Accuracy of Continuous Glucose Monitors for Inpatient Diabetes Management

Abstract

Introduction: In hospitalized patients, continuous glucose monitoring (CGM) may improve glycemic control, prevent hypoglycemic events, and reduce staff workload compared with point-of-care (POC) capillary glucose monitoring. Methods: To evaluate CGM accuracy and safety of use in the inpatient setting, two versions of CGM sensors were placed on 43 and 34 adult patients with diabetes admitted to non-intensive care unit (ICU) medical wards, respectively. CGM accuracy relative to POC and safety of use were measured by calculating mean absolute relative difference (MARD) and by Clarke Error Grid (CEG) analysis. Results: CGM version 2 had improved accuracy compared with CGM version 1 with MARD 17.7 compared with 21.4%. CGM accuracy did not change with POC value or with time of sensor wear. On CEG, 98.8% of paired values fell within acceptable zones A and B. Conclusion: Despite reduced accuracy compared with the outpatient setting, both versions of CGMs had acceptable safety profiles in the inpatient setting.

Accuracy of Flash Glucose Monitoring in Critically Ill Patients Receiving Intravenous Insulin

“…FSL use in an outpatient setting reduced acute events of DM including HHS and DKA [11]. FSL use in inpatient noncritical setting had a MARD of 17.8% with capillary BG of 180-250 mg/dL and 19% with capillary BG of > 250 mg/ dL [4]. Our MARD was 6.74% with BG > 180 mg/dL.…”

“…FDA has not approved the use of FSL in critically ill patients [3]. Recent study showed that FSL2 is safe and accurate in inpatient noncritical care setting [4]. However, it remains unclear whether FGM can safely be used for insulin adjustment in the critical care setting.…”

7. Diabetes Technology: Standards of Care in Diabetes—2023

“…This approach has been used to reduce the use of personal protective equipment and more closely monitor patients so that health care personnel do not have to go into a patient room solely to measure a glucose level (244)(245)(246). Studies are underway to assess the effectiveness of this approach, which may ultimately lead to the approved use of CGM for monitoring hospitalized individuals (247)(248)(249)(250)(251)(252)(253).…”

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023

“…The availability of data about the safe and effective use of CGM in the inpatient setting is evolving. Preliminary data suggest that CGM can significantly improve glycemic management and other hospital outcomes (57,(60)(61)(62)(63).…”

“…Recent inpatient CGM studies show promise for CGM as an early warning system to alert of impending hypoglycemia, offering an opportunity to mitigate it before it happens (60)(61)(62)(63). The use of personal CGM and automated insulin delivery devices, such as insulin pumps that can automatically deliver correction doses and change basal delivery rates in real time, should be supported for ongoing use during hospitalization for individuals who are capable of using devices safely and independently when proper supervision is available.…”