VivaChek Ino Blood Glucose Monitoring System

{0} 1 # 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY AND INSTRUMENT COMBINATION TEMPLATE A. 510(k) Number: k160179 B. Purpose for Submission: New device C. Measurand: Capillary whole blood glucose from fingertip, forearm and palm D. Type of Test: Quantitative, Amperometric Method (Glucose Oxidase) E. Applicant: VivaChek Laboratories, Inc. F. Proprietary and Established Names: VivaChek Ino Blood Glucose Monitoring System G. Regulatory Information: 1. Regulation section: 21 CFR 862.1345, Glucose test system 21 CFR § 862.1660, Quality control material (assayed and unassayed) 2. Classification: Class II; Class I 3. Product code: NBW, System, Test, Blood Glucose, Over The Counter CGA, Glucose Oxidase, Glucose {1} JJX, Quality Control Material (Assayed and Unassayed) 4. Panel: Clinical Chemistry (75) H. Intended Use: 1. Intended use(s): See Indication(s) for use below. 2. Indication(s) for use: VivaChek Ino Blood Glucose Monitoring System is comprised of the VivaChek Ino Blood Glucose Meter and the VivaChek Ino Blood Glucose Test Strips. The VivaChek Ino Blood Glucose Monitoring System (Meter Model: VGM01) is designed to quantitatively measure the glucose concentration in fresh capillary whole blood. It allows diabetics to take blood samples from the fingertip, forearm, or palm. It is used at home as a way to monitor the effectiveness of diabetes control programs. Alternate testing sites (forearm and palm) should be used only during steady-state times (when blood glucose level is not changing rapidly). This system is intended to be used by a single patient and should not be shared. The VivaChek Ino Blood Glucose Monitoring System is not used for the diagnosis of or screening of diabetes or for neonatal use. The VivaChek Ino Blood Glucose Control Solution is for use with the VivaChek Ino Blood Glucose Meter and Strips as a quality control check to verify that the meter and test strip are working together properly, and that the test is performing correctly. 3. Special conditions for use statement(s): - This system is intended to be used by a single patient and should not be shared. - For over the counter use. - Critically ill patients should not be tested with this system. - Patient who is taking oxygen therapy is not recommended for testing with VivaChek Ino Blood Glucose Monitoring System. - Blood samples from patients in shock, or with severe dehydration or from patients in a hyperosmolar state (with or without ketosis) have not been tested and are not recommended for testing with VivaChek Ino Blood Glucose Monitoring System. - Not for neonatal use. - Not for screening or diagnosis of diabetes mellitus. 2 {2} 4. Special instrument requirements: VivaChek Ino Blood Glucose Meter I. Device Description: The VivaChek Ino Blood Glucose Meter Blood Glucose Monitoring System consists of the following components: - VivaChek Ino Blood Glucose Meter - VivaChek Ino Blood Glucose Test Strips - VivaChek Ino Blood Glucose Control Solution (Level 1, 2 and 3) - VivaChek Ino Safety Lancet - Carrying Case - Owner's Manual and Quick Start Guide The VivaChek Ino Blood Glucose Meter can transmit blood glucose measurement data to a computer via an external USB cable. The test strips (individually wrapped or in canisters), lancets, glucose control solutions are also sold separately. J. Substantial Equivalence Information: 1. Predicate device name(s): OneTouch Ultra Blood Glucose Monitoring System 2. Predicate 510(k) number(s): k002134 3. Comparison with predicate: | Item | Candidate Device VivaChek Ino Blood Glucose Monitoring System | Predicate Device OneTouch Ultra Blood Glucose Monitoring System (k002134) | | --- | --- | --- | | Similarities | | | | Indications for use | For the quantitative measurement of glucose in fresh capillary whole blood as an aid to monitor the effectiveness of diabetes control | Same | | Sample type | Whole capillary blood from fingertip, forearm, palm | Same | {3} | Detection method | Amperometric | Same | | --- | --- | --- | | Enzyme | Glucose Oxidase | Same | | Measuring time | 5 seconds | Same | | Data Port | Micro USB | Same | | Differences | | | | Sample volume | 0.8 μL | 1.0 μL | | Operating conditions | 41-113°F (5 to 45°C) | 43-111°F (6-44°C) | | | 10 to 90% R.H. | 10 to 90% R.H. | | HCT range | 20-70% | 30-55% | | Detection range | 20-600 mg/dL | 20-600 mg/dL | | Memory storage | 