Continuous Glucose Monitoring Measures Can Be Used for Glycemic Control in the ICU: An In-Silico Study (2018)
© 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.
CitationZhou 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.
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KeywordsHumans; Hypoglycemia; Blood Glucose; Monitoring, Physiologic; Computer Simulation; Intensive Care Units
ANZSRC Fields of Research40 - Engineering::4003 - Biomedical engineering::400308 - Medical devices
40 - Engineering::4003 - Biomedical engineering::400305 - Biomedical instrumentation
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
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Continuous Glucose Monitors and Tight Glycaemic Control in Intensive Care: An In-Silico Proof of Concept Analysis Signal, M.; Pretty, C.G.; LeCompte, A.J.; Shaw, Geoff; Chase, Geoff (University of Canterbury. Mechanical Engineering, 2010)Tight glycaemic control (TGC) in critical care has shown distinct benefits, but has also proven difficult to obtain. The risk of severe hypoglycaemia (< 2.2mmol/L) raises significant concerns for safety. Continuous Glucose ...
Zhou T; Dickson JL; Chase, Geoff (2017)Continuous glucose monitoring (CGM) devices have the potential to reduce nurse workload in the ICU while improving glycaemic control (GC). However, larger point accuracy errors that are inherent in these devices can lead ...
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