Continuous Glucose Monitoring System in a Rural Intensive Care Unit: A Pilot Study Evaluating Accuracy and Acceptance

Jacobs, Brooke S.; Phan, K. A.; Bertheau, Leonard; Dogbey, Godwin; Schwartz, Frank; Shubrook, Jay H.

doi:10.1177/193229681000400318

Cited by 37 publications

(37 citation statements)

References 29 publications

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“…During the present study, the proportion of sensor glucose values within 20% of reference glucose was 88% with the enhanced protocol, compared with reported values between 63% and 75% [14][15][16] other than for Brunner et al, 17 who reported a higher percentage of 92%. Most intensive care unit studies evaluated Medtronic (Northridge, CA) sensors, 14,[16][17][18] and only one study evaluated Navigator.…”

Section: Discussionmentioning

confidence: 49%

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Accuracy of Subcutaneous Continuous Glucose Monitoring in Critically Ill Adults: Improved Sensor Performance with Enhanced Calibrations

Leelarathna

English²,

Thabit

et al. 2014

Diabetes Technology & Therapeutics

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Objective: Accurate real-time continuous glucose measurements may improve glucose control in the critical care unit. We evaluated the accuracy of the FreeStyle Ò Navigator Ò (Abbott Diabetes Care, Alameda, CA) subcutaneous continuous glucose monitoring (CGM) device in critically ill adults using two methods of calibration. Subjects and Methods: In a randomized trial, paired CGM and reference glucose (hourly arterial blood glucose [ABG]) were collected over a 48-h period from 24 adults with critical illness (mean -SD age, 60 -14 years; mean -SD body mass index, 29.6 -9.3 kg/m 2 ; mean -SD Acute Physiology and Chronic Health Evaluation score, 12 -4 [range, 6-19]) and hyperglycemia. In 12 subjects, the CGM device was calibrated at variable intervals of 1-6 h using ABG. In the other 12 subjects, the sensor was calibrated according to the manufacturer's instructions (1, 2, 10, and 24 h) using arterial blood and the built-in point-of-care glucometer. Results: In total, 1,060 CGM-ABG pairs were analyzed over the glucose range from 4.3 to 18.8 mmol/L. Using enhanced calibration median (interquartile range) every 169 (122-213) min, the absolute relative deviation was lower (7.0% [3.5, 13.0] vs. 12.8% [6.3, 21.8], P < 0.001), and the percentage of points in the Clarke error grid Zone A was higher (87.8% vs. 70.2%). Conclusions: Accuracy of the Navigator CGM device during critical illness was comparable to that observed in non-critical care settings. Further significant improvements in accuracy may be obtained by frequent calibrations with ABG measurements.

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Section: Discussionmentioning

confidence: 49%

“…Most intensive care unit studies evaluated Medtronic (Northridge, CA) sensors, 14,[16][17][18] and only one study evaluated Navigator. 19 Further improvements in accuracy may be achievable through the intravenous sampling route eliminating or significantly reducing the lag time of 6-15 min reported with subcutaneous sensors.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Subcutaneous Continuous Glucose Monitoring in Critically Ill Adults: Improved Sensor Performance with Enhanced Calibrations

Leelarathna

English²,

Thabit

et al. 2014

Diabetes Technology & Therapeutics

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“…However, CGM did not affect the degree of hyperglycemia when compared to intermittent BG testing, which could possibly be explained by having already achieved tight glycemic control in the intermittent BG testing group. 30 In other reports, Jacobs et al showed that their subcutaneous CGM was not sufficiently accurate outside of the euglycemic spectrum 31 and Brunner et al did not appreciate a difference in the control of glycemic variability in their retrospective study of 63 patients. 32 The clinical accuracy of different continuous monitors in various clinical settings is still being explored.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of a Novel Noninvasive Transdermal Continuous Glucose Monitor in Critically Ill Patients

