Use of a Continuous Glucose Monitoring System in High Risk Hospitalized Non-Critically Ill Patients with Diabetes After Cardiac Surgery and During Their Transition of Care From the Intensive Care Unit During COVID-19: A Pilot Study

Continuous glucose monitoring (CGM) has demonstrated benefits in managing inpatient diabetes. We initiated this prospective pilot study to determine the feasibility and accuracy of CGM in high-risk cardiac surgery patients with diabetes after their transition of care from the intensive care unit (ICU).

Methods:

Clarke Error Grid (CEG) analysis was used to compare CGM and point-of-care(POC) measurements. Mean absolute relative difference (MARD) of the paired measurements was calculated to assess the accuracy of the CGM for glucose measurements during the first 24 hours on CGM, the remainder of time on the CGM as well as for different chronic kidney disease (CKD) strata.

Results:

Overall MARD between POC and CGM measurements was 14.80%. MARD for patients without CKD IV and V with eGFR < 20 ml/min/1.73m² was 12.13%. Overall, 97% of the CGM values were within the no-risk zone of the CEG analysis. For the first 24 hours, a sensitivity analysis of the overall MARD for all subjects and for those with eGFR > 20 ml/min/1.73m² was 15.42% (+/- 14.44) and 12.80% (+/- 7.85) respectively. Beyond the first 24 hours, overall MARD for all subjects and for those with eGFR > 20 ml/min/1.73m² was 14.54% (+/- 13.21) and 11.86% (+/- 7.64) respectively.

Discussion/Conclusion:

CGM has great promise to optimize inpatient diabetes management in the noncritical care setting and after the transition of care from the ICU with high clinical reliability, accuracy, and superior detection of hypoglycemia. More studies are needed to further assess CGM in patients with advanced CKD.