Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study
Continuous Glucose Monitoring in Critically Ill Patients With COVID-19: Results of an Emergent Pilot Study
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DOI：
10.1177/1932296820964264
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发表时间：
2020-11-01
影响因子：
5
通讯作者：
Patham, Bhargavi
中科院分区：
文献类型：
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作者：
Sadhu, Archana R.;Serrano, Ivan Alexander;Patham, Bhargavi
背景：在2019冠状病毒病（COVID-19）大流行期间，连续血糖监测（CGM）已成为住院患者即时血糖监测（POC-BG）的替代方案。我们对重症监护病房（ICU）重症COVID-19患者使用CGM进行了可行性试点研究。方法：采用美敦力Guardian Connect和Dexcom G6 CGM系统对新冠肺炎危重患者胰岛素治疗后的血糖监测进行单中心、回顾性研究。主要结果为POC-BG趋势的可行性和准确性。次要结局包括可靠性和护士接受度。采用传感器血糖（SG）监测pocc - bg与护理指导之间的变化趋势，将pocc - bg频率从1 ~ 2小时降低到SG在目标范围内的4小时。平均绝对相对差（MARD）、Clarke误差网格分析（EGA）和Bland-Altman （B&A）图计算配对SG和POC-BG测量的准确性。结果：11例患者使用了CGM装置：美敦力（n=6）和Dexcom G6 （n=5）。两种系统均可行可靠，护士接受度高。为了确定准确性，分析了437对SG和POC-BG读数。美敦力的MARD为13.1%，Clarke EGA的A区和B区读数100%。对于Dexcom， MARD为11.1%，其中98%的读数在A区和b区。B&A图的平均偏差为-17.76mg/dL（美敦力）和-1.94mg/dL (Dexcom)，具有95%的一致性限。结论：在2019冠状病毒病大流行期间，CGM在危重患者中是可行的，并且在识别趋势和指导胰岛素治疗间歇血糖监测方面具有可接受的准确性。
Background: Amidst the coronavirus disease 2019 (COVID-19) pandemic, continuous glucose monitoring (CGM) has emerged as an alternative for inpatient point-of-care blood glucose (POC-BG) monitoring. We performed a feasibility pilot study using CGM in critically ill patients with COVID-19 in the intensive care unit (ICU).Methods: Single-center, retrospective study of glucose monitoring in critically ill patients with COVID-19 on insulin therapy using Medtronic Guardian Connect and Dexcom G6 CGM systems. Primary outcomes were feasibility and accuracy for trending POC-BG. Secondary outcomes included reliability and nurse acceptance. Sensor glucose (SG) was used for trends between POC-BG with nursing guidance to reduce POC-BG frequency from one to two hours to four hours when the SG was in the target range. Mean absolute relative difference (MARD), Clarke error grids analysis (EGA), and Bland-Altman (B&A) plots were calculated for accuracy of paired SG and POC-BG measurements.Results: CGM devices were placed on 11 patients: Medtronic (n=6) and Dexcom G6 (n=5). Both systems were feasible and reliable with good nurse acceptance. To determine accuracy, 437 paired SG and POC-BG readings were analyzed. For Medtronic, the MARD was 13.1% with 100% of readings in zones A and B on Clarke EGA. For Dexcom, MARD was 11.1% with 98% of readings in zones A and B. B&A plots had a mean bias of -17.76mg/dL (Medtronic) and -1.94mg/dL (Dexcom), with wide 95% limits of agreement.Conclusions:During the COVID-19 pandemic, CGM is feasible in critically ill patients and has acceptable accuracy to identify trends and guide intermittent blood glucose monitoring with insulin therapy.