Speaker 1 (00:13.646)
Welcome to the Glucose Never Lies podcast, where science meets real life experience to empower diabetes management. I'm John Pemberton. I've lived with type 1 diabetes since 2008 and have spent nearly 20 years mastering both the science and art of managing it. Through personal experimentation, published research, and my work as a diabetes specialist dietician, I've gained deep insights into what truly makes a difference. When my son Jude tested positive for type 1 diabetes antibodies,

I realised that all the knowledge in my head was wasted if I couldn't communicate it in a way that was clear, actionable and easy to come back to. So I built the Glucose Nebuliser Education Programme, a free online resource designed to teach people diabetes management exactly the way I'd want people to understand it if they were looking after my son. After battling a functional motor disorder for many years and recently experiencing a major depressive episode, I was eventually pulled out of that hole by my friends, family and professionals who helped me get back to being me.

That experience taught me the power of giving and this podcast is my way of giving back. My co-host Louise is a highly experienced diabetes nurse with over 20 years in the field. She brings a wealth of knowledge and her superpower is making complex diabetes science accessible and practical for everyday life. She is the best diabetes nurse I've ever worked with and there have been some good ones. Most importantly, she keeps me in check and keeps the podcast on point. So if you're living with diabetes or supporting someone who is,

We want to make things easier, clearer and importantly, more enjoyable. We hope you enjoy the content. If you do, please share it with those who may like it too. As a disclaimer, the information shared on the Glucose Nebulize podcast is for informational and educational purposes only. While we discuss strategies and insights for diabetes management, this podcast is not a substitute for professional medical advice. Always consult your healthcare team before making any changes to your diabetes plan. That done with...

Let's get into the content.

Speaker 1 (02:17.452)
episode 11, this is part two of the CGM series and this is going to be assessing CGM accuracy performance. So it's important if you just arrived here and you're about to go, all right, I want to find out the performance of these different systems against each other. If you haven't listened to the first part, it's absolutely essential you do because we're only going to be talking about a select number of CGM systems because there are only a number of select CGM systems that in our opinion have had a study design in their accuracy study.

done robustly enough to help us understand whether the accuracy we're about to discuss will represent what will happen in real life and certainly tested the sensor across the full glucose range. So those ones are going to be the Akicik Smart Guide, the Dexcom G6 and Dexcom 1, Dexcom G7 1 Plus, EverSense, Freestyle Libre 2 and 3 Plus, the Medtronic Guardian 4 and the Medtronic Simplera. They're the ones that have been tested with a robust study design, which means when we look at accuracy,

we can get an idea of what that's going to represent in real life. So if you've jumped to here, I would encourage you to kind of go back if that makes sense. What we did have a discussion was as well, and we won't rehash it here, we'll get into it little bit further, is that an ideal world would be testing the CGM performance against capillary glucose because that is what the human body is exposed to at its peak levels. However, most of the studies today

Yeah, definitely.

Speaker 1 (03:37.516)
have actually done them against venous glucose. So we are going to talk about the venous glucose performance first because it is still very instructive around whether a CGM is accurate to venous glucose. And then we'll kick the conversation on to what are the current market leading sensors performing like against capillary glucose. Okay. Happy with that? I'm just good. So the easiest way, first of all, to understand whether a CGM is...

certainly more than accurate enough for insulin dosing decisions is in America, they've got something called the FDA ICGM performance standards, which is basically the highest performance standards, both testing a sensor in the low range, in the target range, in the high range. And there is very strict criteria for it to meet. And what we can be confident is, is the sensor that have met those performance criteria will be more than accurate enough for insulin dosing decisions. And actually those are the sensors that are allowed to be used in America.

with multiple automated instant delivery systems. So again, those are the highest level.

Okay, so that means those sensors that have met those standards are the sensors that are able to be used with different pumps.

Yeah. So for example, I'll explain now. So you've got the Dexcom G6, the Dexcom G7, the Eversense and the Freestyle Leber 2 and the 3 Plus. And what you will notice there is the Dexcom G6, you'll currently know that that's available with the Omnipod 5 system, the Tandem T-Slim and the Cambridge system. You've got the Dexcom G7, which I believe is aligned certainly with the T-Slim, the Omnipod 5 and not too far away from the Cambridge system as I understand it.

