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VOLUME 19 , ISSUE 11 ( 2015 ) > List of Articles

RESEARCH ARTICLE

Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study

Bala Ramachandran, Amruta Kanjani, Sumant Prabhudesai, Karnam G. Ravikumar

Keywords : continuous glucose monitoring system, septic shock,Children

Citation Information : Ramachandran B, Kanjani A, Prabhudesai S, Ravikumar KG. Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study. Indian J Crit Care Med 2015; 19 (11):642-647.

DOI: 10.4103/0972-5229.169331

License: CC BY-ND 3.0

Published Online: 00-11-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims: The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock. Subjects and Methods: Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG). Results: Nineteen children were included, and 235 pairs of BG-CGMS readings were obtained. BG and CGMS had a correlation coefficient of 0.61 (P < 0.001) and a median relative absolute difference of 17.29%. On Clarke′s error grid analysis, 222 (94.5%) readings were in the clinically acceptable zones (A and B). When BG was < 70, 70-180, and > 180 mg/dL, 44%, 100%, and 76.9% readings were in zones A and B, respectively (P < 0.001). The accuracy of CGMS was not affected by the presence of edema, acidosis, vasopressors, steroids, or renal replacement therapy. On receiver operating characteristics curve analysis, a CGMS reading <97 mg/dL predicted hypoglycemia (sensitivity 85.2%, specificity 75%, area under the curve [AUC] =0.85). A reading > 141 mg/dL predicted hyperglycemia (sensitivity 84.6%, specificity 89.6%, AUC = 0.87). Conclusion: CGMS provides a fairly, accurate estimate of BG in children with septic shock. It is unaffected by a variety of clinical variables. The accuracy over extremes of blood sugar may be a concern. We recommend larger studies to evaluate its use for the early detection of hypoglycemia and hyperglycemia.


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  1. Hirshberg E, Lacroix J, Sward K, Willson D, Morris AH. Blood glucose control in critically ill adults and children: A survey on stated practice. Chest 2008;133:1328-35.
  2. Preissig CM, Rigby MR. A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: A survey on actual practice habits. Crit Care 2010;14:R11.
  3. Vogelzang M, Nijboer JM, van der Horst IC, Zijlstra F, ten Duis HJ, Nijsten MW. Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients. J Trauma 2006;60:873-7.
  4. Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr 2005;146:30-4.
  5. Christiansen C, Toft P, Jørgensen HS, Andersen SK, Tønnesen E. Hyperglycaemia and mortality in critically ill patients. A prospective study. Intensive Care Med 2004;30:1685-8.
  6. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004;79:992-1000.
  7. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78:1471-8.
  8. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359-67.
  9. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-61.
  10. Lorencio C, Leal Y, Bonet A, Bondia J, Palerm CC, Tache A, et al. Real-time continuous glucose monitoring in an intensive care unit: Better accuracy in patients with septic shock. Diabetes Technol Ther 2012;14:568-75.
  11. Bridges BC, Preissig CM, Maher KO, Rigby MR. Continuous glucose monitors prove highly accurate in critically ill children. Crit Care 2010;14:R176.
  12. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  13. Clarke W, Kovatchev B. Statistical tools to analyze continuous glucose monitor data. Diabetes Technol Ther 2009;11 Suppl 1:S45-54.
  14. Clarke WL, Cox D, Gonder-Frederick LA, Carter W, Pohl SL. Evaluating clinical accuracy of systems for self-monitoring of blood glucose. Diabetes Care 1987;10:622-8.
  15. Beardsall K, Ogilvy-Stuart AL, Ahluwalia J, Thompson M, Dunger DB. The continuous glucose monitoring sensor in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2005;90:F307-10.
  16. Brunner R, Kitzberger R, Miehsler W, Herkner H, Madl C, Holzinger U. Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients. Crit Care Med 2011;39:659-64.
  17. Goldberg PA, Siegel MD, Russell RR, Sherwin RS, Halickman JI, Cooper DA, et al. Experience with the continuous glucose monitoring system in a medical intensive care unit. Diabetes Technol Ther 2004;6:339-47.
  18. Corstjens AM, Ligtenberg JJ, van der Horst IC, Spanjersberg R, Lind JS, Tulleken JE, et al. Accuracy and feasibility of point-of-care and continuous blood glucose analysis in critically ill ICU patients. Crit Care 2006;10:R135.
  19. Branco RG, Chavan A, Tasker RC. Pilot evaluation of continuous subcutaneous glucose monitoring in children with multiple organ dysfunction syndrome. Pediatr Crit Care Med 2010;11:415-9.
  20. Piper HG, Alexander JL, Shukla A, Pigula F, Costello JM, Laussen PC, et al. Real-time continuous glucose monitoring in pediatric patients during and after cardiac surgery. Pediatrics 2006;118:1176-84.
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