Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation

Author:

Voglová Hagerf Barbora12ORCID,Protus Marek23ORCID,Nemetova Lenka1,Mraz Milos12ORCID,Kieslichova Eva23ORCID,Uchytilova Eva23ORCID,Indrova Veronika3,Lelito Jan3,Girman Peter1ORCID,Haluzík Martin12ORCID,Franekova Janka45ORCID,Svirlochova Veronika4,Klonoff David C.6ORCID,Kohn Michael A.7ORCID,Jabor Antonin45ORCID

Affiliation:

1. 1Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

2. 2First Faculty of Medicine, Charles University, Prague, Czech Republic

3. 3Department of Anesthesiology, Resuscitation and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

4. 4Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

5. 7Third Faculty of Medicine, Charles University, Prague, Czech Republic

6. 5Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA

7. 6University of California San Francisco, San Francisco, CA

Abstract

OBJECTIVE Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. RESEARCH DESIGN AND METHODS We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). RESULTS We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. CONCLUSIONS Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.

Publisher

American Diabetes Association

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