900 test results | 150 test results | | Power battery | 2x3V Li battery (CR2032) | 1x3V | # K. Standard/Guidance Document Referenced (if applicable): CLSI EP05-A2 "Evaluation of Precision Performance of Quantitative Measurement Methods" CLSI EP06-A2 "Evaluation of the Linearity of Quantitative Measurement Procedures: A Statistical Approach" CLSI EP07-A2 "Interference Testing in Clinical Chemistry" CLSI EP09-A2 "Method Comparison and Bias Estimation Using Patient Samples; Approved Guideline" # L. Test Principle: The VivaChek Ino Blood Glucose Monitoring System is designed to quantitatively measure the glucose concentration in fresh capillary whole blood. The glucose measurement is achieved by using the amperometric detection method. The test is based on measurement of electrical current caused by the reaction of the glucose with the reagents on the electrode of the test strip. The blood sample is pulled into the tip of the test strip through capillary action. Glucose in the sample reacts with glucose enzyme and the mediator. Electrons are generated, producing a current that is correlated to the glucose concentration in the sample. After the reaction time, the glucose concentration in the sample is displayed. The meter is calibrated to display plasma-like concentration results. # M. Performance Characteristics (if/when applicable): # 1. Analytical performance: # a. Precision/Reproducibility: The sponsor performed repeatability (within-run) precision studies using venous whole blood spiked to 5 different glucose concentration levels (30 to 50, 51 to 110, {4} 111 to 150, 151 to 250, 251 to 400). Each glucose concentration level was analyzed in replicates of 10, with 3 test strip lots, and 10 meters, for a total of 300 tests per glucose level for each meter. Results are summarized below: ## Repeatability (within-run precision): | Glucose Level, mg/dL | Strip Lot | n | Average Glucose mg/dL | SD, mg/dL | CV, % | | --- | --- | --- | --- | --- | --- | | 30-50 | 1 | 100 | 41.7 | 2.7 | 6.4 | | | 2 | 100 | 41.3 | 2.7 | 6.7 | | | 3 | 100 | 40.9 | 2.8 | 6.9 | | 51-110 | 1 | 100 | 77.1 | 2.8 | 3.6 | | | 2 | 100 | 74.4 | 3.0 | 4.0 | | | 3 | 100 | 76.7 | 3.0 | 3.9 | | 111-150 | 1 | 100 | 134.3 | 3.5 | 2.6 | | | 2 | 100 | 133.4 | 4.3 | 3.2 | | | 3 | 100 | 132.8 | 4.3 | 3.2 | | 151-250 | 1 | 100 | 202.0 | 6.4 | 3.2 | | | 2 | 100 | 201.4 | 6.8 | 3.4 | | | 3 | 100 | 201.3 | 6.4 | 3.2 | | 251-400 | 1 | 100 | 372.2 | 10.1 | 2.7 | | | 2 | 100 | 368.3 | 10.2 | 2.8 | | | 3 | 100 | 370.1 | 10.7 | 2.9 | Intermediate (between run) precision was evaluated using 3 levels of glucose control solutions over 10 days with 3 test strip lots. For each level, on each day, 10 meters were used for testing, with 1 replicate collected per meter for a total of 10 replicates per day for each glucose level. Results are summarized below: ## Intermediate precision | Glucose Level, mg/dL | Strip Lot | n | Average Glucose (mg/dL) | SD, mg/dL | CV, % | | --- | --- | --- | --- | --- | --- | | Level 1 | 1 | 100 | 41.5 | 2.3 | 5.5 | | | 2 | 100 | 41.5 | 2.4 | 5.8 | | | 3 | 100 | 40.4 | 2.4 | 5.8 | | | 1 | 100 | 118.0 | 3.0 | 2.5 | {5} | Glucose Level, mg/dL | Strip Lot | n | Average Glucose (mg/dL) | SD, mg/dL | CV, % | | --- | --- | --- | --- | --- | --- | | Level 2 | 2 | 100 | 119.6 | 3.1 | 2.6 | | | 3 | 100 | 118.3 | 3.6 | 3.0 | | Level 3 | 1 | 100 | 358.9 | 9.8 | 2.7 | | | 2 | 100 | 358.7 | 9.3 | 2.6 | | | 3 | 100 | 359.8 | 9.4 | 2.6 | b. Linearity/assay reportable range: Linearity testing was performed using venous whole blood samples. Samples with the following glucose concentrations were prepared and confirmed by a laboratory reference method (YSI): 8, 25, 50, 80, 110, 170, 220, 330, 450, 550, 650 mg/dL. Each sample was measured in replicates of four using each of three lots of test strips (2 replicates/meter, 2 meters) and the mean was used in the regression analysis. The regression analysis results are summarized in the below table: | Lot | Slope | y-intercept | R² | | --- | --- | --- | --- | | 1 | 0.9972 | -0.9718 | 0.9989 | | 2 | 0.9994 | -1.5257 | 0.9991 | | 3 | 1.0011 | -0.1571 | 0.9988 | The results of the study support the sponsor's claimed glucose measuring range of 20 - 600 mg/dL. Data from bench studies and software verification studies were provided to demonstrate that if a sample is less than 20 mg/dL, the result is flagged by the meter as LO. If a sample result exceeds 600 