BACKGROUND: Continuous glucose monitoring has been proposed to optimize glucose control in critically ill patients. To achieve strict glucose regulation, accurate and reliable continuous glucose-monitoring systems are essential. OBJECTIVE: Evaluation of a subcutaneous continuous glucose-monitoring system for use in critically ill patients. DESIGN: Pooled-data analysis of two prospective, randomized, controlled trials. SETTING: An eight-bed medical intensive care unit of a university hospital. PATIENTS: A total of 174 critically ill patients on intensive insulin therapy. INTERVENTIONS: Subcutaneous continuous glucose monitoring. MEASUREMENTS: Two thousand forty-five continuous glucose-monitoring system sensor glucose values were compared with arterial reference blood glucose levels, determined by a blood gas analyzer. Continuous glucose monitoring data were recorded continuously for up to 72 hrs by using a subcutaneous continuous glucose-monitoring sensor. The correlation of both methods and differences between continuous glucose-monitoring systems and reference values were calculated, as well as the conformity of continuous glucose-monitoring values with the International Organization for Standardization criteria (<0.83 mmol/L [15 mg/dL] difference for glucose values ≤ 4.12 mmol/L [≤ 75 mg/dL] and <20% difference for glucose values >4.12 mmol/L [>75 mg/dL]). RESULTS: The Pearson correlation coefficient was 0.92, showing strong correlation between the two methods. The intraclass correlation coefficient was 0.92, indicating that 92% of the variability is due to subjects and measurement occasions. Mean difference between continuous glucose-monitoring system and reference values was -0.10 mmol/L (confidence interval: -0.13 to -0.07) (-2 mg/dL [confidence interval: -2 to -1]) (continuous glucose-monitoring system minus reference) and absolute difference 0.44 mmol/L (confidence interval: 0.41-0.47) (8 mg/dL [confidence interval: 7-8]). According to the insulin titration error grid analysis, 99.1% of continuous glucose-monitoring system values were in the acceptable treatment zone. No continuous glucose-monitoring system measurements were found in the life-threatening zone, and 92.9% of the continuous glucose-monitoring system glucose values met the International Organization for Standardization criteria. CONCLUSION: The subcutaneous continuous glucose-monitoring system is reliable for use in critically ill patients and showed glucose values with a strong correlation to arterial reference blood glucose levels, determined by a blood gas analyzer.
BACKGROUND: Continuous glucose monitoring has been proposed to optimize glucose control in critically ill patients. To achieve strict glucose regulation, accurate and reliable continuous glucose-monitoring systems are essential. OBJECTIVE: Evaluation of a subcutaneous continuous glucose-monitoring system for use in critically ill patients. DESIGN: Pooled-data analysis of two prospective, randomized, controlled trials. SETTING: An eight-bed medical intensive care unit of a university hospital. PATIENTS: A total of 174 critically ill patients on intensive insulin therapy. INTERVENTIONS: Subcutaneous continuous glucose monitoring. MEASUREMENTS: Two thousand forty-five continuous glucose-monitoring system sensor glucose values were compared with arterial reference blood glucose levels, determined by a blood gas analyzer. Continuous glucose monitoring data were recorded continuously for up to 72 hrs by using a subcutaneous continuous glucose-monitoring sensor. The correlation of both methods and differences between continuous glucose-monitoring systems and reference values were calculated, as well as the conformity of continuous glucose-monitoring values with the International Organization for Standardization criteria (<0.83 mmol/L [15 mg/dL] difference for glucose values ≤ 4.12 mmol/L [≤ 75 mg/dL] and <20% difference for glucose values >4.12 mmol/L [>75 mg/dL]). RESULTS: The Pearson correlation coefficient was 0.92, showing strong correlation between the two methods. The intraclass correlation coefficient was 0.92, indicating that 92% of the variability is due to subjects and measurement occasions. Mean difference between continuous glucose-monitoring system and reference values was -0.10 mmol/L (confidence interval: -0.13 to -0.07) (-2 mg/dL [confidence interval: -2 to -1]) (continuous glucose-monitoring system minus reference) and absolute difference 0.44 mmol/L (confidence interval: 0.41-0.47) (8 mg/dL [confidence interval: 7-8]). According to the insulin titration error grid analysis, 99.1% of continuous glucose-monitoring system values were in the acceptable treatment zone. No continuous glucose-monitoring system measurements were found in the life-threatening zone, and 92.9% of the continuous glucose-monitoring system glucose values met the International Organization for Standardization criteria. CONCLUSION: The subcutaneous continuous glucose-monitoring system is reliable for use in critically ill patients and showed glucose values with a strong correlation to arterial reference blood glucose levels, determined by a blood gas analyzer.
Authors: Rodolfo J Galindo; Guillermo E Umpierrez; Robert J Rushakoff; Ananda Basu; Suzanne Lohnes; James H Nichols; Elias K Spanakis; Juan Espinoza; Nadine E Palermo; Dessa Garnett Awadjie; Leigh Bak; Bruce Buckingham; Curtiss B Cook; Guido Freckmann; Lutz Heinemann; Roman Hovorka; Nestoras Mathioudakis; Tonya Newman; David N O'Neal; Michaela Rickert; David B Sacks; Jane Jeffrie Seley; Amisha Wallia; Trisha Shang; Jennifer Y Zhang; Julia Han; David C Klonoff Journal: J Diabetes Sci Technol Date: 2020-09-28