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The Dexcom G6 Continuous Glucose Monitoring System (Dexcom G6 System) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons age 2 years and older.

The Dexcom G6 System is intended to replace fingerstick blood glucose testing for diabetes treatment decisions. Interpretation of the Dexcom G6 System results should be based on the glucose trends and several sequential readings over time. The Dexcom G6 System also aids in the detection of episodes of hyperglycemia and hypoqlycemia, facilitating both acute and long-term therapy adjustments.

The Dexcom G6 System is also intended to autonomously communicate with digitally connected devices, including automated insulin dosing (AID) systems. The Dexcom G6 System can be used alone or in conjunction with these digitally connected medical devices for the purpose of managing diabetes.

The Dexcom G6 Glucose Program Continuous Glucose Monitoring System (Dexcom Glucose Program System) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons 2 years and older.

The Dexcom Glucose Program System is intended to replace fingerstick blood ducose testing for diabetes treatment decisions for persons with diabetes who are not at significant risk of severe hypoglycemia. Interpretation of the Dexcom Glucose Program System results should be based on the glucose trends and several sequential sensor readings over time. The Dexcom Glucose Program System also aids in the detection of episodes of hyperglycemia and hypoglycemia, facilitating long-term therapy adjustments.

The Dexcom Glucose Program System is also intended to autonomously communicate with digitally connected devices. The Dexcom Glucose Program System can be used alone or in conjunction with these digitally connected devices or services for the purpose of managing diabetes.

The Dexcom G6 Professional Continuous Glucose Monitoring System (Dexcom G6 Pro System) is a real time continuous glucose monitoring device indicated for the management of diabetes in persons age 2 years and older in a home environment while under the supervision of a healthcare professional. The Dexcom G6 Pro System is intended to replace fingerstick blood qlucose testing for diabetes treatment decisions. Interpretation of the real-time Dexcom G6 Pro System results should be based on the glucose trends and several sequential readings over time.

The Dexcom G6 Pro System may also be used as a retrospective glucose recording device indicated for assessing glycemic variability in persons age 2 years and older in a home environment while under the supervision of a healthcare professional. Retrospective interpretation of data recorded by the Dexcom G6 Pro System should be conducted solely by a healthcare professional.

The Dexcom G6 Pro System aids in detecting glucose excursions facilitating care plan adjustments. The Dexcom G6 Pro System is also intended to interface with digitally connected devices. The Dexcom G6 Pro System can be used alone or in coniunction with these digitally connected medical devices for managing diabetes or assessing glycemic variability.

The proposed Dexcom G6 CGM System, Dexcom G6 Glucose Program CGM System, and Dexcom G6 Professional CGM System are based on the same physical principles and fundamental design as the predicate for each respective system but includes a modified adhesive patch. The adhesive patch adheres the transmitter holder to the user's body. The Dexcom G6 CGM System, Dexcom G6 Glucose Program CGM System, and the Dexcom G6 Professional CGM System are designed to function as intended with either the proposed or current adhesive patch. The proposed adhesive patch has the same form, fit, and function as the commercial adhesive patch and, from the users' perspective, functions identically.

Dexcom G6 CGM System: The Dexcom G6 Continuous Glucose Monitoring System is an interoperable connected device that measures and displays glucose values for patients with diabetes. The G6 CGM System consists of three main components: a sensor/applicator, a Bluetooth Low Energy (BLE) transmitter, and a BLE enabled display device (receiver and/or mobile application). The sensor is a small and flexible wire, which is inserted by the applicator into subcutaneous tissue where it converts glucose into electrical current. The sensor has an expected wear time of up to 10 days. The transmitter is connected to the sensor and is worn on the body. The transmitter samples the electrical current produced by the sensor and converts these measurements into estimated glucose values (EGV) using an onboard algorithm. The transmitter sends glucose data to the receiver and/or mobile app, which displays the current glucose reading (updated every 5 minutes) and glucose trends. The receiver and/or mobile app also alerts the user when glucose levels are outside of a target zone and when other important system conditions occur. The G6 CGM System is designed to be used alone or in conjunction with digitally connected devices. The G6 CGM System can communicate Estimated Glucose Values (EGV) and other information wirelessly and securely to and from these digitally connected devices.

Dexcom G6 Glucose Program CGM System: The Dexcom G6 Glucose Program Continuous Glucose Monitoring System measures and displays glucose values and trends for patients with diabetes who are not at significant risk of severe hypoglycemia. The system is factory calibrated and provides continuous qlucose readings at five-minute intervals for up to ten days of use. The system consists of a sensor/applicator, a Bluetooth Low Energy (BLE) transmitter, and a mobile CGM software module (app module) that is embedded within a third-party program provider's mobile app (host app).

