Abbott Diabetes Care, Inc. 1360 South Loop Road Alameda, CA 94502
Applicant Contact: Juni Sarkar
Title: Associate Director, Regulatory Affairs Phone: (510) 322-1076
Correspondent Contact: Naveen Thuramalla Title: Divisional Vice President, Regulatory Affairs and New Medical Sensors Phone: (510) 384-0264
Date Prepared: May 29, 2024
Device Names and Classification:
| Name of Device: | Lingo Glucose System |
|---|---|
| Common Name: | Integrated Continuous Glucose Monitoring System |
| Product Code | SAF |
| Regulatory Section: | 21 CFR 862.1355 |
| Classification: | Class II |
| Review Panel: | Clinical Chemistry |
Predicate Device
Predicate Device: FreeStyle Libre 2 Flash Glucose Monitoring System (K222447)
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Image /page/4/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized "a" in blue on the left, followed by the words "Abbott" in bold black font and "Diabetes Care" in a smaller, regular black font. The logo is simple and professional, and it is likely used to represent the company and its products.
Indications for Use:
Indications for Use:
The Lingo Glucose System is an over-the-counter (OTC) integrated Continuous Glucose Monitor (iCGM) intended to continuously measure, record, analyze and display glucose values in people 18 years and older not on insulin. The Lingo Glucose System helps to detect euglycemic and dysglycemic glucose levels. The Lingo Glucose System may also help the user better understand how lifestyle and behavior modification, including diet and exercise. impact glucose excursion.
The user is not intended to take medical action based on the device output without consultation with a qualified healthcare professional.
Device Description
The Lingo Glucose System (also referred to as 'System') is Abbott's latest biowearable evolution in health technology for glucose measurement. This system encourages users 18 years and older not on insulin, to understand how glucose impacts their body. The Lingo Glucose System includes the Lingo Glucose Biosensor and the Lingo App.
Lingo Biosensor
The Lingo Glucose Biosensor hardware and technology is based on the FDA-cleared FreeStyle Libre 2 (FSL2) sensor (K222447). The Biosensor is a single use disposable on-body Biosensor that incorporates a subcutaneously implanted electrochemical glucose sensor and associated electronics. The Biosensor can be worn for up for 14 days and transmits data to the Lingo App via Bluetooth Low Energy (BLE). Similar to the predicate device, a disposable Biosensor insertion device, consisting of a Biosensor Applicator and Biosensor Pack is used to assemble and apply the Biosensor to the back of the user's upper arm.
Lingo App (iOS)
When downloaded on a compatible smartphone running on iOS, the Lingo App uses Near-Field Communication (NFC) to start a new Biosensor and uses BLE to receive glucose data from the Biosensor. The user can view real-time glucose value, trend arrow, and glucose graph on the app through a glucose range of 55-200 mg/dL. The Lingo App contains on-boarding materials with a self-selection questionnaire that a user must consent prior to using the device. The App does not provide any glucose or system alerts.
Substantial Equivalence
- A. Predicate Device Name: FreeStyle Libre 2 Flash Glucose Monitoring System
- B. Predicate 510(k) Number(s): K222447
- C. Comparison with Predicate: The similarities and differences between the subject and the predicate device are highlighted in the tables below.
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Image /page/5/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized blue "a" on the left, followed by the text "Abbott" in bold, black letters on the top line. Below "Abbott" is the text "Diabetes Care" in a smaller, non-bold font, also in black.