Speaker 1 (05:13.39)
And then you've got the EverSense, which is, don't think currently working with AID systems, but has that approval. And then the Freestyle Libre 2, which is available with the Onipod 5 system in America, available with the T-Slim. And then the 3 Plus, which is available with the Cambridge system. So what you can be sure of is all of those ones are got the highest level of accuracy, both for insulin dosing decisions, full stop, but also for use with multiple AID systems. So if you want something that's the most accurate, those are the ones you would prioritize.

And important to say that the Dexcom 1, which is basically a Dexcom G6 just without a few fancy bits, is the same accuracy. So although it doesn't have approval, it has the same accuracy because it's the same kit, but there's just a bit of functionality taken out. Similarly, the Dexcom 1 Plus also meets those standards, because it's just had a few bit of functionality taken off, it's not been put through as such, the ICGEN. But again, from an accuracy standpoint,

that holds up because it's the same device, the same bits and pieces. Happy with that? Yeah. What you can also be happy with is the Medtronic Guardian 4 and the Medtronic Simplera. And these are all tested against venus, the ICGym that I discussed. And these are also tested against venus are also very accurate. So in America, the Simplera has class three medical approval, which is the highest standard. And when you've been assessed by the FDA, you can be sure that is more robust than anything.

make sense.

Speaker 1 (06:38.326)
The downside of this is the pros and cons of being in Europe and the UK. So in the Europe and the UK, if something has CE marking, which is basically Europe has what they call notified bodies, which is a set of regulatory bodies. they use those as about 50 of them to do their assessments for them. And they basically, if they pass their assessments, you get a four digit CE mark stamped on your forehead and it says this has CE marking.

So what is really easy to do as a healthcare professional, a person living with diabetes is go, if it's got CE marking, then it must have passed some rigorous standards. I can tell you quite clearly the answer to that is categorically no. So I lost about 18 months of my life when I had three broken shoulders and operations looking into CE marking and published a paper on it, which we'll link to in the show notes, which basically shows there are systems available that have CE marking that have no public.

publicly available clinical data, but they have CE marking for insulin dosing decisions from the age of two. I'm not quite sure how that's possible. But if they put that information through for the FDA, for example, they would have no indications for use. So I would love for CE marking to be adequate enough for us to go, if it's got CE marking, it's all good.

But it isn't. That's why we needed the study design part one. And this is why we need the accuracy part two. And this is why we're only talking about specific CGM devices and we've left other ones behind because they haven't been tested in the conditions on the people that it's indicated for and in a way to test the sensor across the full robust range, certainly on publicly available data. That's important to say, they may have data on file they're not willing to share. The only people who are allowed to see that data on file are the company.

the notified body who gave the CE marking and the National Patient Safety Regulator, which in our case is the MHRA, who are the only people who can ask to see that data. So us as health care professionals and people with diabetes are not allowed to see that data if they don't want us to see it. Yet they can have indications from the age of two. So there's kind of a bit of a mismatch in terms of transparency there. And it's hopefully something once we get an ISO standard will be kind of something of the past. But at the moment, it's certainly a thing of the future. Well, it's a thing of the present.

Speaker 2 (08:53.09)
So there's a couple of things there, isn't there? So definitely it's really important to listen to the podcast prior to this, which will enable further understanding into about the published data, peer reviewed data. And then, yeah, the C mark is not sufficient. It needs to have FDA approval, isn't it?

Yeah, well the thing is and this is where it gets a bit tricky we'd love everything to go and have FDA approval but it's expensive and the company might not want to mark it in there so there is another as we'll get to the Rush Smart Guide they don't have FDA approval but they've done a study design properly they have CE marking but we know that that's been tested robustly so if you've got FDA ICGEM or Class 3 you can guarantee it's been looked at properly.

and the ICGS.

Yeah, that's the FDA ICGIM. It's a slightly different classification for those who want to be used with multiple AID systems. Whereas the Medtronic has the approval for just with its own system, the 780G, and also for different things like the smart pen that it uses. So again, the Medtronic ones have been tested against venous glucose very accurately. And again, you can be happy with those. So you can be happy with those from a venous glucose perspective. But as we mentioned in the first,

There is a risk if you align, if the CGM values are aligned to venous glucose, they're going to under-represent what the body is exposed to in the capillary glucose. So although these sensors are very accurate to venous glucose, what are they like compared to capillary glucose? Because really that's what's more important. As you mentioned before, no one walks around with an indolent catheter in the venous glucose to check and calibrate a CGM. They do a finger prick. And again, it just becomes really important to understand.

