Strict glycaemic control in very low birthweight infants using a continuous glucose monitoring system: a randomised controlled trial

Abstract

ObjectiveTo evaluate the efficacy of a strict glycaemic control protocol using a continuous glucose monitoring (CGM) in infants at high risk of dysglycaemia with the aim of reducing the number of dysglycaemic episodes.DesignRandomised controlled trial.SettingNeonatal intensive care unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome.PatientsAll infants <1500 g fed on parental nutrition (PN) since birth were eligible. A total of 63 infants were eligible and 48 were randomised.InterventionAll participants wore a CGM sensor and were randomised in two arms with alarms set at different cut-off values (2.61–10 mmol/L (47–180 mg/dL) vs 3.44–7.78 mmol/L (62–140 mg/dL)), representing the operative threshold requiring modulation of glucose infusion rate according to an innovative protocol.Main outcome measuresThe primary outcome was the number of severe dysglycaemic episodes (<2.61 mmol/L (47 mg/dL) or >10 mmol/L (180 mg/dL)) in the intervention group versus the control group, during the monitoring time.ResultsWe enrolled 47 infants, with similar characteristics between the two arms. The number of dysglycaemic episodes and of infants with at least one episode of dysglycaemia was significantly lower in the intervention group (strict group): respectively, 1 (IQR 0–2) vs 3 (IQR 1–7); (p=0.005) and 12 (52%) vs 20 (83%); p=0.047. Infants managed using the strict protocol had a higher probability of having normal glycaemic values: relative risk 2.87 (95% CI 1.1 to 7.3). They spent more time in euglycaemia: 100% (IQR 97–100) vs 98% (IQR 94–99), p=0.036. The number needed to treat to avoid dysglycaemia episodes is 3.2 (95% CI 1.8 to 16.6).ConclusionWe provide evidence that CGM, combined with a protocol for adjusting glucose infusion, can effectively reduce the episodes of dysglycaemia and increase the percentage of time spent in euglycaemia in very low birthweight infants receiving PN in the first week of life.