619-P: Comparison of Dexcom G6 Continuous Glucose Monitoring and Point-of-Care Blood Glucose Testing in Hospitalized Patients with Diabetes

Background: We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care glucose testing among insulin-treated hospitalized patients with type 2 diabetes (T2D). Methods: Prospective study in general medicine and surgery adult patients with T2D. Patient were monitored with POC before meals and bedtime, and with CGM during the hospital stay. Major endpoints included differences between POC and CGM in mean daily blood glucose, hypoglycemia < 70 and < 54 mg/dl, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), and ±15%/15mg/dl, ±20%/20mg/dl, ± 30%/30mg/dl, and Error Grid analysis between matched glucose pairs. Results: Mean daily glucose was significantly higher by POC testing (188.9±37.3 vs. 176.1±46.9 mg/dl), and proportions of patients with glucoses < 70 mg/dl (14% vs 56%) and < 54 mg/dl (4.1% vs 36%) detected by POC BG were significantly lower compared to CGM, all p<0.001. Nocturnal and prolonged CGM hypoglycemia < 54 mg/dl was 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4 to 16.7% for glucoses between 70 and 250 mg/dl, and lower for 51- 69 mg/dL (MARD= 28.0%). The percentage of glucoses within the ±15%/15mg/dl, ±20%/20mg/dl, and ±30%/30mg/dl were 62%, 76%, and 91%, respectively. Error Grid analysis showed 98.0% of glucose pairs within Zones A and B. Conclusions: Compared to POC testing, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM’s accuracy was lower in hypoglycemic range.

Download Full-text

Comparison of the Freestyle Libre Pro Flash Continuous Glucose Monitoring (CGM) System and Point-of-Care Capillary Glucose Testing (POC) in Hospitalized Patients with Type 2 Diabetes (T2D) Treated with Basal-Bolus Insulin Regimen

10.2337/figshare.12302660 ◽

2020 ◽

Author(s):

Rodolfo J. Galindo ◽

Alexandra L. Migdal ◽

Georgia M. Davis ◽

Maria A. Urrutia ◽

Bonnie Albury ◽

...

Keyword(s):

Type 2 Diabetes ◽

Continuous Glucose Monitoring ◽

Point Of Care ◽

Glucose Monitoring ◽

Hospitalized Patients ◽

Glucose Testing ◽

Grid Analysis ◽

Freestyle Libre ◽

Error Grid

Background: We compared the performance of the FreeStyle Libre Pro continuous glucose monitoring (CGM) and point-of-care glucose testing among insulin-treated hospitalized patients with type 2 diabetes (T2D). Methods: Prospective study in general medicine and surgery adult patients with T2D. Patient were monitored with POC before meals and bedtime, and with CGM during the hospital stay. Major endpoints included differences between POC and CGM in mean daily blood glucose, hypoglycemia < 70 and < 54 mg/dl, and nocturnal hypoglycemia. We also calculated the mean absolute relative difference (MARD), and ±15%/15mg/dl, ±20%/20mg/dl, ± 30%/30mg/dl, and Error Grid analysis between matched glucose pairs. Results: Mean daily glucose was significantly higher by POC testing (188.9±37.3 vs. 176.1±46.9 mg/dl), and proportions of patients with glucoses < 70 mg/dl (14% vs 56%) and < 54 mg/dl (4.1% vs 36%) detected by POC BG were significantly lower compared to CGM, all p<0.001. Nocturnal and prolonged CGM hypoglycemia < 54 mg/dl was 26% and 12%, respectively. The overall MARD was 14.8%, ranging between 11.4 to 16.7% for glucoses between 70 and 250 mg/dl, and lower for 51- 69 mg/dL (MARD= 28.0%). The percentage of glucoses within the ±15%/15mg/dl, ±20%/20mg/dl, and ±30%/30mg/dl were 62%, 76%, and 91%, respectively. Error Grid analysis showed 98.0% of glucose pairs within Zones A and B. Conclusions: Compared to POC testing, FreeStyle Libre CGM showed lower mean daily glucose and higher detection of hypoglycemic events, particularly nocturnal and prolonged hypoglycemia in hospitalized patients with T2D. CGM’s accuracy was lower in hypoglycemic range.

Download Full-text

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

Journal of Diabetes Science and Technology ◽

10.1177/1932296820964264 ◽

2020 ◽

Vol 14 (6) ◽

pp. 1065-1073

Author(s):

Archana R. Sadhu ◽

Ivan Alexander Serrano ◽

Jiaqiong Xu ◽

Tariq Nisar ◽

Jessica Lucier ◽

...

