Continuous Glucose Monitoring in the Intensive Care Unit: A Multicenter, Retrospective Hospital-Based Analysis
Abstract
Background: There is limited experience with continuous glucose monitoring (CGM) in intensive care units (ICUs). This study examined CGM accuracy and changes during hemodynamic instability in ICU patients with COVID-19.
Methods: We pooled data from three ICUs using CGM within a hybrid protocol combining point-of-care (POC) blood glucose testing with intermittent nonadjunctive CGM use. We compared sensor-meter agreement during lowest oxygen saturation, arterial partial pressure of oxygen (PaO2), pH, or mean arterial pressure (MAP). Linear mixed models (LMM) were used to estimate the effects of clinical condition on estimates of sensor accuracy.
Result: Of 169 patients, >80% had a history of diabetes, mean age was 61 ± 12 years, and 82%, 93%, and 62% received corticosteroids, mechanical ventilation and vasopressors respectively. The median percent CGM time in range (TIR, 70-180 mg/dL) was 72% (64.9-81.4), 70% (54.0-76.9), and 46% (26.6-68.5) for hospitals A, B, and C. Median time below 70 mg/dL was 2, oxygen saturation, pH, or mean arterial pressure. In LMM adjusting for within subject and between subject variability, patients on dialysis had higher mean absolute relative difference (MARD, [coefficient = 2.39, P = .05]), while patients on mechanical ventilation had lower MARD ventilation (coefficient = -4.33, P = .05). Of the 6783 pairs 97.3% fell within Clare zones A and B.
Conclusion: These preliminary findings suggest CGM use does not appear to be significantly affected…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 169 participants or records.
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