Speaker 1 (10:36.63)
moving forward, you're better off with a CGM device ideally aligned to capillary glucose and that's where the future standards are kind of going to lie. So before we get there, it's important we mentioned the meal and insulin challenges in the first study design, which is ideally what you want. You get people to come into a lab for seven hours, generally at the beginning, the middle and the end of the sense of life.

You get them to sit there, you have 60 grams of carbs or so, and it pushes the glucose level up. That's called a meal challenge. And then when the glucose level is high, above 16.7 or 300 milligrams per deciliter, you give a little bit instant, make it drop quickly. Now, it's a graphic I'll show that if I was a manufacturer and I wanted my CGM to appear the most accurate, I could still do meal and instant challenges, but I could do them on separate days.

I could bring them on day one and give them all meal challenges and start them higher. So start the glucose at say at 10 or 11, 12, push the glucose up to 16, 17 with only 30 grams of carbs. That's the meal challenge. You get all the numbers. You get the 5 % readings for 16.7, but you don't give insulin. You just let it stay there and you keep it stable so the accuracy is nice. Then on the second day, you start them at a glucose of about five or 100 milligrams per liter. You give them plenty of insulin to get them into the low range and get your 8 % of readings low. And then you've covered both

8 % readings low, 5 % readings high, meal and insulin challenges, published, type 1 diabetes, you would get a beautiful five ticks. But what you will also get is a performance that's skewed and not really in line with real life. And that is what the IFCC team now are kind of suggesting with what's called a dynamic glucose region challenge, which is basically don't do them on separate days, do them on the same day. You have your 60 grams of carbs at a normal glucose level, push it above 16.7.

then give a big dose of insulin and drop you like a stone and get your pluridins there. That way you assess the accuracy going up fast and going down fast. And fortunately, there has been recently a study published of the Medtronic Simplera, Dexcrime G7, Freestyle Libra 3 that have undertaken this dynamic glucose region test and done it against capillary. So we've got a good idea of how these sensors actually perform in the most robust conditions using capillary, therefore,

Speaker 1 (12:55.466)
ideally how accurate those things are. So I'm going to describe a little bit about that. And if you think of that dynamic glucose region test, it's a little bit like now, if you think about the analogy of testing a car, no longer you just testing it either in the slow, medium and fast lane, going at certain speeds, you're now getting them to cross lanes at a fast time. So if a car has been tested like that, and it's been safe, you're pretty sure you're happy to get in that car. That's a little bit like these sensors if they've undergone a dynamic glucose region test.

you can feel pretty kind of confident about that. So.

So it's like, so the principle of that is obviously massive carb intake rises really quickly and then obviously massive correction will drop really quickly. So it's about testing the accuracy of the sensor in those specific conditions.

Correct, yeah, that's really kind of what you want. So we're gonna come to those results as a bit of a teaser of where the current ones are before we get to there because I need to explain some of the metrics that you can use when you do these tests. What are these performance indicators that come out? What do they actually mean in real life? So we have to discuss, although I don't want to, is MAD, Mean Absolute Relative Difference, because that's an average measure. And as I described on the previous podcast, is sort of common folklore that

A mar of 10 % or less is good for insulin dosing decisions, which means on average, the sensor will be 10 % different to the finger prick or the capillary glucose or the measurement, the reference measure. So again, the simple thing is if the CGM is saying 10, the capillary glucose will be between 9 and 11. That would be like a 10 % difference. The challenge with that is in your brain, you can't help but think that every single reading will be 10 % different. Therefore, that's going to be amazing. But the reality is averages don't tell us the full story.

Speaker 1 (14:41.87)
It may be that a lot of the readings within 5 % and then loads of readings are 20, 30, 40 % out and they're the dangerous ones. So unfortunately, the best way of thinking about this is if you couldn't swim and you was approaching a fast flowing river and you was told on average it's four feet deep, would you cross it? I hope the answer will be no, because it might be 12 feet deep in certain places and then you're going to die. So it's a little bit like that with CGM testing is

Thank

Speaker 1 (15:11.52)
An overall for an overall picture, MAD might give some direction, but what better off is thinking about agreement rates and the two probably most common agreement rates to help us here are the 2020 and the 4040. So the easiest way to think about the 2020 is if if it meets the 2020 standard, what percentage of readings meet this 2020 standard? Those are going to be no risk readings. If you make an insulin dose decision or a therapy decision based off a reading that's within 2020, there's no risk.

What do you mean by 2020?

