CGM improves glycemic control in critically ill patients in ICU on intravenous insulin

USA: A new study published in the Journal of Diabetes Science and Technology shows that continuous glucose monitoring improved glycemic control in critically ill COVID-19 patients under IV insulin.

Although it is presently not licensed for inpatients, continuous glucose monitoring (CGM) is used to make insulin dosing decisions in the ambulatory setting. In patients with coronavirus disease 2019 (COVID-19), CGM has the potential to reduce patient-provider interaction, potentially lowering the spread of the virus within the hospital. There is, however, a lack of information about the precision and effectiveness of CGM in titrating insulin dosages in inpatients. In order to relate glycemic outcomes and CGM accuracy to POC measurements, Schafer Boeder and colleagues report on data gathered from 24 people.

CGM (Dexcom G6) was employed in this trial under an emergency usage strategy in conjunction with common point-of-care (POC) glucose readings in patients who were severely unwell with COVID-19 problems and required intravenous (IV) insulin. Retrospective evaluation of glycemic control during IV insulin treatment compared periods with and without concomitant CGM usage. Clarke Error Grid analysis was done to compare CGM glucose levels with POC data, and accuracy metrics were calculated.

The key findings of this study were as follows:

1. 24 severely sick patients who satisfied the requirements for using a CGM in an emergency had readings of 47 333 CGM and 5677 POC glucose.

2. Individuals' glycemic control increased when CGM was utilized during IV insulin treatment (mean difference -30.7 mg/dL).

3. A high degree of concordance was found among 2194 matched CGM: POC glucose pairs, with a mean absolute relative change of 14.8% and 99.5% of CGM: POC pairings lying in Zones A and B of the Clarke Error Grid.

In conclusion, the remarkable agreement between POC and continuous glucose monitoring glucose values during IV insulin administration in critically sick patients suggests that CGM might replace POC measures in inpatients, minimizing patient-provider interaction and infection transmission.

Reference: 

Boeder, S., Kobayashi, E., Ramesh, G., Serences, B., Kulasa, K., & Majithia, A. R. (2022). Accuracy and Glycemic Efficacy of Continuous Glucose Monitors in Critically Ill COVID-19 Patients: A Retrospective Study. In Journal of Diabetes Science and Technology (p. 193229682211138). SAGE Publications. https://doi.org/10.1177/19322968221113865