CGM Can Improve Glucose Control, Reduce Spread of Infectious Disease in In-Hospital Settings

Article

A retrospective study provides insight into the ability of CGM technology to improve glycemic control in in-hospital settings and, potentially, reduce the risk of spreading infectious diseases.

New research underlines the potential for continuous glucose monitoring (CGM) technology for in-hospital settings, with results demonstrating the utility of such devices for patient populations and in settings outside of diabetes management.

A retrospective analysis of data from 24 critically ill patients who met criteria for emergency use of CGM, results of the study demonstrate use of the Dexcom G6 system improved glucose control during IV insulin therapy compared to standard point-of-care, which investigators point out might also reduce potential opportunities for spread of infectious illnesses such as SARS-CoV-2.

“Continuous glucose monitors have not been widely studied in the intensive care unit and have not been approved for inpatient use. In our study of critically ill COVID-19-positive patients on IV insulin, we observe improved glycemic control with adjunctive CGM use compared with standard point-of-care testing alone,” wrote investigators.

After the US Food and Drug Administration awarded a breakthrough device designation to the Dexcom G6 for use in in-hospital settings in March 2022, the University of California, San Diego (UC San Diego) Health developed an emergency use protocol for use in the intensive care units to assist with glycemic control inpatients with COVID-19 requiring IV insulin. The current study is an analysis of data collected from 24 individuals who underwent use of the Dexcom G6 system in intensive care unit settings at UC San Diego Health for COVID-19-related complications.

Under the institution's emergency use protocol, the CGM system was used alongside standard point-of-care glucose measurements. For the purpose of analysis, the primary outcomes of interest were glycemic control during insulin therapy in periods with and without adjunctive CGM use. Investigators noted Clarke Error Grid analysis comparing CGM glucose values with point-of-care measurements was performed as part of assessments of accuracy.

From the 24 critically ill patients who met criteria for emergency use, investigators obtained 47,333 CGM and 5677 point-of-care glucose values for analysis. These patients had a median age of 61years, a median BMI of 31.0 kg/m2, and a median HbA1c of 8.9% on admission. Investigators noted 23 of the 24 patients required intubation and 13 died during hospitalization.

Upon analysis, results indicated use of CGM resulted in improved glycemic control with a mean difference of 30.7 mg/dL observed with CGM use compared to point-of-care testing. In analyses comparing 2194 matched CGM:point-of-care pairs, investigators noted a high degree of concordance with a mean absolute relative difference of 14.8% and 99.5% of CGM:point-of-care pairs falling in Zones A and B of the Clarke Error Grid.

“CGM demonstrated high concordance with point-of-care, suggesting that it can substitute for point-of-care glucose measurements during IV insulin titration. Continuous glucose monitoring use would reduce patient-provider contact, thereby reducing in-hospital transmission of infectious illnesses such as SARS-Cov-2,” investigators added.

This study, “Accuracy and Glycemic Efficacy of Continuous Glucose Monitors in Critically Ill COVID-19 Patients: A Retrospective Study,” was published in Journal of Diabetes Science and Technology.

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