Saur

England

Menzie

et al. 2014

J Diabetes Sci Technol

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Stress hyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the critically ill. Intermittent, random blood glucose (BG) measurements can miss episodes of hyper-and hypoglycemia. The purpose of this study was to determine the accuracy of the Symphony® continuous glucose monitor (CGM) in critically ill cardiac surgery patients. Fifteen adult cardiac surgery patients were evaluated immediately postoperatively in the intensive care unit. Prelude® SkinPrep prepared the skin and a sensor was applied to 2 test sites on each subject to monitor interstitial fluid glucose. Reference BG was sampled at 30-to 60-minute intervals. The skin at the test sites was inspected for adverse effects. Accuracy of the retrospectively analyzed CGM data relative to reference BG values was determined using continuous glucose-error grid analysis (CG-EGA) and mean absolute relative difference (MARD). Using 570 Symphony CGM glucose readings paired with reference BG measurements, CG-EGA showed that 99.6% of the readings were within zones A and B. BG measurements ranged from 73 to 251 mg/dL. The MARD was 12.3%. No adverse device effects were reported. The Symphony CGM system is able to safely, continuously, and noninvasively monitor glucose in the transdermal interstitial fluid of cardiac surgery intensive care unit patients with accuracy similar to that reported with other CGM systems. Future versions of the system will need real-time data analysis, fast warm-up, and less frequent calibrations to be used in the clinical setting.

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“…BMI, body mass index; EF, ejection fraction; WBC, white blood cell; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol Data are reported as the mean ± SD or n (%). BMI, body mass index; EF, ejection fraction; WBC, white blood cell; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol other studies argued that CGMS glucose values are not sufficiently accurate and reliable to be used for therapeutic decisions [30][31][32]. Currently, clinical experience with CGMS in CCUs is limited, particularly for STEMI patients undergoing p-PCI.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

Zhang¹,

Ling²,

Cao³

et al. 2015

CIM

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Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions AbstractPurpose: The purpose of this study was to evaluate the feasibility and safety of continuous glucose monitoring systems (CGMS) in ST segment elevation myocardial infarction (S-TEMI) patients undergoing primary percutaneous coronary interventions (p-PCI) in coronary care units (CCU).Methods: CGMS was performed for 3 days during CCU hospitalization for each of the subjects. The correlation between glucose values, recorded with CGMS, and finger-stick capillary glucose values was examined. The parameters and safety of CGMS were also investigated.Results: Data from 219 subjects were included in the statistical analysis. Correlation analysis showed a strong positive correlation between interstitial glucose values recorded by CGMS and the corresponding capillary glucose values (P<0.001). The daytime mean blood glucose MBG), the nighttime MBG and PT7.8 were the highest in the first day of CGMS compared with the second and third day. Furthermore, there were no indications of major hemorrhage or hematoma at the site of sensor insertion. Any adverse events were mild.Conclusions: CGMS glucose values are relatively accurate and reliable. CGMS were safe and can be used as a tool to detect trends in glucose levels and to predict upcoming glucose excursions in STEMI patients undergoing p-PCI. It is commonly accepted that continuous glucose monitoring systems (CGMS) can provide detailed and accurate glucose information. Relaying this detailed glucose information to patients has been shown to have a positive influence on glycemic control, including reductions in glucose variability, time spent in nocturnal hypoglycemia, time spent in hyperglycemia and levels of glycosylated hemoglobin [1][2][3][4]. Hyperglycemia commonly occurs during acute myocardial infarction (AMI), and in-hospital hyperglycemia is a strong predictor of mortality in AMI patients both with and without a history of diabetes mellitus [5][6]. The adverse outcomes associated with in-hospital hyperglycemia have prompted professional societies to recommend glucose control in AMI patients [5][6][7]; however, implementation of glucose control has been hindered by fear of hypoglycemia, as low glucose levels have been associated with adverse outcomes in AMI patients [8][9]. Patients with STsegment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary interventions (p-PCI) should receive aggressive management and treatment in coronary care units (CCU). As glucose management is a significant component of CCU activity, CGMS are particularly attractive for managing blood glucose (BG) because of their potential to detect hypo-and hyperglycemia as they occur. Many studies have concluded that CGMS face challenges in terms of sensitivity, stability, calibration and the physiological delay between BG and interstitial glucose (IG) concentration [10][11][12]. Moreover, CGMS are more e...

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Continuous Glucose Monitoring System in a Rural Intensive Care Unit: A Pilot Study Evaluating Accuracy and Acceptance

Cited by 37 publications

References 29 publications

Accuracy of Subcutaneous Continuous Glucose Monitoring in Critically Ill Adults: Improved Sensor Performance with Enhanced Calibrations

Accuracy of Subcutaneous Continuous Glucose Monitoring in Critically Ill Adults: Improved Sensor Performance with Enhanced Calibrations

Accuracy of a Novel Noninvasive Transdermal Continuous Glucose Monitor in Critically Ill Patients

Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions

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