Continuous Glucose Monitoring Measures Can Be Used for Glycemic Control in the ICU: An In-Silico Study

Type of content
Journal Article
Thesis discipline
Degree name
Publisher
SAGE Publications
Journal Title
Journal ISSN
Volume Title
Language
English
Date
2018
Authors
Zhou, Tony
Dickson, J.L.
Shaw, Geoff
Chase, Geoff
Abstract

© 2017, © 2017 Diabetes Technology Society. Background: Continuous glucose monitoring (CGM) technology has become more prevalent in the intensive care unit (ICU), offering potential benefits of increased safety and reduced workload in glycemic control (GC). The drift and higher point accuracy errors of CGM devices over traditional intermittent blood glucose (BG) measures have so far limited their application in the ICU. This study delineates the trade-offs of performance, safety and workload that CGM sensors provide in GC protocols. Methods: Clinical data from 236 patients were used for clinically validated virtual trials. A CGM-enabled version of the STAR GC protocol was used to evaluate the use of guard rails and rolling windows. Safety was assessed through percentage of patients who had a severe hypoglycemic episode (BG < 40 mg/dl) as well as percentage of resampled BG < 72 mg/dl. Performance was assessed as percentage of resampled measurements in the 80-126 mg/dl and the 80-144 mg/dl target bands. Workload was measured by number of manual BG measures per day. Results: CGM-enabled versions of STAR decreased the number of required blood draws by up to 74%, while maintaining performance (76.6% BG measurements in the 80-126 mg/dl range vs 62.8% clinically, 87.9% in the 80-144 mg/dl range vs 83.7% clinically) and maintaining patient safety (1.13% of patients experienced a severe hypoglycemic event vs 0.85% clinically, 1.37% of BG measurements were less than 72 mg/dl vs 0.51% clinically). Conclusion: CGM sensor traces were reproduced in virtual trials to guide GC. Existing GC protocols such as STAR may need to be adjusted only slightly to gain the benefits of the increased temporal measurements of CGM sensors, through which workload may be significantly decreased while maintaining GC performance and safety.

Description
Citation
Zhou T, Dickson JL, Shaw GM, Chase JG (2018). Continuous Glucose Monitoring Measures Can Be Used for Glycemic Control in the ICU: An In-Silico Study. Journal of Diabetes Science and Technology. 12(1). 7-19.
Keywords
Humans, Hypoglycemia, Blood Glucose, Monitoring, Physiologic, Computer Simulation, Intensive Care Units
Ngā upoko tukutuku/Māori subject headings
ANZSRC fields of research
Fields of Research::40 - Engineering::4003 - Biomedical engineering::400308 - Medical devices
Fields of Research::40 - Engineering::4003 - Biomedical engineering::400305 - Biomedical instrumentation
Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
Rights