Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Korea.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju-si, Korea.
Diabetes Technol Ther. 2023 Aug;25(8):529-537. doi: 10.1089/dia.2023.0012. Epub 2023 Jul 17.
The use of continuous glucose monitoring (CGM) in pediatric patients with diabetic ketoacidosis (DKA) remains investigational, and data on its accuracy in pediatric intensive care units (PICU) are limited. This study evaluated the accuracy of three CGM devices in pediatric patients with DKA in the PICU. We compared 399 matched pairs of CGM and point-of-care capillary glucose (POC) values and grouped patients based on whether they changed their CGM sensor during their PICU stay. Eighteen patients with a mean age of 10.98 ± 4.20 years were included, with three patients in the sensor change group. The overall mean absolute relative difference (MARD) was 13.02%. The Medtronic Guardian Sensor 3 ( = 331), Dexcom G6 ( = 41), and Abbott FreeStyle Libre 1 ( = 27) showed MARD values of 13.40%, 11.12%, and 11.33%, respectively. The surveillance error grid (SEG), Bland-Altman plot, and Pearson's correlation coefficient demonstrated satisfactory clinical accuracy of the CGM devices (SEG zones A and B, 98.5%; mean difference, 15.5 mg/dL; Pearson's correlation coefficient [], 0.76, < 0.0001). MARD was significantly lower in subjects who did not experience a sensor change (11.74% vs. 17.31%, = 0.048). Also, a statistically significant negative correlation was found between serum bicarbonate levels and POC-CGM values ( = -0.34, < 0.001). The severity of DKA has a major effect on reducing the accuracy of the CGM, especially during the first several days in the intensive care unit. The reduced accuracy appears to be related to acidosis, as reflected in the serum bicarbonate levels.
连续血糖监测（CGM）在伴有糖尿病酮症酸中毒（DKA）的儿科患者中的应用仍处于研究阶段，有关其在儿科重症监护病房（PICU）中的准确性的数据有限。本研究评估了三种 CGM 设备在 PICU 中患有 DKA 的儿科患者中的准确性。我们比较了 399 对 CGM 和即时毛细血管葡萄糖（POC）值，并根据患者在 PICU 期间是否更换 CGM 传感器对患者进行分组。纳入了 18 名平均年龄为 10.98±4.20 岁的患者，其中 3 名患者在传感器更换组。总体平均绝对相对差异（MARD）为 13.02%。美敦力 Guardian Sensor 3（ = 331）、德康 G6（ = 41）和雅培 FreeStyle Libre 1（ = 27）的 MARD 值分别为 13.40%、11.12%和 11.33%。监测误差网格（SEG）、Bland-Altman 图和 Pearson 相关系数表明 CGM 设备具有令人满意的临床准确性（SEG 区 A 和 B，98.5%；平均差异，15.5mg/dL；Pearson 相关系数 []，0.76， < 0.0001）。未经历传感器更换的患者的 MARD 明显较低（11.74%与 17.31%， = 0.048）。此外，血清碳酸氢盐水平与 POC-CGM 值之间存在显著的负相关关系（ = -0.34， < 0.001）。DKA 的严重程度对 CGM 的准确性有重大影响，尤其是在重症监护病房的最初几天。准确性降低似乎与酸中毒有关，这反映在血清碳酸氢盐水平上。
