ASSESSING THE EFFECTIVENESS OF CONTINUOUS GLUCOSE MONITORING (CGM) IN ICU SETTINGS

Sarwat Saif; Khushroo Minhas; Umair Ashfaq; Sohaib Haider; Adnan Saeed Shakir; Amna Riaz; Zobia Zafar

doi:10.46903/gjms/24.1.2142

ASSESSING THE EFFECTIVENESS OF CONTINUOUS GLUCOSE MONITORING (CGM) IN ICU SETTINGS

Sarwat Saif, Khushroo Minhas, Umair Ashfaq, Sohaib Haider, Adnan Saeed Shakir, Amna Riaz, Zobia Zafar

Abstract

Background: Effective glycemic rheostat in censoriously ill affected people is associated with improved clinical outcomes. Traditional point-of-care (POC) glucose monitoring has limitations in detecting rapid glucose fluctuations. This study evaluated the effectiveness and medical utility of Continuous Glucose Monitoring (CGM) in ICU settings compared to standard POC testing.

Materials & Methods: A prospective observational study was conducted involving 100 ICU patients randomized into two clusters: CGM (n=50) and POC (n=50). Key outcomes included accuracy metrics (MARD, Clarke Error Grid), period in glucose series (70–180 mg/dL), incidence of hypo/hyperglycemic events, insulin adjustment frequency, and ICU outcomes (length of stay, mortality).

Results: CGM demonstrated high accuracy (MARD 10.2%) with 96.5% of readings in clinically acceptable zones. Time in range was pointedly higher in the CGM group (78.6% vs. 65.2%, p < 0.001), with fewer hypoglycemic events (0.4 vs. 1.1 per patient-day, p = 0.002) and hyperglycemic episodes (1.2 vs. 2.8 per patient, p = 0.01). CGM enabled more frequent insulin titration (4.5 vs. 2.7 adjustments/day, p < 0.001). No noteworthy differences were experiential in ICU length of stay or mortality.

Conclusion: CGM is a safe and accurate tool for glycemic management in ICU patients.

Keywords

Continuous Glucose Monitoring; ICU, Glycemic Control; Traditional point-of-care (POC); CGM group; CGM demonstrated high accuracy.

Full Text:

PDF

References

Krinsley JS, et al. Continuous glucose monitoring in the ICU: clinical considerations and consensus. Crit Care. 2017;21(1):197. https://doi.org/10.1186/s13054-017-1795-y

Zelada H, et al. Continuous glucose monitoring for inpatient diabetes management: an update on current evidence and practice. Endocr Connect. 2023;12(10). https://doi.org/10.1530/EC-23-0214

Guerrero-Arroyo L, Faulds E, Perez-Guzman MC, Davis GM, Dungan K, Pasquel FJ. Continuous glucose monitoring in the intensive care unit. J Diabetes Sci Technol. 2023;17(3):667–78. https://doi.org/10.1177/19322968221149371

Spanakis EK, Cook CB, Kulasa K, Aloi JA, Bally L, Davis G, et al. A consensus statement for continuous glucose monitoring metrics for inpatient clinical trials. J Diabetes Sci Technol. 2023;17(6):1527–52. https://doi.org/10.1177/19322968231165758

Avari P, Lumb A, Flanagan D, Rayman G, Misra S, Dhatariya K, et al. Continuous glucose monitoring within hospital: a scoping review and summary of guidelines from the Joint British Diabetes Societies for Inpatient Care. J Diabetes Sci Technol. 2023;17(3):611–24. https://doi.org/10.1177/19322968221149372

Van Steen SCJ, Rijkenberg S, Limpens J, Van der Voort PHJ, Hermanides J, DeVries JH. The clinical benefits and accuracy of continuous glucose monitoring systems in critically ill patients: a systematic scoping review. Sensors. 2017;17(1):146. https://doi.org/10.3390/s17010146

De Block CEM, Gios J, Verheyen N, Manuel-y-Keenoy B, Rogiers P, Jorens PG, et al. Randomized evaluation of glycemic control in the medical intensive care unit using real-time continuous glucose monitoring (REGIMEN trial). Diabetes Technol Ther. 2015;17(12):889–98. https://doi.org/10.1089/dia.2015.0147

Perez-Guzman MC, Shang T, Zhang JY, Jornsay D, Klonoff DC. Continuous glucose monitoring in the hospital. Endocrinol Metab (Seoul). 2021;36(2):240–55. https://doi.org/10.3803/EnM.2021.100

Galindo RJ, Migdal AL, Davis GM, Urrutia MA, Albury B, Zambrano C, et al. Comparison of the FreeStyle Libre Pro flash continuous glucose monitoring system and point-of-care capillary glucose testing in hospitalized patients with type 2 diabetes treated with basal-bolus insulin regimen. Diabetes Care. 2020;43(11):2730–5. https://doi.org/10.2337/dc20-0938

Choe HJ, Rhee EJ, Won JC, Park KS, Lee WY, Cho YM. Effects of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring in patients with type 2 diabetes: results from the randomized open-label PDF study. Diabetes Care. 2022;45(10):2224–30. https://doi.org/10.2337/dc21-2499

Chagas GCL, Teixeira L, Clemente MR, Chagas RCL, Pestana DVS, Sombra LRS, et al. Use of continuous glucose monitoring and point-of-care glucose testing in hospitalized patients with diabetes mellitus in non-intensive care unit settings: a systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2025;:111986. https://doi.org/10.1016/j.diabres.2025.111986

Shaw JL, Bannuru RR, Beach L, ElSayed NA, Freckmann G, Füzéry AK, et al. Consensus considerations and good practice points for use of continuous glucose monitoring systems in hospital settings. Diabetes Care. 2024;47(12):2062–75. https://doi.org/10.2337/dc23-1234

DOI: https://doi.org/10.46903/gjms/24.1.2142