Accuracy of continuous glucose monitoring systems in intensive care unit patients: a scoping review

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE Intensive Care Medicine Pub Date : 2024-10-17 DOI:10.1007/s00134-024-07663-6
Christian G. Nielsen, Milda Grigonyte-Daraskeviciene, Mikkel T. Olsen, Morten H. Møller, Kirsten Nørgaard, Anders Perner, Johan Mårtensson, Ulrik Pedersen-Bjergaard, Peter L. Kristensen, Morten H. Bestle
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Abstract

Purpose

Glycemic control poses a challenge in intensive care unit (ICU) patients and dysglycemia is associated with poor outcomes. Continuous glucose monitoring (CGM) has been successfully implemented in the type 1 diabetes out-patient setting and renewed interest has been directed into the transition of CGM into the ICU. This scoping review aimed to provide an overview of CGM accuracy in ICU patients to inform future research and CGM implementation.

Methods

We systematically searched PubMed and EMBASE between 5th of December 2023 and 21st of May 2024 and reported findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for scoping reviews (PRISMA-ScR). We assessed studies reporting the accuracy of CGM in the ICU and report study characteristics and accuracy outcomes.

Results

We identified 2133 studies, of which 96 were included. Most studies were observational (91.7%), conducted in adult patients (74%), in mixed ICUs (47.9%), from 2014 and onward, and assessed subcutaneous CGM systems (80%) using arterial blood samples as reference test (40.6%). Half of the studies (56.3%) mention the use of a prespecified reference test protocol. The mean absolute relative difference (MARD) ranged from 6.6 to 30.5% for all subcutaneous CGM studies. For newer factory calibrated CGM, MARD ranged from 9.7 to 20.6%. MARD for intravenous CGM was 5–14.2% and 6.4–13% for intraarterial CGM.

Conclusions

In this scoping review of CGM accuracy in the ICU, we found great diversity in accuracy reporting. Accuracy varied depending on CGM and comparator, and may be better for intravascular CGM and potentially lower during hypoglycemia.

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重症监护室患者持续葡萄糖监测系统的准确性:范围界定综述
目的 重症监护病房(ICU)患者的血糖控制是一项挑战,血糖异常与不良预后有关。连续血糖监测(CGM)已在 1 型糖尿病门诊环境中成功实施,人们对将 CGM 应用于重症监护病房再次产生了兴趣。方法我们在 2023 年 12 月 5 日至 2024 年 5 月 21 日期间系统地检索了 PubMed 和 EMBASE,并根据系统综述和荟萃分析首选报告项目 (PRISMA) 指南 (PRISMA-ScR) 报告了研究结果。我们评估了报告 ICU 中 CGM 准确性的研究,并报告了研究特征和准确性结果。大多数研究为观察性研究(91.7%),研究对象为成年患者(74%),研究地点为混合重症监护病房(47.9%),研究时间为 2014 年及以后,研究对象为皮下 CGM 系统(80%),使用动脉血样本作为参考测试(40.6%)。半数研究(56.3%)提到使用了预先指定的参考测试协议。所有皮下 CGM 研究的平均绝对相对差值(MARD)从 6.6% 到 30.5% 不等。对于较新的出厂校准 CGM,平均绝对相对差值介于 9.7% 到 20.6% 之间。静脉 CGM 的 MARD 为 5%-14.2%,动脉内 CGM 为 6.4%-13%。准确性因 CGM 和比较对象的不同而不同,血管内 CGM 的准确性可能更高,而低血糖时的准确性可能更低。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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