Good question. So if the glucose level is less than 5.5 to be an accurate reading with the CGM compared to the comparator, the finger prick or the venous, it needs to be within 1.1. So as the example, if the CGM is reading 4.5, as long as the actual reference measure is between 3.4 and 5.6, that will be deemed that'd be a tick as an accurate one. If it fell outside of there, so let's say it was either six or 3.2, it will be a cross. So the higher the percentage,

you're not going to make a mistake with those. And then for glucose readings above 5.5, it needs to be within 20 % to be classified as an accurate reading or not. So again, taking that as a, your CDM is reading 10, as long as the reference measures between 8 and 12, then it's deemed accurate. And you might think, well, that's quite wide. Is that really accurate? But think about it. If you did a correction dose at 11.9 and it was really 10, that'd be fine.

because you wouldn't overdo it because you're aiming for six or you're aiming for 5.5. So it doesn't have to be perfect accuracy, you're just not going to make a mistake. So the higher the number of readings within that 2020 gives you the confidence that was it eight out of 10? Nine out of 10, we'll get there in a second. What percentage of readings are you going to definitely make no mistake with? And then the other metric that's really helpful along the same lines is the 40-40 metric. So the 40-40 metric applies the same principle. If you're less than 5.5,

Speaker 1 (17:07.054)
What percentage of readings fall within this case, 2.2 or 40 milligrams per deciliter? I should have mentioned on 2020, the reason why the bottom 20 is 20 milligrams per deciliter is the same as 1.1 millimoles per liter. That's why it's called 2020. So 40-40 is readings less than 5.5. What percentage of them are within 2.2? Or if you had milligrams per deciliter, if it was 100 milligrams per deciliter, what are within sort of 40? So taking this,

If your CDM is reading 5.5, what percentage of readings are within 2.3 or 6.7 millimoles per liter? So obviously that's quite wide, but what we'll know is if the percentage of the readings that land within 40-40 is very high, the remainder of what left are the really dangerous decisions. What percentage of readings are really dangerous? And you don't really want that any more than 1 % because once that starts getting into two, three, four, 5%, the risk of overdoing correction doses or missing hypos is really high.

So these two metrics will really help us. 2020 tells us the number of no risk. 4040, the readings outside of 4040 tells the number of percentage readings at very high risk. Happy with that?

I think one of the things that's more challenging is about the 20 and 40 applying to military

Yeah, in an ideal world. So if it was in the UK, it would be it would be called the 1.1 20 rule and the 40 rule would be the 2.2 40 rule, but it's not quite as catchy as it and most of these things are kind of come from America. So that's the reason why I know that's really good. That's really good. So what we've got in the show notes is the list of the adult and pediatric 2020 and 4040 performance of the currently available sensors that we're discussing.

Speaker 1 (18:52.142)
And what you will see is for 2020, it ranges from anywhere from 88 % all the way up to 95 % of the readings of absolutely no risk. But nicely, the vast majority of them are at least only 1 % outside 40-40, with a lot of them less than half a percent for both the adult and pediatric data. So I'm not going to call out what the sensors are in particular, because I actually think that all of those, if you're getting at least nine out 10 readings with no risk and less than

1 % or less, no risk. You can confidently use all of those for no insulin dosing. And if you're a person who loves, you know, absolute pristine accuracy, you can go and check out the table and pick out the one with the highest ones if accuracy is your thing. But I think from a realistic perspective, is any of those sensors that hit 90 % on the 2020 and 1 % or less on the 40-40 is going to be more than adequate to be done for insulin dosing decisions as long as

Their study design is a four or a five out of five. Because what you will find is when you see the DSN forum chart published, there are other sensors on there that haven't got a study design. Maybe your study design goes zero or one. And they've also got equivalent numbers of 90 % plus in 2020 and even like 0.1 % in 4040. Well, of course, you're going to get that if you don't test the sensor when it's moving fast. It's whether that will replicate in real life. And again, I'm not saying those sensors are not as accurate as the others. I'm saying we have no way of knowing until they publish the data.

It's excellent that this data is for over two years as well.

Yes, and so yes, from the young people. So actually just to know on that, that actually the data for the accuracy of the pediatrics on the accuracy like that is that from six years old to 17, because you can't do that level of testing on a two to five year old. On a two to five year old, they do their finger pricks. And as long as the accuracy is equivalent to what it was for the adolescent study, they pass it from two years. So we haven't had kids with catheters in their arms and the rest of it. So you have to kind of take a pragmatic approach for that. But that's a really good question.

