Yan Yao1, Yi-He Zhao1, Wen-He Zheng2, Hui-Bin Huang1. 1. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing 102218, China. 2. Department of Critical Care Medicine, The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine No. 282 of 54 Road, Gulou District, Fuzhou 350000, Fujian, China.
Abstract
BACKGROUND: Using continuous glucose monitoring (CGM) in critically ill adult patients requiring insulin therapy has increased with inconsistent results. Thus, we conducted a meta-analysis to assess the effect of CGM and frequent point-of-care (POC) measurements in such a patient population. METHODS: We searched PubMed, Embase, Cochrane Library, China national knowledge infrastructure, and Wanfang for relevant articles from inception to Jan 15, 2022. Randomized controlled trials (RCTs) were considered if they focused on critically ill patients who required insulin and were treated with CGM or any POC measurements. We used the Cochrane risk evaluating tool to assess study quality. Subgroup analysis and publication bias were also conducted. RESULTS: We finally included 19 RCTs with 1,852 participants. The quality of the included studies were at a low to moderate levels. Overall, CGM devices significantly reduced hypoglycemia incidence (Risk ratio (RR) 0.35; 95% CI, 0.25-0.49; P<0.00001) than the POC measurement. Further subgroup and sensitivity analyses confirmed this result. The CGM group also had lower overall mortality (RR 0.54; 95% CI, 0.34-0.86; P=0.01), lower glucose variability, and nosocomial infection. The time in, below, or above target blood glucose range, insulin use, and length of stay in the ICU were comparable between the two groups. In addition, few studies provided data in favor of decreased nursing workload and medical costs in the CGM group. CONCLUSIONS: The CGM technique could significantly reduce hypoglycemia incidence, overall mortality, and glucose variability compared to POC measurement in critically ill patients. However, further large, well-designed RCTs are required to confirm our results. AJTR
BACKGROUND: Using continuous glucose monitoring (CGM) in critically ill adult patients requiring insulin therapy has increased with inconsistent results. Thus, we conducted a meta-analysis to assess the effect of CGM and frequent point-of-care (POC) measurements in such a patient population. METHODS: We searched PubMed, Embase, Cochrane Library, China national knowledge infrastructure, and Wanfang for relevant articles from inception to Jan 15, 2022. Randomized controlled trials (RCTs) were considered if they focused on critically ill patients who required insulin and were treated with CGM or any POC measurements. We used the Cochrane risk evaluating tool to assess study quality. Subgroup analysis and publication bias were also conducted. RESULTS: We finally included 19 RCTs with 1,852 participants. The quality of the included studies were at a low to moderate levels. Overall, CGM devices significantly reduced hypoglycemia incidence (Risk ratio (RR) 0.35; 95% CI, 0.25-0.49; P<0.00001) than the POC measurement. Further subgroup and sensitivity analyses confirmed this result. The CGM group also had lower overall mortality (RR 0.54; 95% CI, 0.34-0.86; P=0.01), lower glucose variability, and nosocomial infection. The time in, below, or above target blood glucose range, insulin use, and length of stay in the ICU were comparable between the two groups. In addition, few studies provided data in favor of decreased nursing workload and medical costs in the CGM group. CONCLUSIONS: The CGM technique could significantly reduce hypoglycemia incidence, overall mortality, and glucose variability compared to POC measurement in critically ill patients. However, further large, well-designed RCTs are required to confirm our results. AJTR
Authors: Daphne T Boom; Marjolein K Sechterberger; Saskia Rijkenberg; Susanne Kreder; Rob J Bosman; Jos Pj Wester; Ilse van Stijn; J Hans DeVries; Peter Hj van der Voort Journal: Crit Care Date: 2014-08-20 Impact factor: 9.097
Authors: James S Krinsley; J Geoffrey Chase; Jan Gunst; Johan Martensson; Marcus J Schultz; Fabio S Taccone; Jan Wernerman; Julien Bohe; Christophe De Block; Thomas Desaive; Pierre Kalfon; Jean-Charles Preiser Journal: Crit Care Date: 2017-07-31 Impact factor: 9.097