Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in...

Area of Science:

• Cardiovascular intensive care
• Endocrinology
• Medical technology

Background:

• Hyperglycemia management in postoperative cardiovascular patients is critical.
• Continuous intravenous insulin infusion (CII) is a common treatment.
• Real-time continuous glucose monitoring (CGM) offers potential for improved titration.

Purpose of the Study:

• To assess the feasibility of CGM for titrating CII in postoperative cardiovascular intensive care unit patients.
• To evaluate the accuracy of CGM compared to point-of-care blood glucose (POC-BG) testing.
• To determine nursing acceptance and patient satisfaction with CGM use.

Main Methods:

• Dexcom G6 CGM devices were used in 59 postsurgical patients with hyperglycemia on CII.
• A hybrid approach combining CGM with periodic POC-BG tests was employed for validation.
• CGM accuracy was evaluated using mean absolute relative difference and Clarke Error Grid analysis.
• Surveys assessed nursing and patient experiences with CGM.

Main Results:

• Analysis of 864 paired POC-BG and CGM values showed mean and median absolute relative differences of 13.2% and 9.8%, respectively.
• 99.7% of paired glucose values fell within acceptable accuracy zones (A and B) on the Clarke Error Grid.
• Nurses found CGM very convenient (93%) and preferred it over POC-BG testing (93%).
• The majority of patients (93%) reported a good or very good care experience with CGM.

Conclusions:

• This pilot study confirms the feasibility, accuracy, and nursing convenience of using CGM with a hybrid approach for insulin titration in postoperative settings.
• The findings support further research into the benefits of CGM for improving workflow, health outcomes, and cost-effectiveness in postoperative care.