Table 1: Similarities with the Predicate Device
| Similarities | ||
|---|---|---|
| Predicate Device:FreeStyle Libre 2 Flash Glucose Monitoring System(K222447) | Subject Device:Lingo Glucose System (K233655) | |
| Intended Use | The System is intended to monitor interstitial fluidglucose concentrations and communicate with digitallyconnected devices. | Same |
| Principle ofOperation | Amperometric measurement of current proportional toglucose concentration in interstitial fluid via glucoseoxidase chemical reaction | Same |
| Compatible sensor | FSL2 sensor is compatible with FreeStyle Libre 2 App | SameLingo Biosensor is compatible with the Lingo App |
| Compatibleoperating systemsfor the App | The App is compatible with Android and iOS enabledsmartphones. | SameThe Lingo App is compatible with iOS enabledsmartphones. |
| ClinicalSetting/Sites of Use | Home use | Same |
| Method of SensorActivation | Near Field Communication (NFC) | Same |
| Method of DataTransfer fromSensor | Bluetooth Low Energy (BLE) for glucose data transfer.User-initiated scan via NFC required to display glucosedata | BLE - data automatically transfers without user-initiatedscan (streaming data) |
| Glucose ReadingUpdate Interval | Every 1 minute | Same |
| Real-Time GlucoseInformationDisplayed | Glucose Value, Trend Arrow, and Glucose Graph | Same |
| Sensor Calibration | Factory Calibrated | Same |
| Compatible SensorWarmup time | 1 hour | Same |
| Anatomical Sensorwear locations | Back of the upper arm | Same |
| Similarities | Predicate Device:FreeStyle Libre 2 Flash Glucose Monitoring System(K222447) | Subject Device:Lingo Glucose System (K233655) |
| Glucose CalculationAlgorithm | ADC Glucose Algorithm established for the predicate device | Same |
| SystemComponents | On-body Sensor(User assembles Sensor Applicator and Sensor Containerprior to applying the Sensor) | SameOn-body Sensor(User assembles Biosensor Applicator and BiosensorContainer prior to applying the Biosensor) |
| Compatible Receiver (App or Reader) | Compatible Receiver (App) | |
| OperatingTemperature | 50 °F to 113 °F | Same |
| Biosensor KitStorageTemperature | 36 °F to 82 °F | Same |
| Operating andstorage relativehumidity | 10-90%, non-condensing | Same |
| Biosensor waterresistance | IP27: Can withstand immersion into 3 ft (one meter) ofwater for up to 30 minutes. Protected against insertion ofobjects > 12 mm diameter. | Same |
| Operating andStorage altitude | -1,250 ft (-381 meters) to 10,000 ft (3,048 meters) | Same |
| Radio Frequency | 2.402-2.480 GHz BLE; GFSK; 0 dBm EIRP | Same |
| Differences | ||
| Predicate Device:FreeStyle Libre 2 Flash Glucose MonitoringSystem (K222447) | Subject Device:Lingo Glucose System (K233655) | |
| Indications for Use | The FreeStyle Libre 2 Flash Glucose MonitoringSystem is a continuous glucose monitoring (CGM)device with real time alarms capability indicated forthe management of diabetes in persons age 2 andolder. It is intended to replace blood glucose testingfor diabetes treatment decisions, unless otherwiseindicated.The System also detects trends and tracks patternsand aids in the detection of episodes ofhyperglycemia and hypoglycemia, facilitating bothacute and long-term therapy adjustments.Interpretation of the System readings should bebased on the glucose trends and several sequentialreadings over time.The System is also intended to autonomouslycommunicate with digitally connected devicesincluding automated insulin dosing (AID) system.The System can be used alone or in conjunctionwith these digitally connected devices for thepurpose of managing diabetes. | The Lingo Glucose System is an over-the-counter (OTC)integrated Continuous Glucose Monitor (iCGM) intendedto continuously measure, record, analyze and displayglucose values in people 18 years and older not on insulin.The Lingo Glucose System helps to detect euglycemic anddysglycemic glucose levels. The Lingo Glucose Systemmay also help the user better understand how lifestyle andbehavior modification, including diet and exercise, impactglucose excursion.The user is not intended to take medical action based onthe device output without consultation with a qualifiedhealthcare professional. |
| Availability to user | Prescription use only | Over the counter |
| Primary display device | FreeStyle Libre 2 Reader or FreeStyle Libre 2 App | Lingo App |
| Glucose MeasuringRange | 40 to 400 mg/dL | 55 to 200mg/dL |
| Differences | ||
| Predicate Device:FreeStyle Libre 2 Flash Glucose MonitoringSystem (K222447) | Subject Device:Lingo Glucose System (K233655) | |
| Sensor Life | Up to 15 days | Up to 14 days |
| Glucose Alarms | Optional Alarms: Low Glucose and High GlucoseMandatory Alarms: Urgent Low | There are no alarms for the Lingo Glucose System |
| Location of glucosealgorithm | Receiver (Reader or App) | Biosensor |
| BLE TransmissionRange | 20 feet unobstructed | 33 feet unobstructed |
| Clinical Application | Management of diabetes mellitus | The Lingo Glucose System is to encourage users tounderstand the correlation between their glucose valuesand their nutrition, exercise and daily activities. |
| Intended UsePopulation | Persons with diabetes age 2 years and older | The Lingo Glucose System is intended for users 18 yearsand older not on insulin |
| Situations WhereFingerstick Test isRequired to ConfirmSensor Reading(Adjunctive Use) | • The user's symptoms do not match the glucosevalues displayed by the device.• The device does not show a glucose value• During the first 12 hours of wear during which thecheck blood glucose icon is displayed | The Lingo Glucose System does not require fingersticktesting based on the intended use of the device. |
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Image /page/6/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized blue "a" on the left, followed by the text "Abbott" in bold black font on the top line and "Diabetes Care" in a smaller, regular black font on the second line. The logo is clean and professional, suggesting a focus on healthcare and technology.