mg/dL, the result is flagged by the meter as HI. c. Traceability, Stability, Expected values (controls, calibrators, or methods): Traceability The system is traceable to NIST SRM #917b reference material. A method comparison was performed using the candidate device and YSI as the reference method. The meter provides plasma-equivalent results. Test Strip Stability Accelerated and Real time stability study protocols and acceptance criteria were reviewed and found acceptable to support the 24 month shelf life and 4 month open vial stability for test strips (Canister and Pouch) stored at temperatures of $41^{\circ}\mathrm{F}$ to $86^{\circ}\mathrm{F}$ ( $5^{\circ}\mathrm{C} - 30^{\circ}\mathrm{C}$ ) and $10 - 90\%$ RH. {6} # d. Detection limit: The reportable range for the VivaChek™ Ino Blood Glucose Monitoring System is 20 to $600\mathrm{mg / dL}$ supported by the linearity assay study above (M.1.b). # e. Analytical specificity: To assess potential interference the sponsor used venous whole blood samples adjusted to 3 glucose concentrations of 50, 100, and $350\mathrm{mg / dL}$ . Each of these samples was divided into a test pool and a control pool, with each of the potential endogenous and exogenous interfering substances added to the test pool. Each substance was tested at a minimum of two concentrations, normal/therapeutic and high/toxic concentrations following EP7-A2 recommendations. The $\%$ difference between the test sample and the control sample was calculated using mean of 10 replicates for each of the 3 strip lots tested. The sponsor defines no significant interference as $\leq \pm 10\%$ difference relative to the control sample. Results are presented in the table below: | Substance | Highest Concentration tested with no observed interference | | --- | --- | | Acetaminophen | 20 mg/dL | | Ascorbic acid | 3 mg/dL | | Dopamine | 0.09 mg/dL | | L-Dopa (Levo-Dopa) | 3 mg/dL | | Methyl-Dopa | 1.50 mg/dL | | Ibuprofen | 50 mg/dL | | Salicylate | 60 mg/dL | | Galactose | 26 mg/dL | | Maltose | 225 mg/dL | | Xylose | 45 mg/dL | | Lactose | 25 mg/dL | | Tetracycline | 1.5 mg/dL | | Tolazamide | 10 mg/dL | | Tolbutamide | 64 mg/dL | | Bilirubin | 40 mg/dL | | Cholesterol | 500 mg/dL | {7} | Substance | Highest Concentration tested with no observed interference | | --- | --- | | Creatinine | 5 mg/dL | | Triglycerides | 3000 mg/dL | | Uric Acid | 23.5 mg/dL | | EDTA | 0.1mg/dL | | Heparin | 3000 U/L | The sponsor lists the following limitations in the Owner’s Manual and the Test Strip Insert: - If you are taking Vitamin C (ascorbic acid >3 mg/dL) then your glucose results using this meter may not be reliable. - The VivaChek Ino Blood Glucose Monitoring System should not be used following xylose absorption procedures. f. Assay cut-off: Not applicable 2. Comparison studies: a. Method comparison with predicate device: To assess system accuracy, a total of 103 subjects were recruited and tested in a 10 day study period by trained technicians using the VivaChek™ Ino Blood Glucose Monitoring System. For each subject, whole blood samples were collected from finger, palm and forearm for meter testing. An additional capillary blood sample from the fingertip was also collected into microtainer tubes containing heparin anticoagulant for the YSI method. The tested glucose concentration range was from 56.3 to 559.4 mg/dL by YSI. Five meters and three test strip lots were tested in the study. The results of the candidate system compared to YSI are summarized in the below tables using one representative lot: Fingertip VivaChek Ino Result vs. Plasma YSI Glucose Concentration <75 mg/dL | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | {8} Glucose Concentration $\geq 75\ \mathrm{mg/dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 57/90 (63.3%) | 84/90 (93.3%) | 90/90 (100%) | 90/90 (100%) | Linear Regression: $$ y = 1.072x - 1.5841, \ R^2 = 0.9855, N = 103 $$ Palm VivaChek Ino Result vs. Plasma YSI Glucose Concentration $< 75\ \mathrm{mg/dL}$ | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | Glucose Concentration $\geq 75\ \mathrm{mg/dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 57/90 (63.3%) | 83/90 (92.2%) | 90/90 (100%) | 90/90 (100%) | Linear Regression: $$ y = 1.0144x - 1.1496, \ R^2 = 0.9849, N = 103 $$ Forearm VivaChek Ino Result vs. Plasma YSI Glucose Concentration $< 75\ \mathrm{mg/dL}$ | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | Glucose Concentration $\geq 75\ \mathrm{mg/dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 57/90 (63.3%) | 84/90 (93.3%) | 90/90 (100%) | 90/90 (100%) | Linear Regression: $$ y = 1.0190x - 1.5526, \ R^2 = 0.9870, N = 103 $$ b. Matrix comparison: Not applicable. 