Morales-Dopico Lourdes, MacLeish Sarah A
Pediatric Endocrinology Fellow, CWRU School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Associate Professor of Pediatrics, Pediatric Endocrinology, CWRU School of Medicine, University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Pediatr Res. 2024 Nov;96(6):1464-1474. doi: 10.1038/s41390-024-03573-x. Epub 2024 Sep 21.
Glucose monitoring has rapidly evolved with the development of minimally invasive continuous glucose monitoring (CGM) using interstitial fluid. It is recommended as standard of care in the ambulatory setting, nearly replacing capillary glucose testing in those with access to CGM. The newest CGM devices continue to be smaller and more accurate, and integration with automated insulin delivery systems has further revolutionized the management of diabetes, leading to successful improvements in care and quality of life. Many studies confirm accuracy and application of CGM in various adult inpatient settings. Studies in adult patients increased during the COVID 19 Pandemic, but despite reassuring results, inpatient CGM use is not yet approved by the FDA. There is a lack of studies in inpatient pediatric settings, although data from the NICU and PICU have started to emerge. Given the exponential increase in the use of CGM, it is imperative that hospitals develop protocols for CGM use, with a need for ongoing implementation research. In this review we describe how CGM systems work, discuss benefits and barriers, summarize research in inpatient pediatric CGM use, explore gaps in research design along with emerging recommendations for inpatient use, and discuss overall CGM utility beyond outpatient diabetes management. IMPACT: Current CGM systems allow for uninterrupted monitoring of interstitial glucose excursions, and have triggered multiple innovations including automated insulin delivery. CGM technology has become part of standard of care for outpatient diabetes management, endorsed by many international medical societies, now with significant uptake, replacing capillary glucose testing for daily management in patients with access to CGM technology. Although CGM is not approved by the FDA for inpatient hospital use, studies in adult settings support its use in hospitals. More studies are needed for pediatrics. Implementation research is paramount to expand the role of CGM in the inpatient setting and beyond.
随着使用组织间液的微创连续血糖监测（CGM）技术的发展，血糖监测迅速发展。在门诊环境中，它被推荐作为护理标准，在能够使用CGM的人群中几乎取代了毛细血管血糖检测。最新的CGM设备越来越小且更加精确，与自动胰岛素输送系统的集成进一步彻底改变了糖尿病的管理方式，使护理和生活质量得到了成功改善。许多研究证实了CGM在各种成人住院环境中的准确性和适用性。在新冠疫情期间，针对成年患者的研究有所增加，但尽管结果令人放心，但住院患者使用CGM尚未获得美国食品药品监督管理局（FDA）的批准。尽管新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）的数据已开始出现，但针对住院儿科环境的研究仍然缺乏。鉴于CGM使用量呈指数级增长，医院制定CGM使用方案势在必行，并且需要持续进行实施研究。在本综述中，我们描述了CGM系统的工作原理，讨论了其益处和障碍，总结了住院儿科患者使用CGM的研究，探讨了研究设计中的差距以及住院使用的新建议，并讨论了CGM在门诊糖尿病管理之外的整体效用。影响：当前的CGM系统可对组织间液葡萄糖波动进行不间断监测，并引发了包括自动胰岛素输送在内的多项创新。CGM技术已成为门诊糖尿病管理护理标准的一部分，得到了许多国际医学协会的认可，目前应用广泛，在能够使用CGM技术的患者日常管理中取代了毛细血管血糖检测。尽管CGM尚未获得FDA批准用于住院医院，但成人环境中的研究支持其在医院中的使用。儿科还需要更多研究。实施研究对于扩大CGM在住院及其他环境中的作用至关重要。