Keyword(s):

Blood Glucose ◽

Pilot Study ◽

Insulin Therapy ◽

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Point Of Care ◽

Glucose Monitoring ◽

Blood Glucose Monitoring ◽

Target Range

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.

Download Full-text

Frequency of blood glucose testing in well educated patients with diabetes mellitus type 1: How often is enough?

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2012.12.024 ◽

2013 ◽

Vol 101 (1) ◽

pp. 57-61 ◽

Cited By ~ 16

Author(s):

Anna Elisabeth Minder ◽

Dominique Albrecht ◽

Juliane Schäfer ◽

Henryk Zulewski

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Diabetes Mellitus Type 1 ◽

Diabetes Mellitus Type ◽

Glucose Testing ◽

Patients With Diabetes ◽

Blood Glucose Testing

Download Full-text

Accuracy of Dexcom G6 Continuous Glucose Monitoring in Non-Critically Ill Hospitalized Patients with Diabetes

10.2337/figshare.14454357.v1 ◽

2021 ◽

Author(s):

Georgia M. Davis ◽

Elias K. Spanakis ◽

Alexandra L. Migdal ◽

Lakshmi G. Singh ◽

Bonnie Albury ◽

...

Keyword(s):

Critically Ill ◽

Continuous Glucose Monitoring ◽

Diabetes Management ◽

Glucose Monitoring ◽

Relative Difference ◽

Hospitalized Patients ◽

Matched Pair ◽

Patients With Diabetes ◽

Clarke Error Grid ◽

Error Grid

Background: 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. Methods: To analyze the accuracy of Dexcom G6 CGM, 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, /20, 0/30). Clinical reliability was assessed using Clarke error grid analyses. Results: A total of 218 patients were included (96% with type 2 diabetes) with a mean age of 60.6 ± 12 years. The overall MARD (n=4,067 matched glucose pairs) was 12.8% and median ARD was 10.1% [IQR 4.6, 17.6]. The proportion of readings meeting ?/15, /20 and 0/30 criteria were 68.7, 81.7, and 93.8%. Clarke error grid analysis showed 98.7% of all values in zones A+B. MARD and median ARD were higher in hypoglycemia (<70mg/dL) and severe anemia (hemoglobin <7g/dL). Conclusion: Our 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.

Download Full-text

Correlation between short- and mid-term hemoglobin A1c and glycemic control determined by continuous glucose monitoring

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00714-8 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Jen-Hung Huang ◽

Yung-Kuo Lin ◽

Ting-Wei Lee ◽

Han-Wen Liu ◽

Yu-Mei Chien ◽

...

Keyword(s):

Blood Glucose ◽

Glycemic Control ◽

Continuous Glucose Monitoring ◽

Hemoglobin A1c ◽

Glucose Monitoring ◽

Mean Amplitude ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Before And After ◽

Patients With Diabetes

Abstract Background Glucose monitoring is vital for glycemic control in patients with diabetes mellitus (DM). Continuous glucose monitoring (CGM) measures whole-day glucose levels. Hemoglobin A1c (HbA1c) is a vital outcome predictor in patients with DM. Methods This study investigated the relationship between HbA1c and CGM, which remained unclear hitherto. Data of patients with DM (n = 91) who received CGM and HbA1c testing (1–3 months before and after CGM) were retrospectively analyzed. Diurnal and nocturnal glucose, highest CGM data (10%, 25%, and 50%), mean amplitude of glycemic excursions (MAGE), percent coefficient of variation (%CV), and continuous overlapping net glycemic action were compared with HbA1c values before and after CGM. Results The CGM results were significantly correlated with HbA1c values measured 1 (r = 0.69) and 2 (r = 0.39) months after CGM and 1 month (r = 0.35) before CGM. However, glucose levels recorded in CGM did not correlate with the HbA1c values 3 months after and 2–3 months before CGM. MAGE and %CV were strongly correlated with HbA1c values 1 and 2 months after CGM, respectively. Diurnal blood glucose levels were significantly correlated with HbA1c values 1–2 months before and 1 month after CGM. The nocturnal blood glucose levels were significantly correlated with HbA1c values 1–3 months before and 1–2 months after CGM. Conclusions CGM can predict HbA1c values within 1 month after CGM in patients with DM.

Download Full-text

Continuous glucose monitoring calibrated with point of care devices or glucometers for self monitoring of blood glucose

10.26226/morressier.617c37307c09fc044a9751a2 ◽

2021 ◽

Author(s):

Soichi Takeishi

Keyword(s):

Blood Glucose ◽

Continuous Glucose Monitoring ◽

Point Of Care ◽

Glucose Monitoring ◽

Self Monitoring

Download Full-text

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.

Download Full-text