Wang Ray, Kyi Mervyn, Krishnamoorthi Brintha, Tjahyadi Jason, Connell Ailie, Chiang Cherie, Renouf Debra, Barmanray Rahul, Fourlanos Spiros
Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Parkville, Australia.
Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Australia.
Diabetes Technol Ther. 2025 May;27(5):376-385. doi: 10.1089/dia.2024.0604. Epub 2025 Jan 13.
Continuous glucose monitoring (CGM) use in people with type 1 diabetes (T1D) is revolutionizing management. Use of CGM in hospital is poised to transform care, however routine use is not currently recommended due to lack of accuracy validation in acute care, including in people with T1D. We aimed to determine real-world CGM accuracy in hospitalized adults with T1D. In this multicenter retrospective observational study, we compared CGM interstitial fluid glucose with reference blood glucose (capillary/whole-blood point-of-care [POC], blood gas [GAS]) in adults with T1D requiring multiday admissions during 2020-2023 across three health services in Australia. Patients requiring dialysis or admitted under pediatric/obstetric/palliative care/psychiatry units were excluded. CGM accuracy was assessed by comparison with time-matched (±5 min) reference glucose measures, utilizing median absolute relative difference (ARD), mean ARD (MARD), and consensus error grid (CEG) analysis. In total, 2,199 CGM-reference glucose pairs from 214 admissions (146 patients) were assessed. Overall, mean (SD) ARD was 12.8% (13.1) and median (IQR) ARD was 9.4% (3.7-17.7). MARD for CGM-POC pairs was 12.3%; MARD for CGM-GAS pairs was 14.3%. In CEG analysis, 99.3% of glucose pairs were within zones A/B. Accuracy was lower in critical care compared with noncritical care wards (MARD 16.1% vs. 12.0%, < 0.001). In this real-world multicenter study, CGM glucose agreed well with reference blood glucose, suggesting modern CGM devices could be safely and effectively used in hospitalized adults with T1D. Further prospective studies of CGM accuracy with newer generation devices across different scenarios will further elucidate inpatient CGM accuracy and safety.
1型糖尿病（T1D）患者使用持续葡萄糖监测（CGM）正在彻底改变疾病管理方式。在医院使用CGM有望变革护理模式，然而，由于在急性护理环境中缺乏准确性验证，包括在T1D患者中，目前不建议常规使用。我们旨在确定住院的T1D成年患者中CGM在现实世界中的准确性。在这项多中心回顾性观察研究中，我们比较了2020年至2023年期间澳大利亚三个医疗服务机构中需要多日住院治疗的T1D成年患者的CGM组织间液葡萄糖与参考血糖（毛细血管/全血即时检测[POC]、血气[GAS]）。需要透析或入住儿科/产科/姑息治疗/精神科病房的患者被排除。通过与时间匹配（±5分钟）的参考葡萄糖测量值进行比较，利用中位数绝对相对差异（ARD）、平均ARD（MARD）和一致性误差网格（CEG）分析来评估CGM的准确性。总共评估了来自214次住院（146例患者）的2199对CGM-参考血糖。总体而言，平均（标准差）ARD为12.8%（13.1），中位数（四分位间距）ARD为9.4%（3.7-17.7）。CGM-POC对的MARD为12.3%；CGM-GAS对的MARD为14.3%。在CEG分析中，99.3%的葡萄糖对在A/B区范围内。与非重症监护病房相比，重症监护病房的准确性较低（MARD 16.1%对12.0%，<0.001）。在这项现实世界的多中心研究中，CGM葡萄糖与参考血糖吻合良好，这表明现代CGM设备可安全有效地用于住院的T1D成年患者。对新一代设备在不同场景下的CGM准确性进行进一步的前瞻性研究将进一步阐明住院患者CGM的准确性和安全性。
