Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study

Abstract

Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU). Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements. Results: CGM devices were placed on 11 patients: Medtronic ( n = 6) and Dexcom G6 ( n = 5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of −17.76 mg/dL (Medtronic) and −1.94 mg/dL (Dexcom), with wide 95% limits of agreement. Conclusions: During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.

Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring

“…Another developing application of rtCGM relevant to both T1D and T2D is use in the inpatient setting, where frequent monitoring with remote display may show significant advantages in nursing demands, more dynamic therapeutic adjustments, and reduced hypoglycemia [63][64][65][66][67] . This use requires further research, including cost-benefit analysis, but holds great promise.…”

Continuous Glucose Monitoring in the Hospital

“…For the full cohort, there was a 14% decrease (235.7 to 202.7 mg/dL, P =0.0003) in mean sensor glucose. Sadhu et al [ 29 ] reported similar accuracy between the Medtronic Guardian Connect (Medtronic Minimed, Northridge, CA, USA) and Dexcom G6 devices in a cohort of 11 ICU patients. This ICU data is promising for eventual routine use of CGMs in an ICU setting.…”

Diabetes Technology Meeting 2020

“…[28][29][30][31][32][33][34] Continued innovations are planned, including: (1) decreased physical footprint of these devices, (2) reduction or elimination of calibrations, (3) assessment of the devices in broader populations with alternate sites of insertion, and (4) the insertion devices for many devices will be made easier to use. Finally, with the COVID-19 pandemic, the FDA will not object to the application of certain sensors in hospitalized persons with diabetes given the extraordinary circumstances, 35,36 and use of these devices has now been shown to be feasible in the inpatient setting. 37 Furthermore, use of CGM based metrics has helped guide optimization of therapy during telehealth encounters.…”

“…145 Unexpectedly, the COVID-19 pandemic presented and, in response, the FDA produced a statement of "no objection" for the inpatient use of CGM during the COVID-19 crisis. 36,146 Hence, CGM systems were being used "off label" to help reduce exposure and preserve personal protection equipment. These new guidelines offer recommendations on the potential use of CGM and AID systems for hospitalized patients taking under consideration the existence of evidence to support its safe use.…”