Comparison of subcutaneous and intravenous continuous glucose monitoring accuracy in an operating room and an intensive care unit

Abstract

Although we have used an intravenous continuous glucose monitor for blood glucose management, a previous study reported that a subcutaneous continuous glucose monitor was also reliable for use in critically ill patients. The aim of this study was to compare the subcutaneous and intravenous continuous glucose monitors. This was an observational trial (UMIN-CTR, ID:000013338). We included patients who were admitted to our intensive care units (ICU) after hepato-biliary pancreatic surgery. Continuous blood glucose measurement was performed from the beginning of the operation to ICU discharge using the intravenous continuous monitor STG-55 (Nikkiso, Tokyo, Japan) and the subcutaneous continuous monitor iPro2 (Medtronic Japan, Tokyo, Japan). The STG-55 measured the glucose level in real time, and the iPro2 measured this every 5 min. We compared glucose levels obtained using the two devices every 5 min using a Bland-Altman plot and a regression analyses. A total of 3592 comparative samples in 15 cases were analyzed. The mean glucose level measured using the STG-55 was 139 ± 21 mg/dl, and that measured using the iPro2 was 144 ± 31 mg/dl. A linear regression line had the equation of the form y = 0.225x + 106. The coefficient of determination was 0.11, and the F-test significance level was set as p < 0.01. The mean of the differences was -5.2 mg/dl, with a 95 % agreement limit of -67 to + 57 mg/dL. The percent error was 44 %. In conclusion, the current study suggests that subcutaneous and intravenous continuous glucose monitoring was not highly correlated during either surgery or ICU stay.

Glucose Management during Insulinoma Resection Using Real-Time Subcutaneous Continuous Glucose Monitoring

“…The SCGM system can provide such useful information for glucose management; however, attention should be paid to the fact that the SCGM system has not been completely established as a substitutable device for BG measurement in the perioperative period because dissociation between BG and IG sometimes occurs [ 6 – 9 ]. For this reason, BG measurement is recommended before administration of insulin and/or glucose, and we avoided the use of automatic control by the insulin pump of the SCGM system.…”

A prolonged run-in period of standard subcutaneous microdialysis ameliorates quality of interstitial glucose signal in patients after major cardiac surgery

“…In contrast, point accuracy was only moderate to good, translating to neglect a threshold of 95% of paired values in zone A of the Clarke error grid 25 , which is similar to the findings in our study. In a different setting during surgery in ICU patients, a disagreement between subcutaneous and intravenous continuous glucose monitoring was found 26 . In this study the mean venous glucose level was 125 ± 29 mg/dl versus a subcutaneous glucose level of 138 ± 26 mg/dl 26 .…”

“…In a different setting during surgery in ICU patients, a disagreement between subcutaneous and intravenous continuous glucose monitoring was found 26 . In this study the mean venous glucose level was 125 ± 29 mg/dl versus a subcutaneous glucose level of 138 ± 26 mg/dl 26 . Additionally, it has to be taken into account that the sensor function was found in previous research to be impaired by blood clots close to the sensor application site 27 .…”

Continuous Glucose Monitoring in Bariatric Patients Undergoing Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-En-Y Gastric Bypass

“…Freestyle Libre CGM Software was used to analyze daily glycemic trends. The measurement error does not exceed 10% [13][14][15][16] and the system was validated for use in the operating room and intensive care unit [17]. The subcutaneous tissue comprises of interstitial fluid, which contains glucose transported from blood capillaries by simple diffusion [18].…”