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

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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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 ◽

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

Diabetes Care ◽

10.2337/dc20-2085 ◽

2021 ◽

Vol 44 (4) ◽

pp. 1055-1058

Author(s):

Georgia M. Davis ◽

Eileen Faulds ◽

Tara Walker ◽

Debbie Vigliotti ◽

Marina Rabinovich ◽

...

Keyword(s):

Critically Ill ◽

Continuous Glucose Monitoring ◽

Critically Ill Patients ◽

Insulin Infusion ◽

Glucose Monitoring ◽

Proof Of Concept ◽

Insulin Infusion Protocol ◽

Infusion Protocol

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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.

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