3. Clinical studies: a. Clinical Sensitivity: Not applicable. b. Clinical specificity: Not applicable. {9} c. Other clinical supportive data (when a. and b. are not applicable): # User performance study To assess the performance of the VivaChek Ino System in the hands of the intended users the sponsor performed a study with a total of 103 lay users that were provided with the labeling in English only and collected their own fingerstick, palm and forearm samples and obtained results on the VivaChek Ino. After the tests were done with the subject meter, additional blood samples were collected from each subject by the professionals into microtainer tubes for testing with the comparator method, YSI. The YSI glucose concentration range of the study subjects was 56.3 to $559.4\mathrm{mg / dL}$ . The results relative to YSI are summarized in the tables below: # Lay user fingertip vs. Plasma YSI Glucose Concentration $< 75\mathrm{mg / dL}$ | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | Glucose Concentration $\geq 75\mathrm{mg / dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 57/90 (63.3%) | 84/90 (93.3%) | 90/90 (100%) | 90/90 (100%) | Linear Regression y=1.0184x-2.2388, $\mathrm{R}^2 = 0.9848$ , $\mathrm{N} = 103$ # Lay user palm vs. Plasma YSI Glucose Concentration $< 75\mathrm{mg / dL}$ | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | Glucose Concentration $\geq 75\mathrm{mg / dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 58/90 (64.4%) | 83/90 (92.2%) | 90/90 (100%) | 90/90 (100%) | Linear Regression: y=1.0171x-1.9436, $\mathrm{R}^2 = 0.9845$ , $\mathrm{N} = 103$ # Lay user Forearm vs. Plasma YSI Glucose Concentration $< 75\mathrm{mg / dL}$ | Within ±5mg/dL | Within ±10mg/dL | Within ±15mg/dL | | --- | --- | --- | | 8/13 (61.5%) | 13/13 (100%) | 13/13 (100%) | Glucose Concentration $\geq 75\mathrm{mg / dL}$ | Within ±5% | Within ±10% | Within ±15% | Within ±20% | | --- | --- | --- | --- | | 57/90 (63.3%) | 84/90 (93.3%) | 90/90 (100%) | 90/90 (100%) | {10} Linear Regression: y=1.0166-1.9178, R²=0.9852, N=103 ## Usability Study: The participants read the instruction manual in English. The responses to the Instructions for Use Questionnaire met the acceptance criteria, with lay users demonstrating acceptable levels of comprehension of the user manual and the strip insert. The readability of the labeling using a Flesch-Kincaid analysis was demonstrated to be less than 8th grade level. 4. Clinical cut-off: Not applicable. 5. Expected values/Reference range: The sponsor lists the following expected blood glucose levels for people without diabetes | Time | Range (mg/dL) | | --- | --- | | Fasting and meals | 70-100 | | 2 hours after meal | Less than 140 | Reference: ADA Clinical Practice Recommendations, 2015 ## N. Instrument Name: VivaChek Ino Blood Glucose Meter ## O. System Descriptions: 1. Modes of Operation: Does the applicant’s device contain the ability to transmit data to a computer, webserver, or mobile device? Yes ☐ X ☐ or No ☐ Does the applicant’s device transmit data to a computer, webserver, or mobile device using wireless transmission? Yes ☐ ☐ or No ☐ X ☐ {11} 12 2. Software: FDA has reviewed applicant’s Hazard Analysis and software development processes for this line of product types: Yes ☐ X ☐ or No ☐ 3. Specimen Identification: There is no sample identification function with this device. Samples are applied directly to the test strip as they are collected. 4. Specimen Sampling and Handling: The system is intended to be used with capillary whole blood from fingerstick, palm and forearm. The whole blood sample is applied directly to the test strip by capillary action. 5. Calibration: The VivaChek Ino Blood Glucose Monitoring System is calibrated such that the result displayed is equivalent to the glucose level in a plasma sample. Calibration is automatic. There is no user input for coding. 