447: THE IMPACT OF CONTINUOUS GLUCOSE MONITORING SYSTEMS ON GLUCOSE CONTROL IN CRITICALLY ILL PATIENTS

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.

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Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study

Journal of Intensive Care ◽

10.1186/s40560-020-00489-6 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Yukari Aoyagi ◽

Takuo Yoshida ◽

Shigehiko Uchino ◽

Masanori Takinami ◽

Shoichi Uezono

Keyword(s):

Blood Glucose ◽

Critically Ill ◽

Critically Ill Patients ◽

Glucose Control ◽

Blood Glucose Control ◽

Kidney Injury ◽

Saline Group ◽

Significant Difference ◽

The Impact ◽

Electrolyte Abnormalities

Abstract Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.

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Accuracy and limitations of continuous glucose monitoring using spectroscopy in critically ill patients

Annals of Intensive Care ◽

10.1186/2110-5820-4-8 ◽

2014 ◽

Vol 4 (1) ◽

pp. 8 ◽

Cited By ~ 17

Author(s):

Roosmarijn TM van Hooijdonk ◽

Tineke Winters ◽

Johan C Fischer ◽

Edmée C van Dongen-Lases ◽

James S Krinsley ◽

...

Keyword(s):

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Glucose Monitoring

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Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study (Preprint)

10.2196/preprints.20175 ◽

2020 ◽

Author(s):

Hector Roux de Bézieux ◽

James Bullard ◽

Orville Kolterman ◽

Michael Souza ◽

Fanny Perraudeau

Keyword(s):

Continuous Glucose Monitoring ◽

Glucose Control ◽

Glucose Monitoring ◽

Smartphone App ◽

Proof Of Concept ◽

Medical Food ◽

Concept Study ◽

Glucose Levels ◽

The Impact ◽

Clinic Visits

BACKGROUND Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. OBJECTIVE We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. METHODS Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. RESULTS All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. CONCLUSIONS We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. CLINICALTRIAL ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888.

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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

10.2337/figshare.13570862.v1 ◽

2021 ◽

Author(s):

Georgia M. Davis ◽

Eileen Faulds ◽

Tara Walker ◽

Debbie Vigliotti ◽

Marina Rabinovich ◽

...

Keyword(s):

Real Time ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Insulin Infusion ◽

Point Of Care ◽

Glucose Monitoring ◽

Proof Of Concept ◽

Computerized Decision Support ◽

Glucose Testing

Objective: The use of remote real-time continuous glucose monitoring (CGM) in the hospital has rapidly emerged to preserve personal protective equipment (PPE) and reduce potential exposures during COVID-19. Design and Methods: We linked a hybrid CGM and point-of-care (POC) glucose testing protocol to a computerized decision support system for continuous insulin infusion (CII) and integrated a validation system for sensor glucose values into the electronic health record. We report our proof-of-concept experience in a COVID-19 ICU. Results: All nine patients required mechanical ventilation and corticosteroids. Seventy six percent of sensor values were within 20% of the reference POC glucose with an associated average reduction in POC of 63%. Mean time in range (70-180 mg/dL) was 71.4 ± 13.9%. Sensor accuracy was impacted by mechanical interferences in four patients. Conclusions: A hybrid protocol integrating real-time CGM and POC is helpful for managing critically ill patients with COVID-19 requiring insulin infusion.

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