Evaluation of continuous flash glucose monitoring in a pediatric ICU setting

Kotzapanagiotou, Eirini; Tsotridou, Eleni; Volakli, Eleni; Dimitriadou, Meropi; Chochliourou, Elpis; Kalamitsou, S; Kotzapanagiotou, Fani; Σδούγκα, Μαρία; Christoforidis, Athanasios

doi:10.1007/s10877-019-00384-y

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…48,49 In the ICU setting, therapy with intravenous insulin infusion allows clinicians to maintain narrow glycemic targets. The panelists reviewed studies using CGMs in the ICU in adult populations (Table 3) and pediatric populations (Table 4) [84][85][86][87][88] . In the ICU, bedside POC glucose using factory-calibrated BGMs (performed every one to two hours) has been recommended as the preferred method to assess glycemic management and to guide hyperglycemia treatment with intravenous insulin infusion.…”

Section: Icu Patientsmentioning

confidence: 99%

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Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Galindo

Umpiérrez

Rushakoff

et al. 2020

J Diabetes Sci Technol

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This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.

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Section: Icu Patientsmentioning

confidence: 99%

Section: Potential Opportunitiesmentioning

confidence: 99%

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Galindo

Umpiérrez

Rushakoff

et al. 2020

J Diabetes Sci Technol

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“…Blood glucose monitoring in critically ill patients is vital for avoiding the occurrence of stress-induced hyperglycemia, hypoglycemia, and excessive glycemic variability (1). In critically ill patients who are unable to express their needs effectively, low blood glucose may result in fatal hypoglycemic reactions and high blood glucose is considered to affect their prognosis.…”

Section: Introductionmentioning

confidence: 99%

A comparison of arterial blood glucose and peripheral blood glucose levels in critically ill patients: measurements using the arterial blood gas analyzer and the rapid glucose meter

Deng¹,

Liu²,

Pan³

et al. 2021

Ann Palliat Med

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Background: This study explored the differences, correlation, and consistency between blood glucose levels measured using an arterial blood gas analyzer and a rapid blood glucose meter in critically ill patients.Methods: A total of 73 critically ill patients admitted to the Department of Critical Care Medicine, from October to December 2016 were enrolled in this study. The patient's arterial blood glucose was measured by arterial blood gas analyzer, while peripheral blood glucose was measured by a rapid blood glucose meter (via the non-infusion limb). The correlation between indicators was analyzed using the linear regression model. Bland-Altman was performed to evaluate the agreement of the two methods for measuring blood glucose. P<0.05 was considered statistically significant. Results:The blood glucose values measured using the arterial blood gas analyzer was significantly different from the values obtained using the rapid blood glucose meter (P=0.000). Regression analysis showed that R2 was 0.857 and β was 0.324 (P=0.000). Bland-Altman plot analysis showed that arterial blood glucose values obtained using the arterial blood gas analyzer were higher than the peripheral blood glucose values obtained using the rapid blood glucose meter on the non-infused limb, with 2.74% of dots lying outside the 95% limit of agreement and the maximum absolute value (2.30 mmol/L) of blood glucose difference within the limit of agreement. The blood glucose levels measured using the two different methods showed good agreement. Conclusions:The difference in blood glucose values measured using the two different measurement methods was statistically significant, but the maximum absolute value (2.30 mmol/L) of blood glucose difference within the limit of agreement, which is acceptable in the clinical setting. In clinical care, it is not necessary to repeat a measure of the patient's capillary blood glucose (CBG) using the rapid blood glucose meter after the blood glucose levels have been measured with the arterial blood gas analyzer, thereby reducing the associated pain and inconvenience for the patients.

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“…[13][14][15][16] We have recently shown that FreeStyle Libre is well tolerated in a pediatric ICU setting, however with a tendency to underestimate glucose levels. 17 Many practices performed in ICU subjects are accompanied by pain and agitation resulting in physical and psychological complications that may last months after discharge from the hospital. 18 Recently published guidelines on the management of pain and agitation in ICU-treated adult subjects recommend a systemic and rigorous assessment of pain, as pain is consistently underestimated and undertreated in ICU subjects.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Various, Everyday Practices on Glucose Levels in Critically Ill Children

Tsotridou

Kotzapanagiotou

Violaki

et al. 2020

J Diabetes Sci Technol

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Background: To evaluate the effect of various, everyday intensive care unit (ICU) practices on glucose levels in critically ill pediatric patients with the use of a continuous glucose monitoring system. Methods: Seventeen sensors were placed in 16 pediatric patients (8 male). All therapeutic and diagnostic interventions were recorded and 15 minutes later, a flash glucose measurement was obtained by swiping the sensor with a reader. Glucose difference was calculated as the glucose value 15 minutes after the intervention minus the mean daily glucose value for each individual patient. Additionally, the consciousness status of the patient (awake or sedated) was recorded. Results: Two hundred and five painful skin interventions were recorded. The mean difference of glucose values was higher by 1.84 ± 14.76 mg/dL (95% CI: −0.19 to 3.87 mg/dL, P = .076). However, when patients were categorized regarding their consciousness level, mean glucose difference was significantly higher in awake state than in sedated patients (4.76 ± 28.07 vs −2.21 ± 15.77 mg/dL, P < .001). Six hundred forty-nine interventions involving the respiratory system were recorded. Glucose difference during washings proved to be significantly higher than the ones during simple suctions (4.74 ± 14.18 mg/dL vs 0.32 ± 18.22 mg/dL, P = .016). Finally, glucose difference in awake patients was higher by 3.66 ± 13.91 mg/dL compared to glucose difference of −2.25 ± 21.07 mg/dL obtained during respiratory intervention in sedated patients. Conclusions: Diagnostic and therapeutic procedures in the ICU, especially when performed in an awake state, exacerbate the stress and lead to a significant rise in glucose levels.

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Evaluation of continuous flash glucose monitoring in a pediatric ICU setting

Cited by 14 publications

References 33 publications

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline

A comparison of arterial blood glucose and peripheral blood glucose levels in critically ill patients: measurements using the arterial blood gas analyzer and the rapid glucose meter

The Effect of Various, Everyday Practices on Glucose Levels in Critically Ill Children

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