The sensor is a small and flexible wire, which is inserted by the applicator into subcutaneous tissue where it converts glucose into electrical current. The transmitter is connected to the sensor and is worn on the body. The transmitter samples the electrical current produced by the sensor and converts these measurements into estimated glucose values (EGV) using an onboard algorithm. The transmitter sends glucose data to the app module, which displays the current glucose reading (updated every 5 minutes) and glucose trends. The app module does not include any glucose related alarm or alerts but will alert the user when important system conditions occur.

Dexcom G6 Professional CGM System: The Dexcom G6 Professional CGM System is a continuous glucose monitor that offers an introduction to CGM for users who would benefit from the supervision of their qualified Healthcare Professional (HCP) during early or initial use of CGM.

The G6 Professional CGM System consists of three main components: a sensor/applicator delivery system, a transmitter, and a mobile application (app). The sensor is a small and flexible wire inserted into subcutaneous tissue where it converts glucose into electrical current. The G6 Professional CGM System transmitter is connected to the sensor and is worn on the body. It samples the electrical current produced by the sensor and converts these measurements into glucose readings using an onboard algorithm. The G6 Professional CGM System transmitter's firmware includes an auto-start feature which enables the transmitter to start a session immediately upon attachment of the transmitter to the on-body wearable. The G6 Professional CGM System transmitter can be used as a retrospective CGM data logger, and it can also send real-time estimated glucose values to the G6 Mobile Application. The HCP elects which type of CGM session the patient receives (retrospective vs. real-time). The G6 Professional CGM System transmitter firmware supports a single-use 10-day sensor session per transmitter. The G6 Mobile Application displays the current glucose reading (updated every 5 minutes) and qlucose trends (up to 24 hours) from the transmitter.

This document, a 510(k) Premarket Notification from the FDA, details the equivalence of several Dexcom G6 Continuous Glucose Monitoring (CGM) Systems to previously cleared predicate devices. The core change in the subject devices compared to their predicates is a modified adhesive patch.

Therefore, the acceptance criteria and study proving the device meets these criteria would primarily relate to the performance of the device with this new adhesive patch, demonstrating it does not adversely affect the system's safety and effectiveness.

Based on the provided text, here's a breakdown of the requested information:

1. A table of acceptance criteria and the reported device performance

The document states that the proposed devices performed "according to their respective specifications" and "met their technological and performance criteria which have not changed from the predicate devices." Because the submission is based on substantial equivalence due to a minor change (adhesive patch), specific performance metrics and their acceptance criteria are not explicitly detailed in this summary; rather, the underlying assumption is that the performance remains consistent with the already-cleared predicates.

Therefore, the table would look like this:

For a CGM system, typical performance metrics would include:

• Accuracy (e.g., MARD - Mean Absolute Relative Difference): How close the CGM readings are to reference blood glucose values.
• Time in Range (TIR): Percentage of time glucose readings are within a target range.
• Detection of Hypo/Hyperglycemia: Ability to accurately identify low and high glucose events.
• Sensor Wear Time: The specified duration the sensor can be worn (stated as up to 10 days).
• Alarm/Alert Performance (where applicable): Timeliness and accuracy of alerts.
• Adhesion Performance: Ensuring the new patch maintains the sensor on the body for the intended wear time without causing adverse skin reactions.

However, these specific quantitative criteria are not provided in this 510(k) summary, as the submission focuses on the impact of the adhesive patch change.

2. Sample size used for the test set and the data provenance (e.g., country of origin of the data, retrospective or prospective)

The document mentions that the devices "were verified and validated according to Dexcom's internal design control process." It does not provide explicit details about the sample sizes used in the testing or the specific provenance of the data (country of origin, retrospective/prospective). This level of detail is typically found in the full 510(k) submission, not the summary.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g., radiologist with 10 years of experience)

This information is not provided in the document. For CGM systems, the "ground truth" for glucose values is typically established using a highly accurate laboratory reference method (e.g., YSI analyzer) for blood samples, rather than human expert consensus, as it's a quantitative measurement.

4. Adjudication method (e.g., 2+1, 3+1, none) for the test set

This information is not provided as it's not relevant for device performance evaluation of a CGM system based on quantitative measurements against a reference. Adjudication methods like 2+1 or 3+1 are common in diagnostic image interpretation studies where human expert consensus on image findings serves as ground truth.

