The Clinical Benefits and Accuracy of Continuous Glucose Monitoring Systems in Critically Ill Patients—A Systematic Scoping Review

Abstract

Continuous Glucose Monitoring (CGM) systems could improve glycemic control in critically ill patients. We aimed to identify the evidence on the clinical benefits and accuracy of CGM systems in these patients. For this, we performed a systematic search in Ovid MEDLINE, from inception to 26 July 2016. Outcomes were efficacy, accuracy, safety, workload and costs. Our search retrieved 356 articles, of which 37 were included. Randomized controlled trials on efficacy were scarce (n = 5) and show methodological limitations. CGM with automated insulin infusion improved time in target and mean glucose in one trial and two trials showed a decrease in hypoglycemic episodes and time in hypoglycemia. Thirty-two articles assessed accuracy, which was overall moderate to good, the latter mainly with intravascular devices. Accuracy in critically ill children seemed lower than in adults. Adverse events were rare. One study investigated the effect on workload and cost, and showed a significant reduction in both. In conclusion, studies on the efficacy and accuracy were heterogeneous and difficult to compare. There was no consistent clinical benefit in the small number of studies available. Overall accuracy was moderate to good with some intravascular devices. CGM systems seemed however safe, and might positively affect workload and costs.

Higher glycemic variability within the first day of ICU admission is associated with increased 30-day mortality in ICU patients with sepsis

“…Previous studies have reported that a wide range of blood sugar samples are needed to calculate GV, ranging from 1 to 5 times/day [6,7]. Moreover, a previous study using a continuous glucose monitoring system reported that a relatively small number of blood sugar samples in critically ill patients may underestimate GV [8]. When to determine GV in patients with sepsis is another important issue.…”

Glycemic Effects of a Low‐Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open‐Label Randomized Controlled Clinical Trial

“…We were not able to place CGM sensors or start enteral feeding until informed consent was given, and therefore we could have missed important data from the first hours after admission. Sensor and device problems occurred relatively frequently, and the use of a subcutaneous CGM is not standard of care in critically ill patients, although overall accuracy seems moderate to good . The enteral formulas used in this study differed in carbohydrate, protein, and fat content, as well as in qualitative terms (eg, more monounsaturated fatty acids in the LCF).…”

Inpatient Continuous Glucose Monitoring and Glycemic Outcomes

“…These limitations may prevent generalizability. 55 While the Sensors review focused on ICU CGM, we also highlighted the limited number of non-ICU CGM studies, a setting where there is less frequent patient monitoring. [43][44][45]56,57 Non-ICU patients, especially T1DM patients with a high likelihood of labile inpatient glycemic control 58 and hypoglycemic unawareness, may benefit most from CGM.…”