Use of the Guardian Connect glycemic monitoring system in patients after total duodenopancreatectomy in the early postoperative period on intravenous insulin therapy

Abstract

BACKGROUND: Among different subtypes of pancreatogenic diabetes mellitus the biggest difficulties of glycemic control arise in patients after total duodenopancreatectomy (TDPE), first of all due to the presence of absolute insulin insufficiency.AIM: Estimating safety and cost-effectiveness Guardian Connect CGM system in early postoperative period in hospitalized patients after TDPE on continuous intravenous insulin therapy (CIVIT).MATERIALS AND METHODS: Glucose measurement results of 26 patients in early postoperative period after TDPE were analyzed. In 12 of them, we used Guardian Connect CGM system. In this group 43 cycles (1 cycle — 6 days, 258 days total) of CGM and 971 glucometer measurements used for CGM calibration were analyzed; in other 14 patients in whom only glucometer was used we analyzed 2496 glycemic values.Cost-effectiveness was calculated over 6 days for CGM and only glucometer use (including cost of CGM, glucometers, disposable materials, clinic wage-costs to medical staff for time required for glucose control).RESULTS: Glucose levels of group #1 were in the target range 5.6 to 10.0 mmol/L (66.7 vs 61.2%, p=0.003) and the range 4.3–11.6 mmol/L (85.2% vs 82.2%, p=0.038) more than in comparison with group #2.The frequency of hypoglycemic episodes (<3.9 mmol/L) was statistically significantly lower in the CGM group (6 vs 54, p<0.001, RO 8.463 [3.579; 20.015], RR 1.746 [1.551; 1.966]).Cost analysis of glucose control using Guardian Connect CGM system for one cycle (6 days) and cost of glucose control using glucose meter for the same period showed that using Guardian Connect CGM system in patients after TDPE on intravenous insulin therapy reduced clinic costs by 21.7% in ICU and by 25.7% in the hospital department.CONCLUSION: Guardian Connect CGM have demonstrated its safety and cost-effectiveness during glucose control in patients in early postoperative period after TDPE on CIVIT.