J Clin Endocrinol Metab. 2021 Jun 8:dgab409. doi: 10.1210/clinem/dgab409. Online ahead of print.
CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic has created a need for remote blood glucose (BG) monitoring in the intensive care unit (ICU).
OBJECTIVE: To evaluate feasibility and patient safety of a hybrid monitoring strategy of point of care (POC) BG plus continuous glucose monitor (CGM) in the ICU.
DESIGN: Retrospective analysis.
SETTING: ICU of an academic medical center.
PATIENTS: Patients with COVID-19 on intravenous (IV) insulin.
INTERVENTION: After meeting initial validation criteria, CGM was used for IV insulin titration and POC BG was performed every 6 hours or as needed.
MAIN OUTCOME MEASURES: Outcomes included frequency of POC BG, workflow, safety, and accuracy measures.
RESULTS: The study included 19 patients, 18 with CGM data, mean age 58 years, 89% on mechanical ventilation, 37% on vasopressors, and 42% on dialysis. The median time to CGM validation was 137 minutes (interquartile range [IQR] 114-206). During IV insulin, the median number of POC values was 7 (IQR 6-16) on day 1, and declined slightly thereafter ( 71% reduction compared to standard of 24 /day). The median number of CGM values used nonadjunctively to titrate IV insulin was 11.5 (IQR 0, 15) on day 1 and increased thereafter. Time in range 70-180mg/dl was 64+/-23% on day 1 and 72+/-16% on day 2-7 while time <70 mg/dl was 1.5 +/-4.1% on day 1 and <1% on days 2-7.
CONCLUSIONS: This study provides data to support that CGM using a hybrid protocol is feasible, accurate, safe, and has potential to reduce nursing and staff workload.