Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

Davis, Georgia; Faulds, Eileen R; Walker, Tara L.; Vigliotti, Debbie; Rabinovich, Marina; Hester, Joi; Peng, Limin; McLean, Barbara; Hannon, Patricia; Poindexter, Norma; Saunders, Petrena; Perez-Guzman, Citlalli; Tekwani, Seema S.; Martin, Greg S.; Agarwal, Shivani; Dungan, Kathleen; Pasquel, Francisco J.

doi:10.2337/dc20-2085

Cited by 60 publications

(52 citation statements)

References 15 publications

(12 reference statements)

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“…Accordingly, we chose also to report median ARD, as this real-life data set obtained from a less controlled environment may reflect a more skewed data distribution. Assessment of additional accuracy metrics, similar to those put forth by the FDA for integrated CGM use in automated insulin delivery, may be required or adapted for the inpatient setting, as protocols for hospital use of CGM continue to develop ( 5 , 20 ). These are important considerations for the management of hospitalized patients with dynamic clinical courses receiving diverse therapies and medications, especially with the interest in using diabetes technologies integrating CGM and insulin delivery in the inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

“…During the coronavirus disease 2019 (COVID-19) pandemic, critical shortages of personal protective equipment led many health care professionals to explore the use of CGM to replace capillary POC BG testing in order to minimize infectious exposures without sacrificing glycemic control and monitoring ( 4 , 5 ). Despite limited experience with CMG use in hospital, the U.S. Food and Drug Administration (FDA) has not objected to the implementation of inpatient CGM during this public health crisis ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

et al. 2021

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Advances in continuous glucose monitoring (CGM) have transformed ambulatory diabetes management. Until recently, inpatient use of CGM has remained investigational, with limited data on its accuracy in the hospital setting. RESEARCH DESIGN AND METHODSTo analyze the accuracy of Dexcom G6, we compared retrospective matched-pair CGM and capillary point-of-care (POC) glucose data from three inpatient CGM studies (two interventional and one observational) in general medicine and surgery patients with diabetes treated with insulin. Analysis of accuracy metrics included mean absolute relative difference (MARD), median absolute relative difference (ARD), and proportion of CGM values within 15, 20, and 30% or 15, 20, and 30 mg/dL of POC reference values for blood glucose >100 mg/dL or #100 mg/dL, respectively (% 15/15, % 20/20, % 30/30). Clinical reliability was assessed with Clarke error grid (CEG) analyses. RESULTSA total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n 5 4,067 matched glucose pairs) was 12.8%, and median ARD was 10.1% (interquartile range 4.6, 17.6]. The proportions of readings meeting % 15/15, % 20/20, and % 30/30 criteria were 68.7, 81.7, and 93.8%, respectively. CEG analysis showed 98.7% of all values in zones A and B. MARD and median ARD were higher in the case of hypoglycemia (<70 mg/dL) and severe anemia (hemoglobin <7 g/dL). CONCLUSIONSOur results indicate that CGM technology is a reliable tool for hospital use and may help improve glucose monitoring in non-critically ill hospitalized patients with diabetes.Continuous glucose monitoring (CGM) technology in the outpatient setting has transformed glucose monitoring for diabetes self-management, providing more comprehensive glycemic control data than intermittent point-of-care (POC) blood glucose (BG) monitoring and hemoglobin A 1c . Ambulatory use of CGM continues to expand as devices improve in accuracy, accessibility, ease of use, and standardization of metrics for CGM data reporting (1).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

et al. 2021

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“…The COVID-19 pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. In the literature, some projects developed the use of remote real-time continuous glucose monitoring (CGM) in hospital like Davis et al (2021) , in a COVID-19 intensive care unit with nine patients included.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results

Zulfiqar

Massimbo²,

Hajjam³

et al. 2021

Front. Physiol.

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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. This was the basis for the “GER-e-TEC COVID study,” an experiment involving the use of the smart MyPrediTM e-platform to automatically detect the exacerbation of glycemic disorder risk in COVID-19 older diabetic patients.Methods: The MyPrediTM platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. An experiment was conducted between December 14th, 2020 and February 25th, 2021 to test this alert system. During this time, the platform was used on COVID-19 patients being monitored in an internal medicine COVID-19 unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, positive and negative predictive values with respect to clinical data.Results: 10 older diabetic COVID-19 patients in total were monitored remotely, six of whom were male. The mean age of the patients was 84.1 years. The patients used the telemedicine solution for an average of 14.5 days. 142 alerts were emitted for the glycemic disorder risk indicating hyperglycemia, with an average of 20.3 alerts per patient and a standard deviation of 26.6. In our study, we did not note any hypoglycemia, so the system emitted any alerts. For the sensitivity of alerts emitted, the results were extremely satisfactory, and also in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts and gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (COVID-19 management).Conclusion: This work is a pilot study with preliminary results. To date, relatively few projects and trials in diabetic patients have been run within the “telemedicine 2.0” setting, particularly using AI, ICT and the Web 2.0 in the era of COVID-19 disease.

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“…This direct view of glucose data from outside the patients’ rooms allowed the healthcare team to monitor glucose data without entering the patients’ rooms. Other studies used remote glucose monitoring with the GTS [ 37 , 39 , 44 ▪ ] or Medtronic Guardian Connect System using the web-based CareLink software accessed through minimized browser windows [ 40 ].…”

Section: Methodsmentioning

confidence: 99%

“…Sensor readings were lower in states of hypoperfusion (i.e., pulseless electrical activity, shock, and therapeutic hypothermia) with signal loss occurring during cardiac arrest and defibrillator use. Sensor accuracy was also impacted by position changes including pronation or inadvertent sensor compression [ 44 ▪ ].…”

Section: Methodsmentioning

confidence: 99%

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

Gothong

Singh

Satyarengga

et al. 2021

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Continuous glucose monitoring (CGM) systems are Food and Drug Administration approved devices for the ambulatory setting; however, they remain investigational systems for inpatient use. This review summarizes the most recent and relevant literature on the use of continuous glucose monitoring in the hospital setting. Recent findings CGM provides real-time glucose data that enable healthcare professionals to make proactive and timelier clinical decisions with regards to diabetes management. CGM devices appear to be safe and accurate systems for glucose monitoring in the hospital setting. Real-time CGM systems and glucose telemetry can decrease hypoglycemia and reduce hyperglycemia in hospitalized patients with diabetes. Remote glucose monitoring decreases the need of frequent Point-of-care checks and personal protective equipment use while also mitigating staff exposure risk which is timely in the advent of the COVID-19 pandemic. Although most nursing staff have limited exposure and training on CGM technology, early studies show that CGM use in the hospital is well received by nurses. Summary Given the evidence in the current literature regarding CGM use in the hospital, CGM devices may be incorporated in the inpatient setting.

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Remote Continuous Glucose Monitoring With a Computerized Insulin Infusion Protocol for Critically Ill Patients in a COVID-19 Medical ICU: Proof of Concept

Cited by 60 publications

References 15 publications

Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non–Critically Ill Hospitalized Patients With Diabetes

Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results

Continuous glucose monitoring in the hospital: an update in the era of COVID-19

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