Continuous Glucose Monitoring in the Intensive Care Unit During the COVID-19 Pandemic

Agarwal, Shivani; Mathew, Justin; Davis, Georgia; Shephardson, Alethea; LeVine, Ann Marie; Louard, Rita J.; Urrutia, Agustina; Perez-Guzman, Citlalli; Umpiérrez, Guillermo E.; Peng, Limin; Pasquel, Francisco J.

doi:10.2337/dc20-2219

Cited by 100 publications

(85 citation statements)

References 14 publications

(12 reference statements)

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“…18 In the hospital, several studies have described how remote monitoring with Share can be used to reduce inpatient hypoglycemia, 19 improve glucose management, 20 and potentially reduce the need for personal protective equipment in the setting of COVID-19. 21,22 This study has several limitations. Data were from users of a single CGM system within the United States, and results might not be generalizable to users of other CGM systems or in other regions.…”

Section: Conclusion/discussionmentioning

confidence: 96%

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Aktürk¹,

Dowd

Shankar

et al. 2021

Diabetes Technology & Therapeutics

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Background: Optional features of continuous glucose monitoring (CGM) systems empower patients and caregivers to understand and manage diabetes in new ways. We examined associations between use of optional features, demographics, and glycemic outcomes. Methods: Retrospective cohort studies were performed with data from US-based users of the G6 CGM System (Dexcom, Inc.). For all cohorts, data included sensor glucose values (SGVs). In separate cohorts, use of alert features (for hyperglycemia, existing hypoglycemia, and impending hypoglycemia), remote data sharing feature (Share), software for retrospective pattern analysis (CLARITY), ''virtual assistant'' feature that announces the current SGV and trend in response to a spoken request were assessed. Descriptive statistics were used to summarize feature set utilization patterns and relate them to glycemic outcomes. Results: Most individual features were consistently adopted by high proportions of G6 users. Threshold SGVs chosen for activating hyperglycemia and hypoglycemia alerts varied with age and were higher among the youngest and oldest patients. Use of the Share feature was more common among young patients and those with type 1 diabetes. Individuals who used more of the alert and notification features had more favorable glycemic outcomes, including time in range (TIR), than those who used fewer. More extensive engagement with CLARITY notifications was associated with higher TIR. Frequent use of the virtual assistant feature was associated with higher TIR and lower mean SGV. Conclusions: Optional features of the G6 CGM system are acceptable to and appear to benefit patients who use them. Different levels of engagement suggest that demographics and personal circumstances play a role in how patients and caregivers use CGM features to help manage diabetes.

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Section: Conclusion/discussionmentioning

confidence: 96%

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Aktürk¹,

Dowd

Shankar

et al. 2021

Diabetes Technology & Therapeutics

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“…The United States Food and Drug Administration issued a policy to expand the availability and capability of noninvasive remote monitoring devices during the pandemic [10]. Previous studies have shown that CGM use might be feasible and reliable in reducing the frequency of point-of-care glucose testing, patient and healthcare worker exposure, and personal protective equipment (PPE) use during the pandemic [3,4]. Although the usefulness of CGM has been reported, the measured glucose levels have been inaccurate because they are often influenced by agents commonly used in critically ill patients, such as severe COVID-19 patients [8].…”

Section: Discussionmentioning

confidence: 99%

“…Constant glucose monitoring can potentially increase the exposure of healthcare workers to COVID-19. To avoid this situation, studies have evaluated and reported the usefulness and safety of continuous glucose monitoring (CGM) systems [3][4][5][6][7]. CGM devices measure glucose in the subcutaneous interstitial fluid; however, this measurement is affected by several factors in critically ill patients [8].…”

Section: Introductionmentioning

confidence: 99%

Glucose control using an artificial pancreas in a severe COVID-19 patient on extracorporeal membrane oxygenation: a case report

Hinoue

Yatabe²,

Fujiwara

et al. 2021

J Anesth

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The usefulness and safety of continuous glucose monitoring (CGM) systems in adult patients with severe coronavirus disease (COVID-19) have been reported. Using CGM might reduce the exposure patients and healthcare workers to COVID-19 and limit the use of personal protective equipment during the pandemic. CGM devices measure glucose in the subcutaneous interstitial fluid, but the accuracy of this technique has not been established in critically ill patients. The artificial pancreas, STG-55 (Nikkiso, Tokyo), is a closed-loop device that conducts continuous blood glucose monitoring using a peripheral vein. We used the STG-55 for glucose control in a 60-year-old woman with severe COVID-19 admitted to the intensive care unit. Due to severe respiratory failure, the patient was intubated, and extracorporeal membrane oxygenation was introduced. Because she had hyperglycemia despite high-dose intravenous insulin therapy, we decided to use STG-55 for glucose control. The STG-55 safely titrated the insulin infusion and monitored glucose levels. Fifty-six hours after adopting the STG-55, it was removed because the blood sampling failed. No episodes of hypoglycemia were observed despite deep sedation during this period. In conclusion, this case demonstrates the potential utility of an artificial pancreas in patients with severe COVID-19.

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“…Finally, two series underscored the usefulness of rCGM in the ICU settings. The first study by Agarwal et al involving 11 critically ill patients due to COVID-19 showed that validated real-time continuous glucose monitoring (rtCGM) is a potential addition to the standard point of care (POC) glucose testing as it is feasible, acceptable, and reliable [54].…”

Section: Health-related Technologiesmentioning

confidence: 99%

Diabetes and COVID-19: The past, the present, and the future

Pranata

Henrina²,

Raffaello

et al. 2021

Metabolism

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Diabetes, one of the most prevalent chronic diseases in the world, is strongly associated with a poor prognosis in COVID-19. Scrupulous blood sugar management is crucial, since the worse outcomes are closely associated with higher blood sugar levels in COVID-19 infection. Although recent observational studies showed that insulin was associated with mortality, it should not deter insulin use in hospitalized patients requiring tight glucose control. Back and forth dilemma in the past with regards to continue/discontinue certain medications used in diabetes have been mostly resolved. The initial fears of consequences related to continuing certain medications have been largely dispelled. COVID-19 also necessitates the transformation in diabetes care through the integration of technologies. Recent advances in health-related technologies, notably telemedicine and remote continuous glucose monitoring, have become essential in the management of diabetes during the pandemic. Today, these technologies have changed the landscape of medicine and become more important than ever. Being a highrisk population, patients with type 1 or type 2 diabetes, should be prioritized for vaccination. In the future, as the pandemic fades, the prevalence of non-communicable diseases is expected to rise due to lifestyle changes and medical issues/dilemma encountered during the pandemic.

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Continuous Glucose Monitoring in the Intensive Care Unit During the COVID-19 Pandemic

Cited by 100 publications

References 14 publications

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Real-World Evidence and Glycemic Improvement Using Dexcom G6 Features

Glucose control using an artificial pancreas in a severe COVID-19 patient on extracorporeal membrane oxygenation: a case report

Diabetes and COVID-19: The past, the present, and the future

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