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Image /page/7/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized blue "a" on the left, followed by the text "Abbott" in bold black font on the top line and "Diabetes Care" in a smaller, regular black font on the second line. The logo is clean and professional, suggesting a focus on healthcare and technology.
Table 2: Differences with the Predicate Device
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Image /page/8/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized blue "a" on the left, followed by the words "Abbott" in bold, black letters on the top line, and "Diabetes Care" in a smaller, non-bold font on the second line. The logo is simple and professional, and the colors are clean and modern.
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Image /page/9/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a blue, stylized letter "a" on the left, followed by the text "Abbott" in bold, black letters on the top line. Below "Abbott" is the text "Diabetes Care" in a smaller, non-bold font, also in black.
Comparison of Technological Characteristics with the Predicate Device
The Lingo Glucose System provides the user with real-time glucose measurements between the range of 55-200 mg/dL. Identical to the predicate FSL2 sensor (K222447), the Lingo Glucose Biosensor is designed to measure glucose levels in the user's interstitial fluid through an amperometric electrochemical sensor component. The sensor tail is inserted into the subcutaneous tissue and generates an electrical current via the oxidation of glucose from the interstitial fluid. The real-time glucose measurements are calculated by the Biosensor software and transmit the glucose results to the App through Bluetooth Low Energy (BLE) technology.
At a high level, the subject and predicate devices are based on the same technological elements for glucose measurement and the same glucose calculation algorithm.
Summary of Performance Testing
The following performance characteristics were confirmed to support substantial equivalence:
- Sterility Based on design similarities between subject Lingo Glucose Biosensor and ● predicate FSL sensor, electron beam sterilization of the Sensor Applicator, which contains the introducer needle and sensor tail, performed on the predicate FSL2 per ISO11137-1 and ISO 11137-2 is applicable to the subject device.
- Shelf-Life, Packaging Integrity, and Shipping - The Lingo Biosensor Kit, including the Biosensor Applicator and Biosensor Pack contained within, has the same shelf life (9 months) as the predicate FreeStyle Libre 2 Sensor Kit and associated contents. This established shelf-life is substantiated to support a storage temperature range of 2°C - 28°C and a humidity range of 10 - 90% RH non-condensing. The predicate FreeStyle Libre 2 Sensor Kit and proposed Lingo Biosensor Kit share the same design and manufacturing process. Therefore, testing used to support the 9-month shelf life of the predicate remains applicable for the Lingo Biosensor Kit, and no additional testing is required.
- Electrical Safety The basic safety and essential performance of the Biosensor of the ● FreeStyle Libre 3 System was conducted to demonstrate compliance to IEC 60601-1: 2005(r)2012, IEC 60601-1-6:2010+A1:2013, and IEC 60601-1-11:2015.
- Electromagnetic Compatibility - Electromagnetic compatibility (EMC) testing was performed for the Lingo Glucose System to verify that the system is able to withstand the electromagnetic interference and emissions in compliance with IEC 60601-1-2 and IEC CISPR 11. Wireless coexistence testing was performed to confirm that the Patch remains functional and perform within acceptable limits while in the presence of common radiating electronic devices in accordance with FDA Guidance "Radio Frequency Wireless Technology in Medical Devices." The subject device underwent coexistence testing consistent with AAMI TIR69 and ANSI C63.27 and included test challenges from in-band interference sources defined in ANSI C63.27 as well as other expected wireless interference sources from the intended use environment. The Lingo Glucose System also successfully demonstrated compliance with Federal Communication Commission (FCC) Regulations Part 15.225 and Part 15.247, and Federal Aviation Administration (FAA)
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Image /page/10/Picture/0 description: The image contains the logo for Abbott Diabetes Care. The logo consists of a stylized blue "a" on the left, followed by the text "Abbott" in bold black font on the right. Below "Abbott" is the text "Diabetes Care" in a smaller, regular black font.
