Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients*

Brunner, Richard; Kitzberger, Reinhard; Miehsler, Wolfgang; Herkner, Harald; Madl, Christian; Holzinger, Ulrike

doi:10.1097/ccm.0b013e318206bf2e

Cited by 87 publications

(73 citation statements)

References 26 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: 45%

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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: 45%

“…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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“…While few animal studies have been done, the reliability of CGMSs in critically ill patients is an area of active research. The results to date have revealed a strong correlation between arterial reference blood glucose and better performance, compared with point-of-care devices (Corstjens et al 2006;Hoedemaekers et al 2008;Holzinger et al 2009;Brunner et al 2011). These studies pointed out that the accuracy of CGMSs becomes diminished in the hypoglycaemic range.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, a larger scale study in 174 critically ill patients revealed a Pearson correlation coefficient of 0.92 when compared to arterial BG levels. Insulin titration error grid analysis to assess the clinical safety of the CGMS demonstrated that more than 99% of determinations were in clinically acceptable zones (Brunner et al 2011). The purpose of using CGMSs is to predict hypo-and hyperglycaemic states, so accurate measurement at the extreme ranges is important.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report

Kim¹,

Kim²,

Kang³

et al. 2017

Vet. Med. - Czech

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ABSTRACT:A Miniature schnauzer (12 years old, neutered male) was referred for lethargy, anorexia, and oral bleeding. On initial evaluation, severe hyperglycaemia (blood glucose concentration of 34.9 mmol/l), ketonuria, systemic inflammation (fever, panting, left-shift neutrophilia, and a high C-reactive protein level of 980.97 nmol/l, abnormal pancreatic lipase immunoreactivity, and periodontitis were found. With consideration of possible insulin resistance, blood glucose (BG) levels were monitored using a portable glucose meter (q 1-3 h) and a continuous glucose monitoring system (CGMS) for 72 h (three consecutive trials); intensive insulin therapy was initiated using regular insulin (2.2 IU/kg intravenously). The insulin doses needed, based on the nadir, peak, and duration of insulin action from a traditional intermittent glucose curve were higher than those based on the CGMS results. Meanwhile, transient hyperglycaemic and hypoglycaemic periods, occurring between the intermittent measurements, were easily identified with the CGMS. Therefore, insulin resistance and the Somogyi phenomenon are less likely to occur with use of the CGMS than with intermittent BG measurements. By comparing data from a CGMS to those from an intermittent portable BG measurement system, this case report emphasises the importance and usefulness of a CGMS.

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“…Others found it useful for reducing hyperglycaemic episodes 35 . The analysis of two prospective randomized trials demonstrated clinically sufficient accuracy and safety 36,37 even in patients on vasopressors 38 . Some reject the use of subcutaneous sensors in the ICU setting 39,40 .…”

Section: Introductionmentioning

confidence: 99%

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

Poljakova¹,

Elsikova²,

Chlup³

et al. 2013

BIOMED PAP

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Aims.To explore the feasibility of subcutaneous continuous glucose monitoring (CGM) in perioperative settings and to evaluate the perioperative development of glycaemia in persons with diabetes mellitus or impaired glucose tolerance by means of CGM. Methods. Monitoring by means of Guardian® REAL-Time CGMS (Medtronic, Nortridge, USA) in 20 perioperative periods. Sensor was inserted on the day before surgery and continued for 3 days with some exceptions. Results. Full implementation of the method was successful in the intensive care unit setting only. No electromagnetic interference and no side effects were found. The Wilcoxon signed-rank test revealed no significant difference between sensor and laboratory analyser values. Pearson´s correlation coefficients of the values obtained by sensor and the Wellion Linus glucometer were 0.875 for the whole perioperative period, 0.866 for the intraoperative period and 0.903 for the first perioperative day. A decline in sensor accuracy on the 6 th day was registered in one case. 16 monitored cases (80%) did not meet the criteria for safe plasma glucose range. Hypoglycaemia was found in 4 (20%) cases. There was an association between grade of the perioperative dysglycaemia and need for reoperation within the next 3 months. The most frequent perioperative glycaemic patterns are demonstrated. Conclusion. Subcutaneous CGM is safe offering detailed insight into glucose homeostasis in the dynamic perioperative period. Laboratory confirmation of sensor plasma glucose concentration by approved laboratory analyser is still necessary. The potentional benefits of maintaining patients within a safe glucose range should be comfirmed by future studies.

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Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients*

Abstract: The subcutaneous continuous glucose-monitoring system is reliable for use in critically ill patients and showed glucose values with a strong correlation to arterial reference blood glucose levels, determined by a blood gas analyzer.

Cited by 87 publications

References 26 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

Comparison of continuous and intermittent glucose monitoring systems in a dog with diabetic ketoacidosis: a case report

Glucose sensing module - is it time to integrate it into real-time perioperative monitoring? An observational pilot study with subcutaneous sensors

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