Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation
Jazyk angličtina Země Spojené státy americké Médium print
Typ dokumentu časopisecké články
Grantová podpora
National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union - Next Generation EU) MH CZ - DRO (Institute for Clinical and Experimental Medicine - IKEM, IN 00023001)
Cooperatio Programme, section Medical Diagnostics and Basic Medical Sciences, Charles University, Prague, Czech Republic
Odkazy
PubMed
38412005
PubMed Central
PMC11116916
DOI
10.2337/dc23-1663
PII: 154297
Knihovny.cz E-zdroje
- MeSH
- břicho chirurgie MeSH
- dospělí MeSH
- kontinuální monitorování glukózy MeSH
- krevní glukóza * analýza MeSH
- kritický stav * MeSH
- lidé středního věku MeSH
- lidé MeSH
- monitorování fyziologických funkcí metody MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- transplantace orgánů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. RESEARCH DESIGN AND METHODS: We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). RESULTS: We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. CONCLUSIONS: Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.
1st Faculty of Medicine Charles University Prague Czech Republic
3rd Faculty of Medicine Charles University Prague Czech Republic
Diabetes Research Institute Mills Peninsula Medical Center San Mateo CA
U.S. Food and Drug Administration . Enforcement policy for non-invasive remote monitoring devices used to support patient monitoring during the coronavirus disease 2019 (COVID-19) public health emergency (revised), 2020. Accessed 17 October 2022. Available from https://www.fda.gov/media/136290/download
Dexcom. Dexcom G6 CGM system performance summary. Accessed 15 August 2023. Available from https://ie.provider.dexcom.com/dexcom-cgm
International Organization for Standardization . ISO 15197:2013 In vitro diagnostic test systems—requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus. Geneva, Switzerland, International Organization for Standardization, 2013
U.S. Food and Drug Administration. Blood glucose monitoring test systems for prescription point-of-care use guidance for industry and Food and Drug Administration staff . U.S. Department of Health and Human Services Food and Drug Administration Center for Devices and Radiological Health. Accessed 15 August 2023. Available from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/blood-glucose-monitoring-test-systems-prescription-point-care-use
