Continuous Glucose Monitoring and Trend Accuracy

Signal, Matthew; Gottlieb, Rebecca; Compte, Aaron Le; Chase, J. Geoffrey

doi:10.1177/1932296814533091

Cited by 12 publications

(15 citation statements)

References 25 publications

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“…These assessments should be independent because one can have perfect trend correlation and poor point accuracy if the values are simply shifted. One possible method of reporting trend accuracy independently of point accuracy is the trend compass [ 56 ]. When considering accuracy in CGM, the degree of sensor drift should also be quantified and taken into account.…”

Section: Moving Forward … and How To Keep The Industry On Board?mentioning

confidence: 99%

Continuous glucose monitoring in the ICU: clinical considerations and consensus

et al. 2017

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Glucose management in intensive care unit (ICU) patients has been a matter of debate for almost two decades. Compared to intermittent monitoring systems, continuous glucose monitoring (CGM) can offer benefit in the prevention of severe hyperglycemia and hypoglycemia by enabling insulin infusions to be adjusted more rapidly and potentially more accurately because trends in glucose concentrations can be more readily identified. Increasingly, it is apparent that a single glucose target/range may not be optimal for all patients at all times and, as with many other aspects of critical care patient management, a personalized approach to glucose control may be more appropriate. Here we consider some of the evidence supporting different glucose targets in various groups of patients, focusing on those with and without diabetes and neurological ICU patients. We also discuss some of the reasons why, despite evidence of benefit, CGM devices are still not widely employed in the ICU and propose areas of research needed to help move CGM from the research arena to routine clinical use.

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Section: Moving Forward … and How To Keep The Industry On Board?mentioning

confidence: 99%

Continuous glucose monitoring in the ICU: clinical considerations and consensus

et al. 2017

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“…More specifically, it is possible to know the metabolic inputs of exogenous insulin and nutrition given to support the patient, but only the BG level is measured. In particular, this BG measurement can be intermittent in 1-4 hourly intervals, but with low error [65][66][67][68][69], or effectively continuous at intervals of 1-5 minutes using continuous glucose monitors (CGMs), but with increased error and drift [70][71][72][73][74][75][76]. Hence, automation must account for either intermittent control with high quality measurements of patient response, or more continuous feedback control with lower quality measurements, both of which will impact the shape and structure of control.…”

Section: Vision Of the Futurementioning

confidence: 99%

Glycemic control in the intensive care unit: A control systems perspective

Chase

Benyó

Desaive

2019

Annual Reviews in Control

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Computers and automation have revolutionised quality and productivity in many industries, but not in medicine. Healthcare costs are thus growing beyond the ability of society to pay for them, multiplied by the impact of increasingly aging populations, and specifically in the demand placed on intensive care unit (ICU) services. Glycemic control is a core ICU therapy with the potential to reduce both mortality and cost, which makes it an area where greater personalisation and automation could play a leading role in improving productivity and care. This review presents the background to the problem and the main issues arising in this area of care from a control systems technology perspective. It then presents a vision of a more automated future with specific goals in the areas of dynamic systems modeling, system identification and control. These areas are then given a state of the art review, mixing both medicine and control systems perspectives. It is concluded by specific recommendations for the field, where control systems expertise can be leveraged to best advantage.

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“…13 With CGM, what constitutes a ‘trend’ is also not clearly defined, leading to potentially dangerous consequences. 14 As a patient does not know in advance if a trend is correct, it is important for them to consider the glucose profile of the last few hours, information about meals, insulin and physical activity when making therapeutic decisions. Therefore, patients need to be adequately educated in appropriate data interpretation by a clinician with expertise in CGM or they need to participate in a well-designed training programme.…”

Section: Glucose Monitoring In Real-life Practicementioning

confidence: 99%

Self-measurement of Blood Glucose and Continuous Glucose Monitoring – Is There Only One Future?

Heinemann¹,

Stuhr

Brown³

et al. 2018

European Endocrinology

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Monitoring glycaemic control in patients with diabetes has evolved dramatically over the past decades. The introduction of easy-to-use systems for self-monitoring of blood glucose (SMBG) utilising capillary blood samples has resulted in the availability of a wide range of systems, providing different measurement quality. Systems for continuous glucose monitoring (CGM) – used mainly in patients with type 1 diabetes (T1D) – were made possible by the development of glucose sensors that measure glucose levels in the interstitial fluid (ISF) in the subcutaneous tissue of the skin. CGM readings might not correspond exactly to SMBG measurement results taken at the same time, especially during rapid changes in either blood glucose or ISF glucose levels. The mean absolute relative difference is the most popular method used for characterising the measurement performance of CGM systems. Unlike the International Organization for Standardization 15197:2013 criteria for SMBG systems, no accuracy standards for CGM systems exist. Measurement quality of CGM systems can vary based on several factors, limiting their safety and effective use in managing diabetes. Patients have to be trained adequately to make safe and efficient use of CGM systems (like with SMBG systems). Also, systems for CGM must be evaluated in terms of patient safety and the ability to provide accurate measurements regardless of the fluctuation of glucose levels. As new technological advancements in glucose monitoring are essential for improved management options of diabetes, such as automated insulin dosing systems, there is a need for a critical view of all such developments. It is likely that both, SMBG and CGM systems, will play important future roles in the treatment of diabetes.

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Continuous Glucose Monitoring and Trend Accuracy

Cited by 12 publications

References 25 publications

Continuous glucose monitoring in the ICU: clinical considerations and consensus

Continuous glucose monitoring in the ICU: clinical considerations and consensus

Glycemic control in the intensive care unit: A control systems perspective

Self-measurement of Blood Glucose and Continuous Glucose Monitoring – Is There Only One Future?

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