Speaker 1 (20:54.956)
It's important to note when you look at that table though, you can't, it's like comparing apples and pears because although these things are gonna have a study design of four or five, it makes you think they've all been tested the same way. But there are so many things to consider such as did they measure against capillary or venous? Did they do meal and insulin challenges on the same day or on different days? When you're comparing the CGM reading to the...

Comparative reading do you choose the CGN value that was before the reading or after the reading because if you choose the before reading it's less accurate if you choose the after it's more accurate, so it's Yeah, and the purpose of these charts is not to say one's more accurate than the other it's to say if you meet a study design of four or five bang we're happy with the results if the numbers are nine, you know nine out of ten ninety percent in 2020 we're all good one percent or less less than 40 40 you're Within outside of 40 for you kind of all good

things to think about.

Speaker 1 (21:47.054)
You can't directly compare, but you can kind of get a feel for the accuracy of the different systems as we kind of move along. So I promised you we'd have a little chat thinking about.

how we're gonna move forward in terms of capillary. What is important to say is the recent study that did the Freestyle Leaver 3, the Dexcom G7 and the Medtronic Simplera, they used that dynamic glucose region test where they gave a meal, they needed to go really high and then give insulin and made it drop really quick and did it against capillary. And what they actually found was all of those systems

that previously met the ICGM high robust criteria.

for venous glucose, none of them achieved all those metrics for capillary when it's tested going up and down quickly. So it's important to know that that doesn't mean the sensors have become less accurate overnight. The only thing that has changed is the testing conditions. So it probably means if the testing conditions were done very robustly and it was done against capillary, those ICGM metrics are too tight. They're too unnecessary for a start. And they're also then, if you have a criteria that's tight, what do you do as a manufacturer?

You try and manipulate the study design to make yours as accurate as possible. And when I say manipulate, I don't mean in a bad way. mean, you do the test to try and meet the conditions. And that's the problem without having standardization is if you don't have a standardization of the study design criteria, you will do whatever you can to get the most accurate because you're not doing it against the rules. You're doing it within rules. So having the rules set in ground in stone for you helps the manufacturers, helps the regulators, helps the people with diabetes know what's going on. Therefore.

Speaker 1 (23:37.964)
The sooner that happens, the better for everybody.

I think you've made it quite clear as to why that is so important to occur as well as the next steps.

So just to put that into context, when you compare the Freestyle Leber 3, the Dexcom G7, and the Medtronic Simplera against capillary glucose, under those testing conditions, you find that roughly about 2020, the Freestyle Leber rolls in at about 90%. The Dexcom G7 also rolls in at 90%, but the Medtronic Simplera drops right down to about 60 or 70%.

And the reason for that is, is because the Medtronic Simplair is very aligned to venous glucose. So it's very accurate to venous glucose, whereas the other ones are kind of a lot more accurate to capillary glucose. And there's been a recent set of studies comparing the Medtronic 780G versus the control IQ that uses Dexcom G6. And what they actually found is, is that on average, the Medtronic 780G got between five to 7 % more time in range because the algorithm is more aggressive.

So if you were the user, what would you think?

Speaker 2 (24:47.874)
would be the one that I'd want to write.

And you think you'd get a lower HbA1c and lower complications. But yet when they did the Hb1c's in those studies, they were exactly the same. And that's because the G6 is more aligned with capillary glucose. Therefore, a let's say a 70 % with a dexcom G7 sensor is about equivalent to a 75 % with a simplera. Now, if you're on a 780, you do not need to panic at this point.

because you are on a set on a system that is very aggressive and will get you the extra 5 % timing range. You do not need to worry about that. You're not going to be. The only thing is you've probably given it the superior that I've got 75 % timing range to check me out. But the reality is it's only worth 70 % for someone else on there. But yeah, potentially when you know, 75 % I should have a hit frequency of 6 % or 42 millimoles per mile. And it comes back at like, you know, 6.7 % or and there's nothing else you can do to push it further. So

be really disappointed at clinic.

Speaker 1 (25:41.898)
Again, this isn't a downside of the sensor. It is accurate to venous glucose, which is where everything was previously aligned to. So it's a very accurate sensor. But when you're looking at capillary, what people's levels are exposed to, it changes the game. So the sooner we get to standard ice testing, doing it against capillary, it's going to be better for the people with diabetes because they're going to have an understanding of what their bodies are exposed to and what gets measured gets managed.

