Sadhu Archana R, Serrano Ivan Alexander, Xu Jiaqiong, Nisar Tariq, Lucier Jessica, Pandya Anjani R, Patham Bhargavi
Division of Endocrinology, Diabetes and Metabolism, Houston Methodist, Weill Cornell Medical College, Texas A&M Health Sciences Center, Houston, TX, USA.
Division of Endocrinology, Diabetes and Metabolism, Houston Methodist, Houston, TX, USA.
J Diabetes Sci Technol. 2020 Nov;14(6):1065-1073. doi: 10.1177/1932296820964264. Epub 2020 Oct 16.
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).
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.
CGM devices were placed on 11 patients: Medtronic ( = 6) and Dexcom G6 ( = 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 -17.76 mg/dL (Medtronic) and -1.94 mg/dL (Dexcom), with wide 95% limits of agreement.
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.
在2019年冠状病毒病（COVID-19）大流行期间，持续葡萄糖监测（CGM）已成为住院患者即时血糖（POC-BG）监测的一种替代方法。我们在重症监护病房（ICU）对患有COVID-19的重症患者使用CGM进行了一项可行性试点研究。
采用美敦力Guardian Connect和德康G6 CGM系统对接受胰岛素治疗的COVID-19重症患者进行葡萄糖监测的单中心回顾性研究。主要结局是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。在护理指导下，当传感器葡萄糖（SG）处于目标范围内时，使用SG来确定POC-BG之间的趋势，将POC-BG监测频率从1至2小时一次减少至4小时一次。计算配对SG和POC-BG测量值准确性的平均绝对相对差异（MARD）、克拉克误差网格分析（EGA）和布兰德-奥特曼（B&A）图。
11例患者使用了CGM设备：美敦力（6例）和德康G6（5例）。两种系统均可行且可靠，护士接受度良好。为确定准确性，分析了437对配对的SG和POC-BG读数。对于美敦力系统，MARD为13.1%，克拉克EGA上100%的读数位于A区和B区。对于德康系统，MARD为11.1%，98%的读数位于A区和B区。B&A图的平均偏差分别为-17.76mg/dL（美敦力）和-1.94mg/dL（德康），一致性界限的95%范围较宽。
在COVID-19大流行期间，CGM在重症患者中是可行的，并且在识别趋势和指导胰岛素治疗的间歇性血糖监测方面具有可接受的准确性。