Advisory Circular RTCA DO-160.
- Mechanical Engineering The subject device underwent performance testing at the System ● level as well as on individual components of the Sensor Applicator. The test results showed that mechanical, electrical, and functional testing all met the acceptance criteria.
- Biocompatibility - Given that the user-contacting material for the Lingo Biosensor (patch mount, adhesive pad, plug components, introducer sharp and sensor component) are identical to those of the predicate, the established biocompatibility evaluation in accordance with with ISO10993-1 and FDA Guidance "Use of International Standard ISO 10993-1, "Biological evaluation of medical devices Part 1: Evaluation and testing within a risk management process," for the predicate is applicable to the Lingo Biosensor.
- . Software Verification and Validation - Software verification and validation testing was conducted in accordance with established specifications and IEC 62304 and documentation was provided as recommended by FDA Guidance "Guidance for the Content of Premarket Submissions for Device Software Functions." Results of executed protocols met the acceptance criteria and therefore support that the Biosensor's embedded software and the Lingo App software are acceptable for its intended use.
- Cybersecurity Abbott has provided cybersecurity risk management documentation for ● the System that includes analysis of confidentiality, integrity, and availability for data, information and software related to the System accordance with FDA Guidance "Cybersecurity in Medical Devices: Quality System Considerations and Content of Premarket Submissions." For each identified threat and vulnerability risk event scenario, risk assessment of impact to confidentiality integrity, and availability was performed and documented within the cybersecurity risk management documentation. Appropriate risk mitigation controls have been implemented and tested.
- Clinical Performance Abbott conducted a statistical analysis to confirm that the clinical ● data of the FSL2 System (submitted under K222447) can be leveraged to support the Lingo Glucose System. Considering that the diabetic subjects experience a higher degree of variability in glucose values with larger fluctuations over the measuring range as compared to healthy individuals, the clinical data collected as part of the FSL2 study under K222447 reflects a worst-case scenario for sensor performance. The subject device calculates glucose information identically to the predicate device. System accuracy was demonstrated to meet the iCGM special controls requirements per 21 CFR 862.1355.
- Human Factors Abbott conducted a risk analysis of the design differences between the ● subject device compared to the predicate device (K222447) and the newly designed Lingo Glucose App in accordance with ANSI/AAMI/IEC 62366, IEC 60601-1-6, and FDA Guidance "Applying Human Factors and Usability Engineering to Medical Devices." The user interface of the Lingo Glucose System has been found to be adequately designed for the intended users, uses, and use environments.
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Lingo Glucose System Traditional 510(k)
Conclusion
The Lingo Glucose System has similar technological characteristics and the same intended use as the predicate device. The differences in indications for use and design have been addressed through risk control measures to provide reasonable assurance of the safety and effectiveness of the Lingo Glucose System. Statistical analysis on glucose data accuracy for the Lingo system confirmed that the device met all specified criteria, which supports that the system meets the iCGM special controls for clinical performance set forth in 21 CFR 862.1355, and provides secure, and reliable glucose readings in accordance with the iCGM special controls. Based on the performance testing and data provided in this pre-market notification, the subject device and predicate device have been shown to be substantially equivalent.
§ 862.1355 Integrated continuous glucose monitoring system.
(a)
Identification. An integrated continuous glucose monitoring system (iCGM) is intended to automatically measure glucose in bodily fluids continuously or frequently for a specified period of time. iCGM systems are designed to reliably and securely transmit glucose measurement data to digitally connected devices, including automated insulin dosing systems, and are intended to be used alone or in conjunction with these digitally connected medical devices for the purpose of managing a disease or condition related to glycemic control.(b)
Classification. Class II (special controls). The special controls for this device are:(1) Design verification and validation must include the following:
(i) Robust clinical data demonstrating the accuracy of the device in the intended use population.