If you think you're running lower than you actually are, you don't do anything about it because you only see the CGM value and you act on that. You don't go, oh, I know that's reading a bit lower, so I have to drive it a bit higher. Like that never comes into your thought process. So basically what we're saying at this point is all of the ones that we've described have been tested robustly. They've all got pretty much compared to venous glucose, 90 % no risk readings, less than 1 % high risk readings.

But against Capillary, you've now got the G7 Freestyle Leaver 3. And also I should mention the new AcuCheck Rush Smart Guide was purposely tested against Capillary. So theirs is the latest paper out in terms of accuracy. And they went to the lead of the IFCC at the time, Dr. Guido Freckmann. And if anyone knows that name, they know he is basically...

the godfather of accuracy of glucose monitors, whether it be fingerprint monitors or CGM. More than you. Well, I sit on the IFC CGM working group. I swear to God, I am the dumbest person on there by a country mile. I sit there and I'm like, I just got to this really stupid question. I'll give you an example of one of them now. So I always used to think that YSI was a venous glucose measure. Okay. As most people probably do. then someone kind of go, are we measured?

The capillary glucose via YSI. So I hopped in and said, how can you measure the venous glucose with YSI on? John, the YSI is a laboratory measure to assess glucose. It doesn't look at where you're measuring it from. It measures glucose, John. I was like, okay, yeah, okay. I mean, that's just one example. If you're sat there and you're thinking, I didn't know that, I'm making these mistakes left, right and center. Who is this bloke that we brought into this group? But if he's on your paper and he is...

Speaker 1 (27:58.542)
doing the senior author, you know, it's been done robustly. So it's been done properly, the study design, and they measured against capillary glucose rather than venous glucose. And again, you can see there on we'll put it in the show notes, but above 90 % and sort of in the no risk category with virtually no readings, less than 1 % in the sort of the high risk category. So again, that is another well tested against capillary sensor that offers another option that you can feel comfortable with.

doing your insulin dose decisions off. So we've got the Freestyle Libra products, two three plus, G6, G7, Dexcom One, Dexcom One Plus, Medtronic Simplera, Guardian Four, AcuCheck, Rush Smart Guide. Now you see I mentioned ever since, I'm not really gonna talk about that much because I don't really know much about it. We don't have it in the UK and I don't like to talk about things that I don't really have an idea about. So I apologize if you work for them or you're using one of those, but I don't like to talk about things that...

really you've got no clear understanding of. So now we know that these ones are all good for insulin dosing decisions, we now get to the fun part which is going to be part three which is talking about right we're happy it's accurate, we're happy it's been measured against capillary glucose and we understand that CGM is low risk, it's not no risk, it's low risk. What are the things, the features, the bells, the whistles, the alarms, the sensor wear?

that these things have got and what's gonna be the best suitable one for me. So that's gonna be part three. So I appreciate that that's probably a lot to take on board, but as I mentioned to you, with the DSM forum, we'll put it on both this site and I'll point to it when they get the charts up on there in the next two or three weeks. It's all broken down for you. Study design score out of five, accuracy out of 20, 20, 40, 40, features, things, and then therefore you've just got one place to go if you wanna kind of...

recap on things or hopefully you've got this and you feel in a position to teach one of some of your colleagues or teach other people diabetes to actually give them the 101 on why it's important to do study design before performance, performance against capillary and understand what no risk and high risk means.

Speaker 2 (30:08.942)
So when's that DSM type going to be published?

good question. So we've got an article under review to kind of give the backbone to that. But with the charts ready to go, we're just waiting for that article so we can kind of pop it up. So today is the ninth or 10th of April. I'll be confident by the end of April that thing will be out. And if so, if you subscribed, you'll certainly get an email ping to you. But if you also go to the DSN forum, I presume you can subscribe to them. you

Yeah, you can just follow them online.

Yeah. I mean, as a note of that, I had a bit of a run in with the DSM forum about two or three years ago about one of the chats that they had. And yeah, and then I ended up meeting some of them at the ATTD and we got sat down and obviously over a glass of wine. We made friends and we thought we need to kind of come together and provide something that's helpful. It doesn't have to be perfect. It just needs to be helpful because as you probably understand by now, it's a very technical and challenging area and we've just scratched the surface.

And like I say, I sit in those IFCC meetings and it's always good to make sure that you're the dumbest person in the room because you're going to learn the most, but you're also going to have a thick skin with people rolling their eyes looking at you. Good for me that I've got a thick skin.

Speaker 2 (31:20.408)
Continue doing that,

Alright, so we'll see you in part three for the bells and whistles.