Outcomes and Healthcare Provider Perceptions of Real-Time Continuous Glucose Monitoring (rtCGM) in Patients With Diabetes and COVID-19 Admitted to the ICU

Abstract

Objective: We assessed the clinical utility and accuracy of real-time continuous glucose monitoring (rtCGM) (Dexcom G6) in managing diabetes patients with severe COVID-19 infection following admission to the intensive care unit (ICU). Methods: We present retrospective analysis of masked rtCGM in 30 patients with severe COVID-19. rtCGM was used during the first 24 hours for comparison with arterial-line point of care (POC) values, where clinicians utilized rtCGM data to adjust insulin therapy in patients if rtCGM values were within 20% of point-of-care (POC) values during the masked period. An investigator-developed survey was administered to assess nursing staff ( n = 66) perceptions regarding the use of rtCGM in the ICU. Results: rtCGM data were used to adjust insulin therapy in 30 patients. Discordance between rtCGM and POC glucose values were observed in 11 patients but the differences were not considered clinically significant. Mean sensor glucose decreased from 235.7 ± 42.1 mg/dL (13.1 ± 2.1 mmol/L) to 202.7 ± 37.6 mg/dL (11.1 ± 2.1 mmol/L) with rtCGM management. Improvements in mean sensor glucose were observed in 77% of patients ( n = 23) with concomitant reductions in daily POC measurements in 50% of patients ( n = 15) with rtCGM management. The majority (63%) of nurses reported that rtCGM was helpful for improving care for patients with diabetes patients during the COVID-19 pandemic, and 49% indicated that rtCGM reduced their use of personal protective equipment (PPE). Conclusions: Our findings provide a strong rationale to increase clinician awareness for the adoption and implementation of rtCGM systems in the ICU. Additional studies are needed to further understand the utility of rtCGM in critically ill patients and other clinical care settings.

Novel Glycemic Index Based on Continuous Glucose Monitoring to Predict Poor Clinical Outcomes in Critically Ill Patients: A Pilot Study

“…Traditional POC glucose measurements are considered to be accurate and reliable and have the advantage of providing quick results compared to central laboratory measurements ( 28 ). CGM in critically ill patients is not only as effective as POC, but also reduces hypoglycemic events ( 29 , 30 ) and nursing workload, and is cost effective ( 31 , 32 ). It may be argued that placing a subcutaneous CGM can be disadvantageous in some clinical scenarios that may occur in the ICU setting, such as hypoperfusion.…”

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

“…Sensor insertion was done by a trained nurse, nurse practitioner or healthcare professional in most of the studies [ 35 – 37 , 38 ▪▪ , 39 , 42 , 43 ]. For the studies using Dexcom G6 system, glucose data was transmitted to Dexcom receivers [ 36 , 42 ], Android phones [ 38 ▪▪ ] or both iPad and iPhones [ 35 ] and were placed close to the patient's room. These receiving devices were within 10–20 feet from the transmitter to ensure Bluetooth transmission.…”

“…Chow et al assessed nursing staff perception and acceptance of real time-CGM revealing 63% of participating nurses viewed real time-CGM as a helpful tool improving clinical care for patients with diabetes and COVID-19. Additionally, 49% of nursing staff reported real time-CGM reduced PPE use [ 42 ]. Other studies noted reduction in POC ranging between 50 and 63% [ 36 , 42 , 44 ▪ ].…”

“…Additionally, 49% of nursing staff reported real time-CGM reduced PPE use [ 42 ]. Other studies noted reduction in POC ranging between 50 and 63% [ 36 , 42 , 44 ▪ ]. While implementation of a hybrid CGM and POC protocol by Faulds et al was well received by nursing staff, there was unanimous consensus amongst them that the protocol was excessively lengthy [ 38 ▪▪ ].…”

Real-World Studies Support Use of Continuous Glucose Monitoring in Type 1 and Type 2 Diabetes Independently of Treatment Regimen

“…In another single-center cohort study, CGM data (Dexcom G6) from 30 diabetic patients during the first 24 h of admission to intensive care with severe coronavirus disease 2019 (COVID-19) infection were compared with glucose values from arterial line point-of-care (POC) values. 42 CGM data were used to adjust insulin if CGM values were within 20% ), and gender Reduction in A1C in all three countries: -0.9% (Austria), -0.8% (France), and -0.9% (Germany), all P < 0.0001 A1C improvements across all subgroups, with no significant differences between subgroups ACH, all-cause hospitalization; ADEs, acute diabetes-related adverse events; BGM, blood glucose monitoring; BMI, body-mass index; CGM, continuous glucose monitoring; CV, coefficient of variation; CSII, continuous subcutaneous insulin infusion; DKA, diabetic ketoacidosis; DPV, Diabetes Prospective Follow-up Registry; HR, hazard ratio; IBM; MDI, multiple daily insulin injections; QoL, quality of life; SH, severe hypoglycemia; SH; Studies; T1D, type 1 diabetes; T2D, type 2 diabetes; TAR, time above range; TBR, time below range; TIR, time in range.…”