(ii) The clinical data must include a comparison between iCGM values and blood glucose values in specimens collected in parallel that are measured on an FDA-accepted laboratory-based glucose measurement method that is precise and accurate, and that is traceable to a higher order (
e.g., an internationally recognized reference material and/or method).(iii) The clinical data must be obtained from a clinical study designed to fully represent the performance of the device throughout the intended use population and throughout the measuring range of the device.
(iv) Clinical study results must demonstrate consistent analytical and clinical performance throughout the sensor wear period.
(v) Clinical study results in the adult population must meet the following performance requirements:
(A) For all iCGM measurements less than 70 milligrams/deciliter (mg/dL), the percentage of iCGM measurements within ±15 mg/dL of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 85 percent.
(B) For all iCGM measurements from 70 mg/dL to 180 mg/dL, the percentage of iCGM measurements within ±15 percent of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 70 percent.
(C) For all iCGM measurements greater than 180 mg/dL, the percentage of iCGM measurements within ±15 percent of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 80 percent.
(D) For all iCGM measurements less than 70 mg/dL, the percentage of iCGM measurements within ±40 mg/dL of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 98 percent.
(E) For all iCGM measurements from 70 mg/dL to 180 mg/dL, the percentage of iCGM measurements within ±40 percent of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 99 percent.
(F) For all iCGM measurements greater than180 mg/dL, the percentage of iCGM measurements within ±40 percent of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 99 percent.
(G) Throughout the device measuring range, the percentage of iCGM measurements within ±20 percent of the corresponding blood glucose value must be calculated, and the lower one-sided 95 percent confidence bound must exceed 87 percent.
(H) When iCGM values are less than 70 mg/dL, no corresponding blood glucose value shall read above 180 mg/dL.
(I) When iCGM values are greater than 180 mg/dL, no corresponding blood glucose value shall read less than 70 mg/dL.
(J) There shall be no more than 1 percent of iCGM measurements that indicate a positive glucose rate of change greater than 1 mg/dL per minute (/min) when the corresponding true negative glucose rate of change is less than −2 mg/dL/min as determined by the corresponding blood glucose measurements.
(K) There shall be no more than 1 percent of iCGM measurements that indicate a negative glucose rate of change less than −1 mg/dL/min when the corresponding true positive glucose rate of change is greater than 2 mg/dL/min as determined by the corresponding blood glucose measurements.
(vi) Data demonstrating similar accuracy and rate of change performance of the iCGM in the pediatric population as compared to that in the adult population, or alternatively a clinical and/or technical justification for why pediatric data are not needed, must be provided and determined by FDA to be acceptable and appropriate.
(vii) Data must demonstrate that throughout the claimed sensor life, the device does not allow clinically significant gaps in sensor data availability that would prevent any digitally connected devices from achieving their intended use.
(2) Design verification and validation must include a detailed strategy to ensure secure and reliable means of iCGM data transmission to provide real-time glucose readings at clinically meaningful time intervals to devices intended to receive the iCGM glucose data.
(3) Design verification and validation must include adequate controls established during manufacturing and at product release to ensure the released product meets the performance specifications as defined in paragraphs (b)(1) and (b)(2) of this section.
(4) The device must demonstrate clinically acceptable performance in the presence of clinically relevant levels of potential interfering substances that are reasonably present in the intended use population, including but not limited to endogenous substances and metabolites, foods, dietary supplements, and medications.
(5) The device must include appropriate measures to ensure that disposable sensors cannot be used beyond its claimed sensor wear period.
(6) Design verification and validation must include results obtained through a usability study that demonstrates that the intended user can use the device safely and obtain the expected glucose measurement accuracy.
(7) The labeling required under § 809.10(b) of this chapter must include a separate description of the following sensor performance data observed in the clinical study performed in conformance with paragraph (b)(1) of this section for each intended use population, in addition to separate sensor performance data for each different iCGM insertion or use sites (
e.g., abdomen, arm, buttock):(i) A description of the accuracy in the following blood glucose concentration ranges: less than 54 mg/dL, 54 mg/dL to less than 70 mg/dL, 70 to 180 mg/dL, greater than 180 to 250 mg/dL, and greater than 250 mg/dL.
(ii) A description of the accuracy of positive and negative rate of change data.
(iii) A description of the frequency and duration of gaps in sensor data.
(iv) A description of the true, false, missed, and correct alert rates and a description of the available glucose concentration alert settings, if applicable.
(v) A description of the observed duration of iCGM life for the device.