Targeting glucose control in preterm infants: pilot studies of continuous glucose monitoring

Thomson, Lynn; Elleri, Daniela; Bond, Simon; Howlett, James; Beardsall, Kathryn

doi:10.1136/archdischild-2018-314814

Cited by 28 publications

(30 citation statements)

References 28 publications

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“…However, we found a median MAD of 9.7% between the CGM and glucometer readings overall, and 9.1% at values <63 mg/dL, suggesting acceptable accuracy (37). This is consistent with previous studies of similar systems in infant populations, which also demonstrated acceptable accuracy using the same sensor as our study with a different monitor (38), and using an older Medtronic sensor (39). The latter study found that this older CGM system was less accurate at lower glucose levels, when more than 50% of readings had an error in excess of 10%.…”

Section: Discussionsupporting

confidence: 91%

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

Stewart

Thomson

Murphy

et al. 2019

Diabetes Technology & Therapeutics

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To describe the continuous glucose monitoring (CGM) profiles of type 1 diabetes (T1D) offspring in the early neonatal period and its association with maternal intrapartum glucose control. Methods: A prospective observational study of T1D pregnant women and their neonatal offspring. Women had a CGM sensor inserted 2-3 days prior to delivery. Infants had a masked CGM sensor inserted as soon as possible following delivery. Maternal glycaemic outcomes were time-in-target (70-140 mg/dL [3.9-7.8 mmol/L]), hyperglycaemia >140 mg/dL (7.8 mmol/L) and mean CGM glucose during the 24 hours preceding delivery. Neonatal outcomes included lowest recorded blood glucose concentration, and CGM measures (glucose <47 mg/dL [2.6 mmol/L], time-in-target (47-144 mg/dL [2.6-8.0 mmol/L]), glucose SD) during the first 72 hours of life. Results: Data were available for 16 mother-infant pairs. Mothers had a mean age (SD) 32.3 (4.3) years, T1D duration 17.6 (6.8) years, first antenatal HbA1c 7.4 (0.8)% (57 [8.5] mmol/mol). In the 24 hours preceding delivery, mothers spent mean (SD) 72 (20) % time-intarget (70-140 mg/dL [3.9-7.8 mmol/L]), 19 (15) % time >140 mg/dL (7.8 mmol/L), and 9 (9) % time < 70 mg/dL (3.9 mmol/L) with mean (SD) CGM glucose 113 (9) mg/dL (6.3 [0.7] mmol/L). 15 infants (93.8%) had ≥1 blood glucose concentration < 47 mg/dL (2.6 mmol/L) and five had ≥1 blood glucose concentration < 18 mg/dL (1.0 mmol/L). The mean infant CGM glucose on days 1, 2, and 3 of life was 63 (14), 67 (13), 76 (11) mg/dL (3.5 [0.8], 3.7 [0.7], and 4.2 [0.6] mmol/L). Four infants (25%) spent more than 50% time with CGM glucose levels < 47 mg/dL (2.6 mmol/L) on day 1. Conclusions: CGM detected widespread neonatal hypoglycaemia, even among mothers with good intrapartum glucose control. .

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Section: Discussionsupporting

confidence: 91%

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

Stewart

Thomson

Murphy

et al. 2019

Diabetes Technology & Therapeutics

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“…The paper algorithm for insulin delivery has previously been described (see online supplementary appendix 1). 14 It provided guidance based on the absolute SG value as well as glucose trends. If SG levels were outside of the target range it advised to review the clinical care, dextrose infusion rate and to consider modifying insulin delivery, which could be instigated by the nurse at the cot side.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Continuous glucose monitoring (CGM) has been used in neonatal care to identify hypoglycaemia and is increasingly being considered as a potential adjunct to support clinical management 8 11–1514. Adaptive computerised algorithms using blood glucose (BG) measurements have been evaluated in adults16–18 and neonates undergoing intensive care 12 19.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of automated insulin delivery guided by continuous glucose monitoring in preterm infants

Beardsall

Thomson

Elleri

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveClosed-loop systems have been used to optimise insulin delivery in children with diabetes, but they have not been tested in neonatal intensive care. Extremely preterm infants are prone to hyperglycaemia and hypoglycaemia; both of which have been associated with adverse outcomes. Insulin sensitivity is notoriously variable in these babies and glucose control is time-consuming, with management requiring frequent changes of dextrose-containing fluids and careful monitoring of insulin treatment. We aimed to evaluate the feasibility of closed-loop management of glucose control in these infants.Design and settingSingle-centre feasibility study with a randomised parallel design in a neonatal intensive care unit. Eligibility criteria included birth weight <1200 g and <48 hours of age. All infants had subcutaneous continuous glucose monitoring for the first week of life, with those in the intervention group receiving closed-loop insulin delivery in a prespecified window, between 48 and 72 hours of age during which time the primary outcome was percentage of time in target (sensor glucose 4–8 mmol/L).ResultsThe mean (SD) gestational age and birth weight of intervention and control study arms were 27.0 (2.4) weeks, 962 (164) g and 27.5 (2.8) weeks, 823 (282) g, respectively, and were not significantly different. The time in target was dramatically increased from median (IQR) 26% (6-64) with paper guidance to 91% (78-99) during closed loop (p<0.001). There were no serious adverse events and no difference in total insulin infused.ConclusionsClosed-loop glucose control based on subcutaneous glucose measurements appears feasible as a potential method of optimising glucose control in extremely preterm infants.

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“…Thomson et al 1 report the results of a single-centre study in which feasibility of CGM for very preterm infants was assessed. The study was divided into two phases.…”

mentioning

confidence: 99%

Continuous glucose monitoring in the neonatal intensive care unit: not quite ready for ‘plug and play’

Hernandez

Hay

Rozance

2018

Arch Dis Child Fetal Neonatal Ed

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Targeting glucose control in preterm infants: pilot studies of continuous glucose monitoring

Abstract: This study suggests that CGM has sufficient accuracy and utility in preterm infants to warrant formal testing in a RCT.

Cited by 28 publications

References 28 publications

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes

Feasibility of automated insulin delivery guided by continuous glucose monitoring in preterm infants

Continuous glucose monitoring in the neonatal intensive care unit: not quite ready for ‘plug and play’

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