North Kansas City Hospital, North Kansas City, MO, USA.
Heart of America Research Foundation, North Kansas City MO, USA.
Am J Health Syst Pharm. 2022 Mar 7;79(6):452-458. doi: 10.1093/ajhp/zxab456.
Inpatient diabetes management involves frequent assessment of glucose levels for treatment decisions. Here we describe a program for inpatient real-time continuous glucose monitoring (rtCGM) at a community hospital and the accuracy of rtCGM-based glucose estimates.
Adult inpatients with preexisting diabetes managed with intensive insulin therapy and a diagnosis of coronavirus disease 2019 (COVID-19) were monitored via rtCGM for safety. An rtCGM system transmitted glucose concentration and trending information at 5-minute intervals to nearby smartphones, which relayed the data to a centralized monitoring station. Hypoglycemia alerts were triggered by rtCGM values of ≤85 mg/dL, but rtCGM data were otherwise not used in management decisions; insulin dosing adjustments were based on blood glucose values measured via fingerstick blood sampling. Accuracy was evaluated retrospectively by comparing rtCGM values to contemporaneous point-of-care (POC) blood glucose values.
A total of 238 pairs of rtCGM and POC data points from 10 patients showed an overall mean absolute relative difference (MARD) of 10.3%. Clarke error grid analysis showed 99.2% of points in the clinically acceptable range, and surveillance error grid analysis showed 89.1% of points in the lowest risk category. It was determined that for 25% of the rtCGM values, discordances in rtCGM and POC values would likely have resulted in different insulin doses. Insulin dose recommendations based on rtCGM values differed by 1 to 3 units from POC-based recommendations.
rtCGM for inpatient diabetes monitoring is feasible. Evaluation of individual rtCGM-POC paired values suggested that using rtCGM data for management decisions poses minimal risks to patients. Further studies to establish the safety and cost implications of using rtCGM data for inpatient diabetes management decisions are warranted.
住院患者的糖尿病管理需要频繁评估血糖以做出治疗决策。在此，我们描述了一家社区医院住院患者实时连续血糖监测（rtCGM）的方案及其基于 rtCGM 的血糖估计值的准确性。
患有 2019 冠状病毒病（COVID-19）的成年住院患者，且既往患有糖尿病并接受强化胰岛素治疗，使用 rtCGM 进行安全性监测。rtCGM 系统以 5 分钟的间隔传输血糖浓度和趋势信息到附近的智能手机，然后将数据转发到集中监测站。rtCGM 值≤85mg/dL 时会触发低血糖警报，但 rtCGM 数据不会用于管理决策；胰岛素剂量调整基于指尖采血测量的血糖值。通过比较 rtCGM 值与即时点护理（POC）血糖值，回顾性评估准确性。
10 名患者的 238 对 rtCGM 和 POC 数据点的总体平均绝对相对差异（MARD）为 10.3%。Clarke 误差网格分析显示，99.2%的点处于临床可接受范围内，监测误差网格分析显示，89.1%的点处于最低风险类别。确定 25%的 rtCGM 值，rtCGM 和 POC 值之间的差异可能导致胰岛素剂量不同。基于 rtCGM 值的胰岛素剂量建议与基于 POC 值的建议相差 1 至 3 个单位。
rtCGM 用于住院患者的糖尿病监测是可行的。对个体 rtCGM-POC 配对值的评估表明，使用 rtCGM 数据进行管理决策对患者的风险最小。进一步的研究需要建立使用 rtCGM 数据进行住院患者糖尿病管理决策的安全性和成本影响。