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 relevant for AI-assisted image interpretation. This document describes a Continuous Glucose Monitoring (CGM) system, which is a sensor-based medical device that measures glucose levels directly. It is not an AI-assisted diagnostic imaging device, and therefore, an MRMC comparative effectiveness study would not be applicable or performed for this device.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

For a CGM system, the device (sensor + transmitter + algorithm) generates glucose values autonomously. The "human-in-the-loop" is the user who interprets these values for diabetes management. The system is inherently designed to provide standalone glucose readings. The "Estimated Glucose Value (EGV) using an onboard algorithm" indicates standalone algorithmic performance. The document states: "Interpretation of the Dexcom G6 System results should be based on the glucose trends and several sequential readings over time" and the system "aids in the detection of episodes of hyperglycemia and hypoglycemia, facilitating both acute and long-term therapy adjustments."

This confirms that the algorithm provides direct, actionable results, and its performance is evaluated as a standalone system generating glucose values.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

The ground truth for a CGM system is typically established by concurrent blood glucose measurements obtained using a highly accurate laboratory reference method (e.g., YSI glucose analyzer) from venous blood draws. While not explicitly stated in this summary, this is the standard for CGM validation. The device's "Estimated Glucose Values (EGV)" are compared against these laboratory reference values.

8. The sample size for the training set

This document describes a 510(k) submission for a device change (adhesive patch) to existing, cleared devices. The core algorithms (e.g., "Joint Probability Algorithm") are already established and cleared from prior submissions (the predicates). Therefore, specific training set information for the algorithms themselves is not detailed here, as the algorithms are not being fundamentally changed or retrained. The testing mentioned in this document (verification and validation) would be focused on demonstrating that the new adhesive patch does not negatively impact the already-established performance of the system.

9. How the ground truth for the training set was established

As in point 8, the algorithms are inherited from previously cleared devices. For the original development of these algorithms, the ground truth would have been established through extensive clinical studies involving human subjects, where CGM readings were compared against simultaneous, high-accuracy laboratory reference blood glucose measurements. The process would involve collecting paired data points (CGM reading and reference blood glucose) across a wide range of glucose values, physiological states, and patient populations.

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The Dexcom G6 Glucose Program Continuous Glucose Monitoring System (Dexcom Glucose Program System) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons 2 years and older.

The Dexcom Glucose Program System is intended to replace fingerstick blood glucose testing for diabetes treatment decisions for persons with diabetes who are not at significant risk of severe hypoglycemia. Interpretation of the Dexcom Glucose Program System results should be based on the glucose trends and several sequential readings over time. The Dexcom Glucose Program System also aids in the detection of episodes of hyperglycemia, facilitating long-term therapy adjustments.

The Dexcom Glucose Program System is also intended to autonomously communicate with digitally connected devices. The Dexcom Glucose Program System can be used alone or in conjunction with these digitally connected devices or services for the purpose of managing diabetes.

The Dexcom G6 Glucose Program Continuous Glucose Monitoring (CGM) System measures and displays glucose values and trends for patients with diabetes who are not at significant risk of severe hypoglycemia. The system is factory calibrated and provides continuous glucose readings at five-minute intervals for up to ten days of use. The system consists of a sensor/applicator, a Bluetooth Low Energy (BLE) transmitter, and a BLE enabled mobile CGM display.

The sensor is a small and flexible wire, which is inserted by the applicator into subcutaneous tissue where it converts glucose into electrical current. The transmitter is connected to the sensor and is worn on the body. The transmitter samples the electrical current produced by the sensor and converts these measurements into estimated glucose values (EGV) using an onboard algorithm. The transmitter sends glucose data to the mobile CGM displays the current glucose reading (updated every 5 minutes) and glucose trends. The mobile CGM display does not include any glucose related alarm or alerts but will alert the user when important system conditions occur.

The subject of this submission is a change to the primary display mobile device software. Compared to the predicate device which uses a standalone mobile CGM application, the proposed Glucose Program System uses a new mobile CGM software module (app module) that is embedded within a third party program provider's mobile app (host app).

This change is to help encourage CGM retention for those not at significant risk of severe hypoglycemia by providing Dexcom Glucose Program CGM functions and program provider's functions on a single unified mobile application. The app module is designed as a finished sovereign software that interacts directly with smart device hardware/operating system and maintains the same core CGM functionality as the predicate device, independent of the host app. The proposed Glucose Program System uses the same sensor/applicator and transmitter as the predicate device, with only changes to the mobile CGM software.

The change to the primary display mobile device software described in this submission does not impact the standalone G6 mobile application used in the G6 CGM System (last cleared K200876) and only affects the Glucose Program System which is designed for payor-sponsored, valuebased health programs.