6. Quality Control: Glucose control solutions at 3 different concentration ranges (Level 1, Level 2, and Level 3) can be used with this device. Recommendations on when to test the control materials are provided in the labeling. An acceptable range for each control level is printed on the test strip vial label. The user is cautioned not to use the meter and to contact customer support if the control result falls outside these ranges. P. Other Supportive Instrument Performance Characteristics Data Not Covered In The "Performance Characteristics" Section above: 1. Hematocrit Study: To evaluate the effect of hematocrit on the VivaChek Ino Blood Glucose Monitoring System, venous blood samples with hematocrit levels of 20%, 30%, 42%, 55%, and 70% were tested at 3 glucose concentrations (40, 110, and 350 mg/dL). Each sample was tested in replicates of 10/strip lot, with a total 3 lots of testes strips tested. Results from the meter were compared to results obtained using a laboratory-based reference method (YSI). The evaluation of percent bias relative to YSI demonstrated acceptable performance across the hematocrit range of 20-70%. 2. Altitude study: To evaluate the effect of altitude on the VivaChek Ino Blood Glucose Monitoring System, meters were tested at 2 altitudes locations sea level and 9777 feet. Fingertip {12} capillary blood samples from 15 subjects were tested at each altitude. The evaluation included 2 meters and 3 test strip lots. The glucose range tested was 43 to 482 mg/dl at sea level; 46-470 mg/dl at 9777 feet. Results at each altitude were compared to the comparator method, YSI. Results demonstrated that altitudes up to 9,777 feet above sea level have no significant effect on blood glucose measurements from the candidate device. 3. Sample Volume: The sponsor performed a study to verify the test strip minimum sample volume requirement and the test strip fill error requirement established for the VivaChek Ino Blood Glucose Monitoring System. Blood samples were tested at 0.6, 0.7, 0.8, 0.9 and 1.0μL of venous whole blood samples at glucose concentrations of 50, 100, 280, and 500 mg/dL. Results support the claimed minimum sample volume of 0.8μL. Adequate validation was provided to support the fill error feature that is displayed when too little blood is applied to the test strip. 4. Operating Conditions Study: Temperature and humidity operating conditions were evaluated for temperatures ranging from 41°F to 113°F (5°C to 45°C) and relative humidity between 10 and 90% R.H. including extreme combinations of temperature and humidity, including lowest humidity with lowest and highest temperature and highest humidity with lowest and highest temperature. Meter results were compared to YSI values. Results support the claimed operating conditions of 41°F to 113°F (5°C to 45°C) and relative humidity between 10 and 90% R.H. 5. EMC Testing: The sponsor provided documentation certifying that acceptable electromagnetic testing (EMC) had been performed. 6. Software documentation: The software documentation was reviewed and found to be acceptable. The firm provided documentation to support the device was designed, developed and is under good software lifecycle processes. 7. Infection Control Studies: The device system is intended for single-patient use only. Disinfection efficacy studies were performed on the materials comprising the meter by an outside commercial testing laboratory demonstrating complete inactivation of hepatitis B virus (HBV) with the chosen disinfectant, Clorox Germicidal Wipes, 0.55% sodium hypochlorite (EPA Registration # 67619-12). Robustness studies were also performed by the sponsor demonstrating that there was no change in performance or external materials of the meter after 608 cleanings and disinfection cycles with the Clorox Germicidal Wipes. The robustness studies were designed to simulate 5 years of single-patient use for the meter to be cleaned and disinfected at least once a week. Labeling was reviewed for adequate instructions for the validated cleaning and disinfection procedures. 13 {13} 8. This device was cleared after the FDA issued final guidance documents for prescription use blood glucose monitoring systems (BGMS) and over-the-counter use blood glucose monitoring systems (SMBG). However, the recommendations in the guidance documents were not followed for this device since the submission was received prior to the finalization of the guidance documents. Q. Proposed Labeling: The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10. R. Conclusion: The submitted information in this premarket notification is complete and supports a substantial equivalence decision. 14