The document describes the Dexcom G6 Glucose Program Continuous Glucose Monitoring (CGM) System and its comparison to a predicate device (K200876). The core of the information provided shows that the new device, referred to as the "subject device," is substantially equivalent to the predicate, with the primary change being a modification to the mobile display software.

Here's an analysis of the provided text in relation to the requested information:

1. Table of acceptance criteria and the reported device performance

The document does not explicitly present a table of acceptance criteria with corresponding reported device performance values. Instead, it asserts "substantial equivalence" to a predicate device, implying that the subject device meets the same performance standards as the predicate. The description highlights that the subject device "has the same core CGM functionality and meets the same system requirements as the predicate G6 Glucose Program System."

2. Sample size used for the test set and the data provenance

The document does not specify a sample size for a test set that was used to prove the device meets acceptance criteria. It mentions that "All testing referenced in the predicate device (K200876) in accordance with special controls for integrated continuous glucose monitors remain applicable." This suggests that new clinical performance testing with human subjects was not conducted for this specific submission because the underlying hardware and core algorithms are the same as the predicate.

Regarding data provenance (country of origin, retrospective/prospective), this information is also not provided as new clinical trials were not detailed for this submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not provided in the document. As stated above, new clinical performance data from human subjects is not detailed for this submission, as the claim is based on substantial equivalence to a predicate device for which such testing would have been performed.

4. Adjudication method for the test set

This information is not provided in the document.

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

This type of study is not applicable to this device. The Dexcom G6 Glucose Program CGM System is a continuous glucose monitoring device, not an AI-assisted diagnostic imaging or interpretation tool that would involve "human readers" in the context of an MRMC study.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

The device itself is a continuous glucose monitoring system with an onboard algorithm that converts sensor measurements into estimated glucose values. The document states, "The transmitter samples the electrical current produced by the sensor and converts these measurements into estimated glucose values (EGV) using an onboard algorithm." This confirms a standalone algorithm that processes raw sensor data. The claim of substantial equivalence implies that the performance of this standalone algorithm has been previously validated as part of the predicate device's clearance.

7. The type of ground truth used

For a glucose monitoring device, the typical "ground truth" for evaluating accuracy would be laboratory reference standard blood glucose measurements (e.g., from a YSI analyzer). While the document doesn't explicitly state the ground truth used for this specific submission, it relies on the predicate device's clearance, which would have established accuracy against such a standard. The section "Glucose Value Estimation Algorithm" mentions an "Optimized Joint Probability Algorithm with improved data availability," which would be evaluated against such ground truth.

8. The sample size for the training set

The document does not provide information regarding the sample size for the training set. This is likely because the core algorithm remains the same as the predicate device, and new training data for algorithm development is not part of this specific submission.

9. How the ground truth for the training set was established

The document does not provide this information. It only states that the "Optimized Joint Probability Algorithm" is used, implying that any training and its associated ground truth establishment would have occurred during the development of this algorithm (likely for the predicate device).

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The Dexcom G6 Glucose Program Continuous Glucose Monitoring System (Dexcom Glucose Program System) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons age 2 years and older.

The Dexcom Glucose Program System is intended to replace fingerstick blood glucose testing for diabetes treatment decisions for persons with diabetes who are not at significant risk of severe hypoglycemia. Interpretation of the Dexcom Glucose Program System results should be based on the glucose trends and sequential sensor readings over time. The Dexcom Glucose Program System also aids in the detection of episodes of hyperglycemia, facilitating long-term therapy adjustments.

The Dexcom Glucose Program System is also intended to autonomously communicate with digitally connected devices. The Dexcom Glucose Program System can be used alone or in conjunction with these digitally connected devices or services for the purpose of managing diabetes.

The proposed Dexcom G6 Glucose Program Continuous Glucose Monitoring System consists of three main components: the sensor/applicator delivery system, transmitter, and mobile application (app). The sensor is a small and flexible wire inserted into subcutaneous tissue where it converts glucose into electrical current. The transmitter is connected to the sensor and is worn on the body. It samples the electrical current produced by the sensor and converts these measurements into glucose readings using an onboard algorithm. The transmitter sends glucose data to either the Android app (part of the predicate system) or iOS app (part of the proposed system). The app displays the current glucose reading (updated every 5 minutes) and glucose trends from the transmitter. The app alert users of important system conditions, when it enters an error state, or when it requires the user to enter information. The app also supports connectivity to Dexcom Share and the Follow mobile application.

This document describes a 510(k) premarket notification for the Dexcom G6 Glucose Program Continuous Glucose Monitoring (CGM) System. The submission, K193642, seeks to add an iOS mobile application to an existing Android-based system. As such, the performance data provided largely defers to the existing predicate and reference devices.

Here's an analysis of the provided information concerning acceptance criteria and study data:

Overall Assessment:
The document does not contain explicit acceptance criteria tables with numerical targets, nor does it present detailed performance study results from a new test set for K193642. This is because the core technology (sensor, transmitter, underlying algorithm) and the intended use remain unchanged from the predicate device (K192787) and reference device (K182041). The current submission is primarily for the addition of an iOS application that functions identically to the already cleared Android application. Therefore, performance claims and acceptance are based on the previously cleared devices.

The document states: "All testing performed on the predicate device and reference device in accordance with special controls for integrated continuous glucose monitors remain applicable." and "Therefore, performance testing and software verification and validation testing completed for the predicate device (K192787) remain applicable."

Given this, I will extract information related to what would be the basis for acceptance for such a device, and explicitly note where the information is not present in this specific submission document as a new study.

1. Table of Acceptance Criteria and Reported Device Performance

As noted, this document (K193642) does not present a new table of acceptance criteria with numerical targets and corresponding performance data from a new study specific to the iOS app's glucose measurement accuracy. Instead, it relies on the predicate (K192787) and reference (K182041) devices for performance.

For a CGM system, typical acceptance criteria and performance metrics would include:

2. Sample Size Used for the Test Set and Data Provenance

• Test Set Sample Size: Not explicitly stated for this specific submission (K193642) regarding new clinical performance data. The submission relies on the data from the predicate (K192787) and reference (K182041) devices. These previous submissions would have contained the sample sizes for their clinical studies.
• Data Provenance: Not explicitly stated for this specific submission. Given Dexcom's nature, previous studies would likely be prospective clinical trials conducted with human subjects. The country of origin for previous studies is not specified in this document, but typically for a US FDA submission, significant clinical data would either be from the US or internationally recognized clinical trials. It implies that data is prospective as it's from clinical trials for performance verification.

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications

This document does not describe the establishment of a "ground truth" using human experts for image or signal interpretation, as it's a CGM device, not an AI diagnostic imaging algorithm. For CGM devices, the ground truth is typically established by laboratory reference methods for blood glucose, not expert consensus. These methods are highly accurate and standardized (e.g., YSI instrument measurements).

4. Adjudication Method for the Test Set

Not applicable in the context of a CGM device performing direct physiological measurements against a reference lab method. Adjudication (e.g., 2+1, 3+1) is typically used in studies where human readers are interpreting complex data (like medical images) and their opinions need to be reconciled to form a ground truth.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

• Was it done? No, an MRMC study was not done. MRMC studies are relevant for evaluating the impact of AI on human reader performance for tasks involving interpretation (e.g., radiology). This is a continuous glucose monitor; its function is to measure glucose, not to assist human interpretation in the way an AI would.
• Effect Size of Human Improvement: Not applicable, as no MRMC study was performed.

6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Performance

• Was it done? Yes, the core performance of the Dexcom G6 system (sensor, transmitter, and onboard algorithm) is evaluated in a standalone manner against laboratory reference methods. The system autonomously measures and processes glucose data.
• Details: While K193642 itself doesn't present new standalone performance data, it explicitly states that the previous standalone performance testing for the predicate (K192787) and reference (K182041) devices remains applicable. The device "samples the electrical current produced by the sensor and converts these measurements into glucose readings using an onboard algorithm." This "onboard algorithm" is the standalone component, and its accuracy is assessed by comparing its output directly to reference glucose values.

7. The Type of Ground Truth Used

The ground truth for CGM devices is established by laboratory reference blood glucose measurements. These are highly accurate measurements from a venipuncture blood sample, typically performed in a clinical setting using a YSI glucose analyzer or similar highly accurate laboratory method. This is a form of "outcomes data" or "pathology" in the sense of a gold standard for a physiological measurement.

8. The Sample Size for the Training Set

• Not explicitly stated in K193642. The G6 system's core algorithm was likely developed and trained using extensive datasets from previous clinical studies and internal data. The training set size for the original G6 algorithm (from predicate/reference devices) would have been substantial, but this specific submission does not provide those details. Since the algorithm itself is not being fundamentally changed, new training is not the focus of this 510(k).

9. How the Ground Truth for the Training Set Was Established

• Not explicitly stated in K193642. For the development and training of the original G6 algorithm (from predicate/reference devices), the ground truth for the training set would have also been established using laboratory reference blood glucose measurements, similar to the test set ground truth. These measurements would be collected concurrently with the sensor readings over a long period from a diverse group of individuals to train the algorithm to accurately translate interstitial fluid glucose signals into blood glucose estimates.

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